Thursday, March 4, 2010

Harvest is almost 70% complete

Another early start this morning. Audrey took Talitha to the Oncology Clinic at the hospital for a 7:30am blood draw to confirm the CD34 bone marrow count was still rising. (The count jumped from 9.9 on Wednesday to 32+ today!)

From Oncology (4th floor) to surgery (1st floor): Talitha was sedated around 9am for the relatively short surgery—less than two hours—to install a double lumen catheter in her groin area.

From surgery (1st floor) to ICS (4th floor): After surgery, Talitha was brought to a room—same room she was in last Friday through Sunday—to get hooked up to the stem cell harvesting equipment. Blood was pulled out of her body through one of the catheter lumens and then put back in her body through the second lumen after the white blood cells had been extracted.

They will need to harvest 15 million stem cells per kilo of weight. (Talitha is about 11 kilos so they will need to get about 165 million stem cells.) The stem cells make up about 1% of the white blood cells during peak production so they have to process a minimum of 16.5 billion white blood cells to get enough stem cells (more if the concentration of stem cells to white blood cells is less than 1%).

As it turned out, they didn’t get enough stem cells today—only about 70% of what they need—so Tali gets to stay the night at “hotel” PCMC. (I think the blood counts shot up so fast that the ideal harvest window had already begun closing. If they had it to do over again and knew her counts would move so quickly, I believe they’d do the procedure a day earlier.) Please pray that tomorrow’s harvest will still be abundant enough to get the remaining required volume of stem cells.

During the 6 hour harvest procedure today, Talitha had to remain lying down. The harvest machine is never left unattended and when Talitha would make unexpected movements or move too much the technicians and nurses would respond very quickly to ward of actions that could adversely affect the process or be detrimental to her well being.
The idea of keeping her lying on her back all day again tomorrow without her going completely stir crazy is not pleasantly anticipated.

Why they are harvesting and freezing Tali’s stem cells: after the three induction cycles of chemotherapy are complete—we are finishing up cycle #2—then she will enter what’s called the Consolidation Phase. During each of the three consolidation cycles the chemotherapy gets even more intense to the point that it will completely eliminate all her bone marrow. The bone marrow is the originating factory throughout the bone structures of the body where stem cells are produced that become red, white, and platelet blood cells.

They plan to use 5 million of her own stem cells per kilo (approximately 55 million each cycle) to rescue her / rebuild her bone marrow each cycle. These miraculous stem cells intuitively know where to go when injected into the body; they move immediately to the open areas within the bones and set up shop. First they rebuild the bone marrow in as short a time as five days, then they become the respective red, white, and platelet blood cells for the body as needed.
Once Talitha was unhooked from the machine late this afternoon, Audrey was able to hold her. But while the groin catheter is in place, she must be either lying down or held at an angle if being held (she can’t be held straight up and down again until the catheter is removed).

The removal of the catheter requires that they put hard pressure on the removal area for a full 20 minutes. They’ve warned that this will not be pleasant and that Audrey should consider leaving the room while they do it. I’m praying Talitha will have added strength and courage. I never dreamed our baby would ever have to go through stuff like this.

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