Stem cell transplant details

I’ve been completely ineffective at catching up on the details of the stem cell transplant, so I will aim to write and post this quickly, so I can just get it out.

When I started writing some weeks ago, I was going to write “now it’s over”, but that’s the thing with a donor transplant, it won’t be ‘over‘ for quite some time. More on this in another post.

Some friends and family said they would be thinking of me on Wed 16 May – transplant day – which is a lovely thought, but really not a lot happened. On the Saturday, Sunday and Monday, I went into hospital each morning, onto the Transplant ward, sat on my bed and received a reduced dose of chemotherapy (Fludarabine), which was literally a case of sitting still while the drug infused into the PICC line in my arm. I didn’t feel a thing. Once it was done, I could go home.

On the Tuesday I had the Total Body Irradiation, which was exactly like the planning session described previously except that the blasts of radiation lasted longer and it was less odd the second time around. Once that was done, I went back up to the ward and became a proper inpatient. This was because they began giving me immune suppressant medication, again through the line, and needed to keep an eye on me, with regular observations, to make sure I didn’t have a bad reaction to it, which fortunately I didn’t.

Later that evening I had to have a nebuliser of Salbutamol, then Pentamidine. Because Pentamidine is cyto-toxic, I had to sit in a tiny room, into which no one could come for a couple of hours after I’d finished. Having a nebuliser isn’t painful – simply a matter of breathing in medication through a hard plastic mouthpiece, which you hold between your teeth. The liquid medication is poured into a container below the mouthpiece, which is then aerated by a pump that blows it through the mouthpiece as a mist, enabling it to be absorbed by the small airways within the lungs.

The Salbutamol was easy – it only takes about 15 minutes. Normally, Pentamidine takes about 45-60 minutes, but for some reason the liquid drug had not fully disappeared after the expected time. I came out of the room and explained that about half the liquid still remained in the container.

Because I had had to wait for the two other stem cell transplant recipients to have their nebulisers before me, it was already quite late in the evening and all the daytime doctors had long gone home. The nurse contacted one of the on-call doctors who advised that I needed to go back into the room and have another go at it. I was really not a happy bunny, but conceded – what else could I do? I checked all the points where the tubes joined the pump and the mouthpiece and I couldn’t find any loose joins, so I proceeded. At the end of a further 45 minutes, the liquid still hadn’t disappeared, but by that time, I was too tired and fed up to be bothered with it any more and I could see it wasn’t going to make a difference. I would deal with it when I saw the doctors the next day.

Salbutamol and Pentamidine are given to protect me against lung infections, including pneumonia, due to my lowered immunity to infections. I will have to have a nebuliser of both drugs once every four weeks, although now the small room in which I’m confined for an hour or so is in Daycase instead of on the ward.

When I asked about the problem with the nebuliser the next day, Prof wasn’t too bothered about it. He just advised that instead of waiting four weeks before the first four-weekly outpatient nebuliser, I could have it in two weeks.

On the Wednesday, the actual transplant took place in the late afternoon. I sat on my bed, a bag was hooked up and infused into me by IV through the PICC line. Job done! It was such a non-event, I didn’t even think to take photos. So thank you to everyone who said they would think about me, but there was really nothing to it.

I stayed in hospital till Friday, with no adverse reactions, no temperature, no sickness, no diarrhoea, no infections, no weakness, just plenty of regular observations and at some point a change of the immune suppression medication, from IV to tablet form, which I would continue taking at home. On Friday, I was discharged by the Prof and went off quite merrily, with a big bag of tablets. More on those later.

As you can see, the experience was not at all traumatic and certainly nothing like the misery of the auto transplant I had last year. It really was like the “walk in the park” that my consultant promised.