Saturday, October 6

Just waiting... and some of your questions answered!!!!

!!!!On tuesday MRI !!!!
!!!!On Wednesday Regina will see Dr Dhall!!!!!
and after that new chemo ....
I am exited and anxious about this MRI. Right now I am worried sick. REGINA is doing great. I am just worried that tumors are sitting still - not shrinking. I want them shrink faster, I want doctors know more... I know stable is good, but I can't take any more stable... I want more than stable...
Now, few of you have asked WHAT THE HECK ARE STEM CELLS?? WHAT TO THEY DO?? here is your answer. Blood cells grow from stem cells. Stem cells are the parent cells that have the ability to re-grow all the normal blood cells. Stem cells are found in the bone marrow but they can also travel (or circulate) in the blood stream (called peripheral blood stem cells). And Reginas stem cells were collected from blood stream while her ANC was recovering.

WHY REGINA NEEDS STEM CELL TRANSPLANT??? Chemotherapy given at transplant doses will damage the stem cells so that they cannot recover to produce normal blood cells. To avoid this severe side effect, stem cells that were collected and stored at an earlier time (before transplant chemotherapy is given) are given back to the patient (like a blood transfusion) to replace the stem cells that were lost. These stem cells then grow to restore normal working blood cells.

An autologous stem cell transplant uses the patient's own stem cells to replace the stem cells that are killed by the high dose transplant chemotherapy. These stem cells are collected from the patient at a time before transplant (weeks to months) and are stored until they are needed. Once the high dose chemotherapy has been given, these stem cells are infused into the patient.

The procedure of giving back the patient's own stem cells to restore normal working blood cells is called an autologous stem cell transplant. As blood cells are known as hematopoietic (means blood forming) cells, these transplants are often called autologous hematopoietic stem cell transplants, or AHSCT.

Stem cells can be collected from either the bone marrow or the peripheral blood (bloodstream). The procedure for collecting stem cells from the blood stream or peripheral blood is called a peripheral stem cell harvest or pheresis. The procedure for collecting stem cells from the bone marrow is called a bone marrow harvest. Peripheral blood stem cell pheresis or PBSC pheresis: Peripheral stem cell collection is done when the blood cell counts are beginning to recover after the patient has gotten a course of chemotherapy. (usually 10-14 days after the first day chemo was given). This is the time when the most stem cells can be found travelling in the blood stream. A special central line or catheter with 2 lumens or ports is needed to collect peripheral blood stem cells (PBSC). A temporary catheter may need to be placed only for the PBSC harvest. Your doctor or nurse will tell you if a temporary catheter is needed to collect stem cells. PBSCs are pheresed or collected by connecting the central line to a special machine. The central line is used to pass your child's blood through the machine that takes out the stem cells and then returns the rest of the blood to your child's body. The collected PBSCs are taken from the machine to the lab to be processed and frozen until they are needed. Each PBSC collection takes four to six hours to complete. PBSC collections are done in the clinic but patients can be hospitalized if there are complications during the collections in the clinic.. It can take 2 to 3 days to collect enough PBSC to be used after high dose chemotherapy. G-CSF is a drug which causes a quicker increase in the number of white blood cells seen in the blood after chemotherapy. All patients will get G-CSF as an injection under the skin once a day for several days before and during the PBSC collections, to help increase the number of stem cells in the peripheral blood. G-CSF will be stopped when the collections are finished. Bone marrow harvest : A bone marrow harvest is usually done after your child's blood counts have completely recovered after getting a course of chemotherapy (usually 4-5 weeks after chemo was given). A bone marrow harvest is done in the operating room under general anesthesia and sterile conditions. Part of your child's bone marrow will be withdrawn or removed from the back of the pelvic bone (hip bone) on the right and left sides using syringes and needles. If needed, bone marrow also will be taken from the front of the pelvic bone on the right and left. The exact amount of bone marrow removed depends on your (your child's) size, but will be approximately 400 to 800 ml (2 to 4 cups). Larger children need more stem cells for transplantation and other procedures which need stem cell support. Your child would be in the hospital over night the day of the harvest. Longer hospitalization may be needed if complications occur.

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