On the Verge of a Daunting Fortuity

This afternoon I, along with my sister Shelly, met Dr. George Selby, M.D., for my consultation at the Stephenson Cancer Center. We both liked him immediately. As Shelly said, he seemed “very laid back” and easy to talk to. He has quite a distinctive appearance, with long gray hair tied back in a pony tail. Of course, he wore a mask, so I couldn’t see his face, but I have included a snapshot of the picture of him in the guide he gave me.

He described the bone marrow transplant process in detail and answered several of my questions as he did. At one point when he was explaining the high-dose chemotherapy I would receive, he remarked, “I hate for you to lose your pretty hair.” Coming from a man whose gray hair was longer than mine, I knew his sentiment was genuine. I have a much better idea now of the timeline for when things will happen, and as with everything I have experienced in this journey so far, things are happening very fast. One of my questions for Dr. Selby was whether they would need another bone marrow biopsy, as the original one I had was done back in November. He answered in the affirmative and suggested we might be able to do it this week while I’m here in Oklahoma City. Oh my! I thought. I wasn’t expecting that. Wouldn’t you know, they wanted to schedule it for Friday, but John and I will be in Tulsa on Friday for my nephew’s wedding rehearsal dinner, so Nancy, Dr. Selby’s nurse and “Transplant and Cellular Therapy Coordinator” is checking on the possibility of doing it on Thursday instead.

“As long as I can be asleep for it, like the first one, that’s fine with me,” I told him. He assured me I could.

He mentioned some other tests they would want to perform prior to the harvesting and transplant, including a nuclear heart scan or echocardiogram, pulmonary (lung) function tests, and urine tests to determine my general physical condition. The riskiest part of the process will be the high-dose chemotherapy drug that will essentially destroy my bone marrow, or blood factory, and places extra stress on my body, so the results of these tests are especially relevant. My general health is good, so I don’t anticipate any problems.

I will also have a central venous catheter, or CVC, placed in my chest near my collar bone. This is a tube that is placed in a large vein with the internal tip extending as far as my heart. The external portion of the tube will have two or three ports or lumens, referred to as “pigtails.” A surgeon inserts the catheter with local or general anesthetic. It is used to administer chemotherapy, medications, IV fluids, blood products, and to draw blood. The high-dose chemotherapy, stem cell collection, and transplant will be done through the CVC.

Dr. Selby explained that I would be given a drug known as a CSF, or colony-stimulating factor, during the “mobilization” process, which increases the number of stem cells in my blood so they can be collected. It essentially forces them out of the marrow and into the blood stream. An additional CSF called Mozobil might be used as well to increase my blood cell production. This is done via a series of injections over four to six days that I will be taught to give myself. I can’t wait – hah!

A process called apheresis is used to collect the stem cells from the peripheral blood. Dr. Selby explained that this will take approximately four hours each time and involves drawing the blood through my catheter and into a cell-separating machine, which separates and collects white blood cells, including stem cells, along with a few red blood cells and platelets. The remaining blood cells are returned to me through my CVC. I will have two to four of these apheresis sessions to collect enough stem cells to give back to me after my high-dose chemotherapy, and they are usually performed daily. The cells are frozen in liquid nitrogen until they are needed for my transplant. They can be stored safely for up to 10 years.

The high-dose chemotherapy is used to destroy cancer cells with higher doses than the standard regimen I’ve been doing, and it destroys normal cells too. Most of the side effects from it occur within two weeks. My body will begin to repair the damage immediately, but it will need the help of transfusions to replenish red blood cells and platelets. The transplant team will review my blood counts, electrolytes, and temperature daily to help determine whether I need replacement blood cells, replacement of blood chemicals, or antibiotics.

Dr. Selby suggested that the transplant could likely be done at the end of March. He instructed me to hold off on beginning my next cycle of Revlimid but to continue with the Velcade injections and dexamethasone. Within a few weeks following the transplant, we should begin to see signs that my stems cells are growing and producing blood cells. Within six weeks, all three blood cell lines – white, platelets, and red – usually engraft or grow.

There is a lot more information that I need to read and digest, but hopefully, this will give you a good idea of what the process will entail. I have a calendar notebook at home that I plan to use to project the different procedures and estimate the timeline so I can get an idea of when I will need to return to Oklahoma City. If we can’t do the biopsy this week, Dr. Selby said I could do it in Florida, as well as the other tests, and that relieved a bit of the anxiety I was feeling. When I return to Oklahoma City, it will likely be for a period of at least a few months.

As eager as I am to put this all behind me, there is a possibility that I will request a brief delay between the harvesting and the high-dose chemotherapy. I have not seen my youngest son, Kohlson, since June of last year. He is in the Army and his home base is Fort Campbell, Kentucky. He was there for only a few months after graduation from Advanced Individual Training when he was deployed on a rotation to Romania in July 2020. Over the last eight months, he has been in Romania at Mihail Kogalniceanu (MK) Air Base; participated in joint exercises with Bulgarian forces; then to Volos, Greece; and currently he is at the United States Army Garrison Hohenfels Training Area in Germany. He is scheduled to return to the States 20-22 March. Once he returns and goes through COVID quarantine, he will have two weeks of leave, and if I am about to undergo a bone marrow transplant, it could be another month or more before I can hug him, and that’s just not acceptable. When I pencil in the timeline for each of the upcoming procedures, Kohlson’s return to the states and leave will definitely be priority for me.

So, there we are. I feel like I’m standing on a precipice, and whether I fall into the abyss or soar across it with wind beneath my wings will depend on whether or not I can spend a little time with both of my sons before I make the leap. I know they will lift my spirit and make my outlook bright.