We've really missed all of our new hospital buddies, so we're headed back for more. Ethan will be re-admitted to INOVA Fairfax early Tuesday morning for a stem cell rescue. We anticipate that this will be a short, 1- to 2-day stay.
Stem cells are the cells from which all other blood cells (white, red and platelets) evolve. Stem cells can be collected directly from the bone marrow (called bone marrow harvest) or from within the circulating blood (called stem cell pheresis). Although stem cells are less concentrated in the blood then in the bone cavities, a pheresis collection is less painful, allows the body to reproduce stem cells more quickly, and introduces a lower risk of secondary cancers during subsequent transplant. For these reasons, Ethan's stem cells will be collected from his circulating blood using the pheresis procedure.
To prepare for the procedure, he's been getting 2 neupogen shots per day to stimulate the release of stem cells from the bone marrow into the blood stream. The agony of it all has been excruciating! The whole day is filled with dread and anxiety and the shot itself is done through tears. Ethan doesn't like it much either...
Early tomorrow, Physicians from the Interventional Radiology Department will place a larger pheresis catheter in either his leg or his neck. Once the placement is complete, he'll be admitted into the hospital on the regular Pediatric Oncology floor. The catheter will then be hooked up to a very large, very noisy apheresis machine that will remove circulating blood, extract the stem cells, and then return the blood to his body. The procedure should take 3-4 hours. During the procedure, there will be a nurse with him in the room at all times, monitoring him as well as the equipment. She'll be drawing various labs and performing several tests to ensure that no complications develop and to determine when/if we have harvested enough stem cells. The always harvest twice as many as they anticipate needing. If we don't get enough the first day, we'll spend the night and try for more in the morning.
Some of the side effects we're expecting are:
Once the stem cells are collected, they'll be processed by the blood bank and then frozen in liquid nitrogen (or cryopreserved... there's a new word-of-the-day for you, Ed) until they are needed.
The stem cell rescue is primarily intended as a safety net for us. Ethan is receiving a very aggressive chemotherapy regimen and it is possible that the bone marrow may be totally destroyed to the extent that it would not recover on its own without an infusion of new stem cells. Should Ethan ever find himself in need of a bone marrow transplant, we can use his own stem cells (called autologous transplant), rather than having to find a matching donor (called allogeneic transplant). This greatly reduces the likelihood of him rejecting the transplant, if one should ever become necessary.
This second cycle has been very difficult so we're understandably anxious to put it behind us and hope for a better one next time around. Once the collection is finished, we expect to be home for about 3 days before returning to start his third cycle. We'll keep everyone posted on his progress.
Regards,
Kim, Bert, Ethan and Kyra