Having already told you what HSCT is, I thought I would also lay out the order of events for the treatments in Moscow, Russia.
So, here it is (adapted from the Russia HSCT information booklet):
Steps of AHSCT treatment
1. Stem cells stimulation - 4 days (sometimes 5-6 days, depending on the results of stem cell collection). Granulocyte-colony stimulating factor (G-CSF) 10 μg/kg.b.w./day (2 subcutaneous injections 11 pm and 3 am) in combination with steroid infusion (Methylprednisolone 500 mg) at 10am-11am (200 ml liquid for 20-40 min intravenous infusion). Also, patient takes one antacid pill twice a day 30 mins before food (before breakfast and before dinner). The most common side effects are: bone pain, headache, bad sleep, fever and other flu-like symptoms.
2. Insertion of special central venous catheter (dialysis) in external jugular or subclavian vein under ultrasound control for stem cell collection. Then chest X-ray control of catheter position.
3. Collection of stem cells (for 1 or 2, sometimes 3 days). To rebuild immune system, we need to collect 2 or more million hematopoietic stem cells per kg of body weight (>2 x 106/kg/b.w. CD34+ HSC). Stem cells collection (harvesting) takes 5-6 hours (7-8 am – 1-2 pm). Autologous stem cell harvesting is performed by Haemonetics MCS+ multicomponent collections system or Spectra Optia Apheresis System.
4. Removing of dialysis catheter and insertion of new ordinary triple-lumen catheter in external jugular or subclavian vein under ultrasound control for chemotherapy and further treatment.
5. Chemotherapy (4 days) and stem cell reinfusion. Chemotherapy (conditioning) takes 4 days. The main morning infusion of Cyclophosphamide with supportive medicine and hydration (3 L of normal saline) takes 3 h (usually 10 am – 1 pm). Second and third infusions (mesna uroprotection, nausea prophylaxis) – in 4 and 8 hours after the first one. The most common side effects are: nausea, vomiting, diarrhea, constipation, oropharyngeal mucositis, alopecia, pancytopenia (low leucocytes, hemoglobin, platelets), hemorrhagic cystitis, fever. From 1st day of chemotherapy we start antiviral, antibacterial and antifungal prophylaxis – Ciprofloxacin 1000 mg/d, Fluconazole 200 mg/d, Aciclovire 1200 mg/d, Co-trimoxazole (Bactrim) 960 mg/d on Mon, Wed, Fri. Patient should take all tablets: pills for breakfast – patient takes one antacid pill before meals, other pills – after meals. Pills for lunch – patient takes one pill after meals. Pills for dinner - patient takes one antacid pill before meals, other pills – after meals. Patient has additional oral medications on Mon, Wen, Fri –Co-trimoxasole (2 white big pills –morning, evening).
We give 1 day for rest before stem cell reinfusion (D-1) Stem cell reinfusion (D-0). After finishing chemotherapy, we provide stem cell reinfusion – D0 (transplantation day). We start stem cell infusion at 1-2 pm and finish at 3-4 pm. We recommend not to have meals after midday (12 pm), you can drink as much as you want. We remove the cryopreservation bags individually from liquid nitrogen and place them immediately in the water bath and thaw it. When thawed (-2-3 minutes), we infuse it as quickly as possible. Together with stem cells, we give fluids (3-4 L of saline), antihistamine, steroids and other symptomatic medications as needed. Also, we monitor heart rate (ECG), blood pressure, respirations, body temperature. Possible adverse reactions: nausea, coughing, vomiting, flushing, fever, dyspnea, chills, high or low blood pressure, allergy, low or rapid ventricular rate. Other side effects are pungent/tomato taste and smell, red-stained urine. We ask patients to urinate in special bag to assess the colour of urine after stem cell reinfusion.
6. Isolation period (from D+1-D+3 to D+8-D+12). Patient should never leave the room. Patient should keep the door closed. Medical staff will clean the room every day. Patient’s suitcases will be removed. Patient should heat up food (approx. 10-20 seconds) in the microwave before consuming. Patient should use a special solution for mouthwash (mix half of cup of red solution with cap of water). Patient should use provided chlorhexidine solutions for washing body – alcohol-containing for legs/arms/body, water-based - for genital area and head. Our staff will change bedding and wash clothing every day.
We monitor blood pressure, heart rate, body temperature 3 times a day. Patient usually has supportive infusions – natrium saline, electrolytes, low-dose dexamethasone twice a day, GCSF (subcutaneous shot, once a day at 3 pm) to decrease length of neutropenic phase. Additionally, we can use intravenous antibacterial, antivirus, antifungal medications when needed. We provide blood component transfusion when hemoglobin or platelet level is too low (Hb<80 g/L, Plt< 20 x 109/L). Patient has 5h Rituximab infusion on D+10-D+12.
Discharge day is usually on D+12 - D+15.
No comments:
Post a Comment