Chemotherapy that accompanies the stem cell transplant is usually given in massive amounts
massive doses meaning that this chemotherapy is hopefully able to ablate and eradicate
any micro tumor cells or any small number of tumor cells or small number of diseased
cells and the doses of chemotherapy are very very high and the complications associated
with the aggressiveness of the high doses of chemotherapy and the complications are
starting from fatigue hair loss nausea vomiting mouth sore low blood counts requiring blood
and platelet transfusions immune suppression leading to infections fevers bleeding uh loss
of appetite obviously infertility uh and things like that you know that is the main stay of
treatment is the high doses of chemotherapy and I think the stem cells they make it possible
for the delivery of high doses of chemotherapy day one uh you will come in as you did previously
we draw on your bloods through your central line just to check your bloods counts to make
sure the white cells are okay nothing has changed your potassium your electrolytes are
okay after that we start the pre hydration that will run for about two hours probably
about a half an hour before fluid is to end I will come in and I will give you antiemetics
usually that's Kytril Decadron and Ativan and those are used to prevent nausea during
the chemo about fifteen minutes before the chemotherapy is to start I will be giving
you ice uh what you'll have to do is uh pack your mouth with ice fifteen minutes before
during the chemotherapy the mouth which will run for about fifteen twenty minutes and after
the chemotherapy which will uh be about fifteen minutes so all together you're looking at
about a hour and a half purpose of the ice is to decrease the blood flow to the mouth
because we don't really need the chemo going there and what that's going to do is cut down
on the uh blood supply the uh and therefore you won't have mouth sores 'cause if you are
to get mouth sores u that could be devastating you can end up your mouth cavity from your
mouth oral cavity all the way down your uh digestive system the maculsa and once that
becomes compromised uh you could bleed you could have a lot of pain you could end up
in the hospital you could actually end up on a morphine drip 'cause you won't be able
to swallow and it'd be very very painful I'll give you an idea what's going to happen so
obviously the room is going to be busy and crowded you'll have Cynthia come in she's
your one to one nurse and she's gonna sit over here and put you on the monitor the monitor
allows us to watch your uh oxygen levels it allows us to watch your heart rate and your
heart rhythm and it allows us to monitor your blood pressure along the way okay all of those
things can be affected by the DMSO that your stem cells have been preserved in so we really
want to monitor them carefully the other thing is we give you pre medications as we did when
you had the high dose Malfulin but some of those medications make you a little bit sleepy
and when you're a little bit sleepy you don't take such deep breaths and your oxygen levels
may drop so don't and this is for you too yep so you know don't be fearful if we wake
you up and say you know Dianne we're gonna put a little oxygen on you okay it doesn't
mean that anything is going wrong okay good to know it just means you're sleepy you're
not taking deep breaths we're either going to poke you and keep telling you to do so
okay or we're just going to give you a little bit of oxygen so we can let you sleep we've
already started IV fluids so you get pre hydration and then afterwards you'll get post hydration
in a little while the blood bank will come up and they're going to come up with a bath
that kind of uh warms up the stem cells so they're still frozen right to the minute they
come into the room for you okay we're going to give you all of the bags back you collected
five bags or you know we processed them in five bags uh you collected nine million cells
per kilogram so that's a really good yeah that's a really good collection okay that's
great so what the blood bank will do is they will thaw out your bag one bag at a time they'll
thaw it out to your body's temperature because you don't want anything super cold and you
certainly don't want anything super hot okay uh as they thaw it out one bag at a time then
they'll hand it off to me we do double checks so we'll talk to each other about the bag
the volumes the amount of stem cells who you are and when your birthday is okay so often
you'll hear me saying even though you know I know you you'll hear me saying Diane what's
your birthday okay okay it's not 'cause I don't remember it's just because we're doing
the double check so that will happen for each bag okay and when we're half way done with
one bag they'll start warming up the next bag okay all right uh you'll probably be sleepy
through this okay okay you've already had some Benadryl prior to the chemotherapy and
it really didn't make you fidgety or anxious which it sometimes does so I anticipate for
you that you're going to be more sleepy than anything okay all right but easily I'll be
able to wake you up all right and talk to you okay if you want to stay awake during
the process and you want to ask questions you're more than welcome to but don't fight
the sleep okay I won't okay yep one thing I'm certain the audience Dr.Seldin is thinking
if patients are ill with some abnormal uh protein in their blood and you do a stem cell
transplant where you're freezing that person's blood how is it that when you uh put the cells
back in the patient the disease doesn't just regrow yeah that's a great question but it
seems like when we collect the cells which Dr, Sanchawalla described with the uh mobilization
process we get healthy cells and the uh abnormal cells that are responsible for the disease
are for the most part left behind in the bone marrow and then they get taken care of by
the chemotherapy that the patient goes through uh the cells that are put back into the patient
as part of the transplant appear to be healthy cells uh and uh in the best cases don't uh
provide any problems in the future This excerpt is brought to you by the Massachusetts School
of Law