The Battle

I am nearing the end of my second cycle of chemotherapy in the initial phase of my treatment of Myeloma. So far I have concentrated on the day to day but thought I really ought to look at the overall process towards Battling the Bone Breaker

There are two pathway options and for someone like me who is apparently younger and fitter (?) the option of Intensive Induction is employed.  There are more side-effects with this approach, but benefits will outweigh risks. Obviously if it does not work then another pathway is employed.

There are six steps to the treatment overall and I am still in step 1. Notes here based on information received by Myeloma UK in their helpful guide and interpretation is my own and may or may not be medically rigorous.

Step 1 – Induction Treatment

In this period I am receiving a combination of Valcade ( Bartezomib), Cyclophosphamide and Dexamethasone – this is known as the VCD pathway and is relatively new – with Valcade replacing an older combination which involved thalidomide (CTD).

The Valcade is administered twice a week (Tuesday and Friday) by a combination of injection (Valcade) and tablet (Cyclophosphamide) and supported by Dexamethasone tablets taken on the day of and day following Valcade.

Each cycle lasts two week with a rest week in between.

It is reckoned I will have six cycles – which will run up to the end of August.

Step 2 – Stem Cell Mobilisation

In this period a new treatment will be administered which will stimulate the multiplication of stem cells  In this step so many stem cells are produced in the bone marrow that these are forced into the blood stream so that enough can be collected in the next step.

It uses a combination of three medications – G-CSF, cyclophosphamide and plerixafor.

  • Granulocyte-colony stimulating factor (G-CSF) stimulates the growth of stem cells in the bone marrow.
  • Cyclophosphamide helps to mobilise the stem cells moving them into the blood stream.
  • Plerixafor (Mozobil ®) also aids in the mobilisation process allowing the stem cells to enter the blood stream by inhibiting the body’s natural mechanisms which usually prevent all but a small amount of  this from happening.

A very technical video below – not for the layman but interesting if you can work through the technobabble.

This process might take only a day or so.

Step 3 – Stem Cell Collection

In this period stem cells are collected in a process called apheresis.  Blood will be  taken from one arm and goes through the line into the apheresis machine. The blood is spun in the machine, which will separate out various cell components. Stem cells will be drawn off and the remaining blood is returned to me through the line into my other arm.

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The collected stem cells are then frozen and stored until they are needed. They will need about 2 million stem cells for every kg body weight for a single transplant (so quite a lot from me!) and they will actually collect in the region of transplants worth!

As an acknowledged hemaphobe  (I really don’t like the sight of blood!) this will be a challenging phase for me, though recent weeks have made me a lot more resilient!

This process will involve spending time on as an inpatient or outpatient where stem cells will be collected during a period of up to  3-4 hours over a 2- 3 day period.

Step 4 – High Dose Therapy

The process will start approximately 4 – 6 weeks after the previous step.

Most of my Myeloma cells will have been destroyed but in this period I will be given a high dose of chemotherapy to kill as many of the remaining myeloma cells as possible before rescuing with an infusion of stem cells.

The drug used is likely to be melphalan. This is a very effective chemotherapy drug and will kill healthy cells too. This will be risky as it will lower my immunity significantly. The benefit will be a longer remission period or plateau at the end of the process.

This process will take approximately 2-3 weeks and most probably as an inpatient.

Step 5 – Transplantation

This process will start within a day or two of the high dose therapy.

In this period I will undergo autologous stem cell transplant (transplanting my own stem cells back into my bone marrow).

Frozen bags of my own stem cells will be defrosted on the ward and then over an hour or so infused by a drip back into my body. Here they will migrate back into the bone marrow where they settle and develop into new blood cells. This process is called engraftment and will take 10 -14 days to produce enough blood cells and so I will be immunocompromised. It is vital at that point I am in a sterile environment and many tests will be carried out to ensure this.

Step 6 – Recovery

In particular it is important for the while blood cell count to rise and until this happens there will be very close monitoring of my body stats. Cleanliness and diet are vital in maintaining good health at this point. A special diet will be needed and regular changes of bedding and clothes. Visitors will need to be screened and should have protective clothing.

At this stage I may well lose my hair (2-3 weeks after high dose treatment) but it should grow back in 3-6 months.