This post is continued from the previous post…
What happens in a stem cell transplant is that they administer another growth factor called Nupogin which mobilizes white blood cells. They then collect millions of stem cells which will be transplanted back into your system. Once the collection is done high doses of chemotherapy are given to essentially destroy your immune system and also so that your body doesn’t reject the transplanted cells. Then the healty cells are put back in via an IV and the immune system begins to rebuild itself.
Through a combination of drugs the hope is to get the cancer into remission. One of the more popular treatments is a drug called Thalidomide which was originally used to treat nausea in pregnant women. One of the problems with it though is that it causes neurotoxicities which present as numbness, tingling and gastrointestinal upset. There is a new drug similar to thalidomide but without the side effects called Revlimid (lenalidomide) and it’s used in conjunction with a steroid called Dexamethasone. Both are given in pill form. The Revlimid is taken 21 days on and 7 days off (one full cycle or one month) and the steroid is taken once a week. Side effects of the Revlimid can include lowering of blood counts (platelets and white blood cells). Low platelets can lead to risk of bleeding and low white cells lead to risk of infection. Because of this dad has to come in once a week in the beginning of the treatment to have his blood counts monitored.
Side effects of the Dex can include upset stomach and thinning of bones and over a long usage period can affect the blood sugar. When used with Revlimid it increases the chances of blood clots in the lungs (pulmonary embolism) or clots in the legs (deep vein thrombosis). Because of this dad will also be put on a full daily dose of aspirin.
Dad will have his protein levels checked the 3rd week of each month. Dr. Dushkin said the number of cycles necessary is uncertain and depends on the response to the medication, but to plan on 4-6 cycles until dad can get to transplant.
As far as restrictions go the doctor said there were none as long as dad feels well enough. He shouldn’t perform any moderate exercise but light is ok – but first and foremost he needs radiation on his legs. He can also have alcohol occasionally but has to be careful not to overdo it because of his impaired kidney function.
Some Good News
OK so remember how I was talking about dad’s creatinine levels earlier? As we were waiting for dad to get his shot Dr. Dushkin came out and spoke to us. She was clearly excited. She told us the results of dad’s blood test taken when we got there were in and that his creatinine level was down to 1 – and his calcium level was 9 – both normal numbers and a very encouraging development! It was the pomidrenate that he was administered in the hospital (plus drinking all that water we bugged him about) that helped to get his levels in check. It is a great development because the doctor wasn’t sure if dad could regain the lost kidney function. As a result she decided to put dad on the full dose of Revlimid as initially she wanted to reduce the dose to lessen the strain on the kidneys.
So more than you ever wanted to know yes? I felt that we should all be as informed as possible so we can make sure dad gets the best treatment available.