Stem Cell Transplant Team meeting 23rd May 2017

just a little recap on the story to date

Diagnosed Hodgkins Lymphoma Stage 4B 14th Feb 2014

ABVD Chemotherapy March 2014 to August 2014

Radiotherapy 40Gml over 4 weeks November 2014 to December 2014

Long gaps between test but generally non conclusive including 3 biopsies to throat and neck.

Remission Dec 2016

Relapse April 2017

R-ICE chemotherapy 3 cycles Commenced April 2017

followed by a Stem Cell harvest, followed by BEAM Chemotherapy followed by Stem Cell Transplant.
ICE Chemo

Ice Chemo is designed to kill all cancer cells in the blood, plus white cells, stem cells and production of stem cells. I will go under 3 cycles, each cycle takes 3 days in hospital followed by 18 days of no Chemo then cycle 2 18 days of no Chemo then cycle 3

Cycle 1 Completed 13th April 2017

Cycle 2 Completed 5th May 2017

P.E.T Scan 18th May 2017

Transplant Team meeting 23rd May 2017

Cycle 3 Ice Chemo 25th May 2017

Most of this section and Cycle 3 is aimed at the cancer victims/families as a guideline to what goes on. General readers may not have much interest in these sections as I will only partly touch on personal feelings and emotions.

As I have said from the beginning the range of medical input here is so high it requires to hospital teams from two different Cities.If I resided in Dublin then only one would be involved.

For chemotherapy and general care Bon Secours Cork

For Stem Cell Transplant & advanced chemotherapy St James Dublin

So basically I have been through 2 Cycles (6 day) of Ice Chemotherapy and in 48 hours will commence Cycle 3. I have completed my 9th P.E.T Scan with good results. All of this has been done in Cork – ICE Chemo in Bon Secours and PET in CUH. Now I have to meet with the Transplant team in St James Dublin.

Appointment set for 9am Tuesday 23rd May with the Transplant liaison specialist. We travelled up the day before and arrive for the appointment early. The last time I was in St James was about 1990 to visit a relative and I could hardly believe the difference. So we proceeded to the oncology day care unit for the meeting. First of all they required blood samples so I have nine files of blood taken, by 9:30am we were in front of the Liaison specialist and she was fantastic. She explained every step of the procedure in detail, left no stones unturned, willingly answer every question we asked. I will go into brief details here on what will happen but not deep details as there is just too much, I will attempt to answer you questions so just e-mail me ian@hlai.ie

Firstly the PET was considered by them to be excellent, they called it PET negative. It is a clear sign that Chemo is working. They want the next cycle stalled by a day. Roughly 10 days from the end of this Cycle they will attempt a Stem Cell harvest 6th of June (the 5th is a bank holiday in Ireland so the scientists who determine if your ready for the harvest will not be available, hence the stall by a day). I will have my blood tested at 8am and if good then they will commence with harvest. A twin line will be connected to my jugular to a special machine that will separate the stem cells from my blood and basically bag them for freezing. Stem cells are not naturally in your blood they are a product produced by bone marrow. The ICE chemotherapy is used to stop stop the production of stem cell but also to kill cancer cells however the 8 days I have to self inject Neupogen GSF – these injections stimulate new stem cell production at an accelerated rate, this is the trick, basically ICE stops it and then suddenly the bone marrow is hit with a stimulant that forces bone marrow to produce a substantial amount of stem cells so much that the bone marrow pushes the new stem cells out of the marrow into the blood stream and that is when they harvest. But the window of opportunity is tiny so they must get the stem stem cells on the 6th or 7th, failing this would lead to further ICE chemotherapy. But we don’t talk above failure EVER they will get them on the day and that is without question. The procedure takes about 8 hours from start to finish all going well. Once successfully extracted the scientists will then check the number of stem cell which are millions as against thousands. The stem cells are checked for any viruses or contamination, if all is good they are frozen at -190 in nitrogen freezers till needed. So all sounds good and easy enough. Till the next step.

They can’t confirm a date till after the harvest but within 4 weeks following the harvest I will be admitted to St James. This will be for a very aggressive form of chemotherapy called BEAM the idea of BEAM is to wipe out cancer cells, bone marrow, and the ability for my body to regenerate cells. Basically your colon, mouth, gastric track regenerates itself constantly, this is seen by BEAM as possible treat and attacks these cells killing them. BEAM like most Chemotherapy not only kills cancer cells but kills good cells. After 5 days they will stop giving me BEAM and 2 days later my harvested stem cells will be thawed out and given back to me. All sounds good but here come the but. Or maybe the horror story.

Within 48 hours of the Transplant the results of the Chemo will translate. I have been warned that without doubt I will by extremely ill, I will be in pain, everything from my mouth to my urethra will feel like I have swallowed razor blades. I will be given morphine (not an option) I will without doubts feel worse that I have ever felt. This will last 5 to 7 days. All going right the stem cells will kick in and I will suddenly feels a whole lot better. So let me simplify this in my own way, I have been fighting Lymphoma for over 3 years, I have had ABVD Chemo, Radiotherapy at an extreme level, currently taking ICE Chemo which is sever, I have stood tall through it all, and to finally have the opportunity to kill this Lymphoma I can’t see 5 to 7 days of extreme illness bothering me that much. You know even as I write this it does not scare me I feel that okay this is going to be gruelling but this medical team are ready to help to relieve as much as they can. So yes I’m ready to finally get the opportunity to completely eradicate Hodgkins Lymphoma

Anyway I them meet with my Transplant Doctor. A really nice guy but not sure if I’ll think that during the BEAM… he went through everything again, felt that I was genuinely strong both physically & mentally – we completed consent forms . He then gave me a physical examination and felt I was in good shape. The extra walking and cutting lawns has paid off. The Transplant doctor advised that he was contacting the Bon to make sure that the ICE was delayed by a day and that was it. 2 hours briefing and we left with a lot to think about.

Back to Cork 167 miles to be admitted today 23rd at 7:30pm for Cycle 3