Course of treatment

Overall, the stay in Moscow takes 30 to 40 days.

 

Sequence of stem cell transplantation in Moscow, simply explained:

1. Fish stem cells – Früher musste man Knochenmark aus dem Beckenknochen abnehmen, um dort an die sozusagen Baby-Stammzellen zu gelangen. Inzwischen kann man diese medikamentös dazu bringen, den Knochen zu verlassen und ins Blut zu schwimmen. Dort werden sie abgefischt und eingefroren.

2. Destroy the (ill) immune system – Using chemotherapy, the immune system is deleted. All cells in the blood that have learned to attack the body’s own nervous tissue are now eliminated.

3. The baby stem cells are used – The previously fused baby stem cells are now thawed and returned to the blood.

4. Isolation – Since the immune system practically does not exist yet and is formed only by means of the baby stem cells, the body no longer has a functioning defense system and the most normal bacterium can be life-threatening. Therefore, I am isolated in a sterile as possible and receive no visit.

5. Departure and aftercare in Germany – The immune system is still not fully functional, but with mouth protection, caution and antibiotics I may leave the clinic and fly home. The follow-up then consists of recovery time as well as regular blood count checks, avoidance of people gathering in the first months, wearing a mask etc.

 

*******

 

Sequence of stem cell transplantation in Moscow, explained in detail:

1. Stem cell stimulation – 4 days (sometimes 5-6 days, depending on the results of the stem cell study). Granulocyte colony stimulation factor (G-CSF) 10 μg / kg body weight / day (2 subcutaneous injections 11:00 am and 3:00 am) in combination with steroid infusion (methylprednisolone 500 mg) at 10:00 am to 11:00 am (200 ml liquid for 20- 40) min intravenous infusion). In addition, the patient takes an antacid pill twice a day, 30 minutes before eating (before breakfast and before dinner). The most common side effects are: bone pain, headache, sleep disorders, fever and other flu-like symptoms.

Introduction of a special central venous catheter (dialysis) into an external jugular or subclavian vein under ultrasound control for stem cell collection. Then x-ray control of the catheter position over the breast.

2. Collection of stem cells – (1 or 2, sometimes 3 days). In order to rebuild the immune system, 2 or more millions of hematopoietic stem cells per kg of body weight must be collected (> 2 x 10 6 / kg / g. CD34 + HSC). The stem cell harvesting (harvest) takes 5-6 hours (7-8 clock – 1-2 clock). The autologous stem cell harvest is performed by the MCS + multi-component collection system from Haemonetics or the Spectra Optia Apheresis System.

Removal of the dialysis catheter and insertion of a new ordinary three-lumen catheter into an external jugular or subclavian vein under ultrasound control for chemotherapy and further treatment.

3. Chemotherapy – (4 days) and stem cell reinfusion. The chemotherapy (conditioning) lasts 4 days. The main infusion of cyclophosphamide in the morning with supportive medicine and hydration (3 L normal saline) lasts 3 hours (usually 10-13 o’clock). Second and third infusions (Mesna-Uroprotektion, nausea prophylaxis) – in 4 and 8 hours after the first. The most common side effects are: nausea, vomiting, diarrhea, constipation, oropharyngeal mucositis, alopecia, pancytopenia (low white blood cells, hemoglobin, platelets), hemorrhagic cystitis, fever. From the first day of chemotherapy we start with antiviral, antibacterial and antifungal prophylaxis – ciprofloxacin 1000 mg / d, fluconazole 200 mg / d, acyclovir 1200 mg / d, co-trimoxazole (bactrim) 960 mg / d on Mon, Wed, Fr.

Taking Antacid Pill, Co-Trimoxasol. 1 day recovery from stem cell reinfusion. After completion of chemotherapy, stem cell fusion takes place. Remove the cryopreservation bag individually from liquid nitrogen, thawing 2-3 minutes. Administration along with the stem cells as needed also liquid (3-4 liters of saline), antihistamines, steroids and other symptomatic drugs. Monitoring heart rate (ECG), blood pressure, breathing and body temperature. Possible side effects: nausea, coughing, vomiting, flushing, fever, dyspnea, chills, high or low blood pressure, allergy, low or fast ventricular rate. Other side effects are stinging / odor and odor intensive tomato taste.

5. Isolation period – (from D + 1-D + 3 to D + 8-D + 12). The patient should never leave the room. The medical staff will clean the room every day, wash sheets and clothes, clean the room air etc. Daily monitoring of blood pressure, heart rate and body temperature. The patient will normally have supportive infusions – sodium saline, electrolytes, low-dose dexamethasone twice daily, G-CSF (subcutaneous shot once daily at 15.00) to reduce the length of the neutropenic phase. In addition, if necessary, intravenous antibacterial, antiviral and antifungal drugs can be used. Blood component transfusions are available when the hemoglobin or platelet level is too low (Hb <80 g / L, Plt <20 x 109 / L). The patient has 5 hours rituximab infusion at D + 10-D + 12.

4. Entlassung – Concrete instructions are given. The doctor also keeps in touch with the patient after discharge and return. Aftercare takes place in cooperation with Moscow and my hematologist here in Germany.

General rules after discharge.
It may take several months for the immune system to become an autologous
Transplant has recovered. Therefore, some precautions must be taken to
Prevent infections during this time.