“The two main types of transplantation used to treat non-Hodgkin lymphoma are autologous and allogeneic.
Allogeneic stem cell transplantation uses stem cells from a donor, usually a close blood relative or someone who is a genetic match with similar blood and tissue types. The goal is the same as with an autologous transplant: to repopulate the bone marrow with stem cells. These cells then develop into healthy white blood cells that can mount an immune response that destroys non-Hodgkin lymphoma cells in your body.
But it carries more risk than autologous transplant: the donor stem cells may see your healthy cells as foreign, attacking them in a condition called graft-versus-host disease, or your body may see the donor stem cells as foreign, creating an unhealthy immune response.”
Perlmutter Cancer Center, NYU Langone
Basically, I needed my sister’s cells to fight my cancer cells or whatever remains of it. Through this, we hoped I will remain in remission for a long time.
My transplant journey began on May 9. Together with my sister as my caregiver, I was admitted to the hospital and was inserted with a central line in my femoral vein.
For the next 5 days, I had chemotherapy (Cyclophosphamide + Fludarabine) which I tolerated well.
On May 15, I had a Total Body Irradiation (TBI) and the experience was unique because I had to be naked! Gratefully, the staff was nothing short of professional. The procedure itself was short – around 15 minutes each side of the body. But, the preparation took longer. I lay in the table and there were lots of hands strapping, positioning, measuring me, and putting electrodes on me. They also covered me in water bags! That, I didn’t know what for.
I needed the chemotherapy and TBI to suppress my immune system prior to transplant. Hence, after the TBI, I was transferred from a regular room to a Stem Cell Unit room, where there was strict isolation precautions.
My mother came with me in the Stem Cell Unit as my caregiver. Meanwhile, few doors down, my sister, as my donor, got admitted herself.
On May 16 and 17, I had my rebirthday. I was reborn with a new immune system. I was given another fighting chance in life. It was Day 0.
My sister had her stem cells harvested through her femoral vein through an apheresis machine for 4 hours. It was then immediately transfused to me. We had to do it twice because on the 16th, we only had 2.5M stem cells and I needed 5M stem cells. God multiplied what we lacked! On the 17th, we had 4.7M stem cells. My sister was then able to go home on the 18th.
I knew that the days following a transplant will be tough but I didn’t expect how terrible they were!
Right after my second infusion of stem cells, I began having some reactions. My eyes were swollen and I started having fever.
My oncologist told us that on Day 3 and 4, I will have high-dose Cyclophosphamide and my blood counts are expected to drop so I have to prepare at least 4 blood donors for red blood cell and platelet transfusions.
May 17, 2020
The following 2 weeks in the Stem Cell Unit, I was a wreck.
On the first week, my fever continued and I had pulmonary congestion. I needed oxygen support. I was started on antibiotics and diuretics. I was inserted with a Foley catheter to drain and measure my urine. But oh boy, I had to change catheter size thrice because of a leak! We eventually had to remove it. But, my urethra was already irritated. And, my hemorrhoids started acting up. My pain from urination and bowel movement was unimaginable!
Blood transfusions were also started. With the current pandemic, it was more difficult to acquire blood products, but we were able to get help. God worked through people! Dopamine drip was started too because my blood pressure was dropping. A lot was happening! I also had Kidney Ureter Bladder ultrasound and echocardiogram to check my abdomen and chest because I was having pains in these areas.
On the second week, I was restless. I wanted to be out from the Stem Cell Unit but my white blood cells were still nonexistent. We were waiting for the stem cells to engraft and produce a minimum amount of white blood cells before I can be transferred out to a regular room.
Meanwhile, I was dealing with an awful edema or the accumulation of fluids.
Background: I already have a compromised circulation because of Deep Vein Thrombosis. I have blood clots on my chest and neck, which scarred my veins, because of the tumor that occluded my superior vena cava or the large vein that brings blood from the upper body back to the heart. My body compensates this narrowing of my veins through collateral circulation or the formation of small capillary-like veins, which are actually visible on my chest! But, I have to take an anticoagulant to help my body and to prevent more clot formation.
When my blood counts started to drop, specifically my platelet, I had to stop my anticoagulant. When my intestines were inflamed, I had to stop consuming food and water for 48 hours and I was hooked to a Total Parenteral Nutrition or food directly to my veins. I also had other intravenous infusions. And, my mobility was already very limited. My body’s circulation couldn’t keep up!
I weighed 54 kg and my admission weight was 47 kg. I had 7 kg of fluid accumulation! I was so swollen. I felt like exploding! And, I did – not physically. But, my spirit broke.
I cried so hard to God. I kept questioning Him again even though I already knew the answers. I was struggling to rise above despair. I was not able to portray a Christ-like attitude because I was consumed with physical pain. I slept that night exhausted but holding on to one truth: God loves me!
Voila! The next day, I was informed that my white blood cells are enough for me to be transferred to a regular room.
On Day 15, I was out of the Stem Cell Unit.
5 days later, I totally lost my hair! My mother easily plucked them from my head. She did not have to shave it! I actually felt relieved to have a clean head. Hair fall was stressful!
Finally, I was starting to lose the excess fluids and was closer to my admission weight. I pitied and was in awe of my body. The toil it went through was unworldy.
I thought I was on my way to discharge but on Day 21, I was breathless and I had intense pain on my left upper abdomen. I had a CT scan, which showed fluid on my right lung and micro nodules on both lower lobes. I had a chest ultrasound, which measured the fluid at 400 mL. The plan was to drain the fluid the next day through a procedure called thoracentesis.
God is full of compassion and mercy!
When they checked the fluid right before the procedure, it was barely 30 mL. I probably had urinated it overnight! The procedure was cancelled and I was started on an antifungal drug instead.
On Day 24, I was able to go home.
Looking back to my month-long hospitalization, from May 9 to June 10, I see that “not for a minute was I forsaken!”
God was with me in that hospital room.
God continues to be with me.
I am humbled by my dependence of God and others. From the beginning, my family has done everything to keep me alive. My mother and sister have always been with me. My father and brother, though are back home, have always supported me. Our extended families and friends have always been one call away. And, strangers have always been there to help.
As of this writing, I’m on Day 75. Since discharge, I have weekly blood works and consultations. I am on a lot of medicines and I have been dealing with side effects such as graft-versus-host disease.
Post-transplant is another chapter of my story. There are fears of relapse, rejection, and complications. I have to learn to rise above them. I hope to share what’s been happening post-transplant but I’m still treading unsurely. Meanwhile, let us praise God that I made it through transplant! I also ask for prayers for my Day 100 because I will be having another scan to see if I remain in remission.
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