On Friday Kim, her mom and I all went to Princess Margaret Hospital for Kim's consult concerning the stem cell transplant. We spoke with two doctors and the co-ordinating nurse and they were all very friendly and helpful. PMH seems like an amazing facility too, it's very big and shiny and stuff.
Anyway, the plan is as follows. On Tuesday Kim will get a CT scan at St. Michael's and then on Wednesday the doctors at PMH will hopefully be able to compare the results to the CT scan that was taken before the salvage chemo started. I say "hopefully," just because the timing is a bit tight. Assuming the scan is received in time, and assuming it shows that the cancer is responding well enough to the salvage chemo they will begin the preparation for the transplant that same day (Wednesday).
As I mentioned before, the transplant does not actually do anything to help cure the cancer. Rather it is a necessity in order to facilitate recovery from extremely high-dose chemotherapy given to attempt to kill the cancer all at once. The toxicity of the high-dose chemotherapy causes the patient's immune system to be completely wiped out. The transplant allows the patient to recover after that happens.
In the past, before stem cell transplants, a bone marrow transplant was done instead. This was a much more invasive procedure as the marrow had to be harvested from deep in the hip bone and a lot of marrow was needed. For the stem cell transplant, the cells are collected from the blood and so it's a lot easier.
The preparation for the collection involves a single round of chemotherapy followed by a week of daily Neupogen injections. The chemotherapy is similar in strength to the treatments Kim has already received and is meant to help mobilize the stem cells in her body (ie. get them moving about the blood stream to facilitate collection). The Neupogen helps boost the counts so that there are more cells available to collect.
If all goes well, the mobilization chemo will start Wednesday, and continue on Thursday and Friday (all as out-patient procedures). Then the Neopogen injections will start the following week. They expect that Kim might be ready to have the actual collection done as early as the week of May 30.
While all the prep work for collection is happening, Kim will also go through a whole bunch of examinations to ensure that there are no latent problems anywhere in her body. The doctors would much rather treat and resolve such issues before Kim becomes severely immuno-compromised. She'll get a physical, plus heart and lung tests and even a special dental exam (need to be careful about gum inflammation and cavities and stuff). Anything that could cause an infection later needs to be fixed first.
Once all the crazy pre-amble work is done the collection itself is pretty simple. They take blood out one arm, run it through a machine which filters out the stem cells and then put the blood back in the other arm. It can be a lengthy procedure though and Kim may have to come in more than one day to complete it.
After the collection is complete, they wait until Kim recovers enough from the mobilization chemo and then admit her to PMH as an in-patient. Then they give the extremely high-dose chemotherapy and a few days later introduce the stem cells collected earlier. Finally they keep her for at least two more weeks until she has recovered enough immune system function to go back out into the world. The hope is that it could be done by the end of June.
Again, this is all still tentative pending the results of the CT scan on Tuesday. They had us come in before the results so that we would know what to expect so that they can move quickly when they're ready.
We're pretty anxious to find out what will happen!