Today is the fifth day since treatment. I’m done with the chemo and dex. Now, each morning, for several days, I meet with the team nurse. She gives me two injections of neupogen, or G-CSF. The acronym stands for granulocyte-colony stimulating factor hormone. It is a growth factor produced by a number of different tissues to stimulate the bone marrow to increase the number of hematopoietic stem cells in the blood of the donor before collection by apheresis. They are the prize sought for an autologous transplant.
Since the chemo is killing cells and the neupogen is aggressively stimulating new production, a fluctuation occurs with WBC counts rising, then descending, and rising. This is not unlike watching a volatile week in the stock market. What eventually happens is that my marrow becomes crowded due to the growth factor’s work. Therefore, the cells start to migrate into the blood stream. This is noted by bone pain (a good sign) and by increasing numbers of stem cells in the blood stream. They are identified by a genetic marker, CD-34. Since my blood is being monitored closely, it is easy to watch the stem cell production and capture them on the up tick.
Collection is simply a matter of hooking up my new double lumen Hickman to an apheresis machine. My blood flows out one port, the machine identifies and separates the CD-34 cells and allows the remainder of the blood to return to my body through the other port. This takes a few hours. Often, they can harvest a sufficient number of stem cells in a single setting for two transplants. If necessary, multiple collections can be performed. The stem cells from each collection are frozen and saved.
My body must rest and purge the recent chemo treatment. Thus, I can expect the transplant to occur sometime around mid-August. As I mentioned before, the transplant is elegant in its simplicity. I love the science. Successful responses and/or remissions are another matter. We’ll see.
With the advent of my chemo treatment, the clinic draws blood each morning. They no longer require a needle stick due to my Hickman catheter. There’s always a collection of characters waiting their turn. I am one of them.
Yesterday, in the waiting room I sat across from a middle-aged man who carried with him an iridescent gold coconut sized orb. As it turned out, when it was my turn, I sat at the table next to him. So, I remarked on his knickknack. He smiled and said, “Yes, it is my companion. I no longer go anywhere without it.” He added that it was akin to the soccer ball Tom Hanks had befriended in a movie from a few years ago, Cast Away.
Later, I thought of Marilyn’s update from two days ago about the young child with her many tubes and wispy hair. She smiled as she led an entourage of mom and siblings toward her infusion bay for a day of chemo. In her arms she clutched a bright but worn stuffed animal. I am learning good lessons: Keep smiling and hold on tightly to whatever makes you brave.