Line In, Cell Collection, Line Out

If only things were so simple as the title of this post. But, dear reader, never fear – all is well.

I drove to Boston at 5:00 am on Monday morning, December 7th. I valet parked my car and left my suitcase with the front desk. And then I walked the mile to Dana Farber.

Then I walked the maze that is the Dana Fraber/Brigham & Women’s complex, all inside in overhead walkways. They schedule you to arrive at 9 am for a 10:30 procedure. Tending toward the prompt side, I had a long wait in the waiting room.

When I got down to the pre/post op area the nurse started running through her questions. She noted that I had told them I would Uber back to the hotel. She then asked me who would be staying with me? “No one.” “You are having conscious sedation, you need someone with you for 12 hours.” Of course, this would have been good to know when I had the lengthy pre-op discussion on Thursday night!! Oy. They landed on giving me less sedation. And they did, and I was fine.

The next day I arrived at the Kraft Family Dlood Donor Center where they do the apheresis. Yes, that Kraft, the whole place is strewn with Patriots memorabilia! I had a visit from one of the research nurses, she told me I might want to stay over night because some people get tired from the aphaeresis. Do these people not know that I am a planner and need all of this information up front?!?! Anyway, a mere five and a half hours later and the apheresis was complete. I loved my nurse who sat with me for most of those hours. I asked a lot of questions, he was very informative and had good advice. He also had a lot to say about the ways politics and medicine come to play. He kept pointing doing the street and referencing “Cambridge”.

Then I headed back to have the line removed, which was inconsequential, other than the slight discomfort of laying down flat on your back with your head below your heart for 30 minutes.

Next up was a special bonus visit, back up to the multiple myeloma clinic for an Xgeva shot because my calcium was elevated (12.9). And then the drive home, which did not include any traffic even though I left a little after 4 pm. I always like to point out whatever little upside there is to this pandemic – no outbound traffic on a Monday night in Boston!

Wednesday morning I started my bridging therapy at Smilow. And because my hemoglobin was low (7.9) I needed to get a blood transfusion.

I felt pretty terrible on Thursday and Friday, probably the worst I have felt since the stem cell transplant. Very out of breath and oh so tired. Saturday I went into Smilow as scheduled for a neupogen (zarzio) injection to make sure my white blood count doesn’t go too low. Now, get your score cards out: my hemoglobin was down to 7.7, and on the bright side my calcium was almost normal at 10.3. So, another blood transfusion. Four and a half hours there.

Calendar updates

Bridging therapy: December 9 (done), December 16 and 23 (all Smilow)
Arrive in Boston: for the next phase of the overall CAR-T Cel therapy: January 13

I will stay in Boston from that date until 21 days after I receive the cells back (Day 0)(approximately January 20). However, they have warned that these dates are NOT set in stone and even mentioned that Dr. Munshi might want me to stay in Boston until 28 days after Day 0.

The Clinical Trial That Almost Wasn’t

On Tuesday afternoon, exactly one week before my leukapheresis, I got a phone call from my regular APRN at Dana Farber, Tina Flaherty. She told me that my M-spike was 2.06 and to be accepted into the study it needed to be 2.1. (A higher M-spike = more cancer.)

She told me to get another protein electrophoresis done at Smilow. They were also going to try and talk the pharmaceutical company into accepting me since it was so close and all of my numbers qualified me.

As an interesting point about these numbers, Dana Farber gives the results to the 100th decimal place, so the same test at the same time would have had me at 2.1 since they only report to the tenth decimal place.

So I found myself hoping that my cancer had gotten worse in the last week. I also was much more anxious about not having the treatment than having it.

While I waited for the results from Smilow (Alfredo my APRN there was really great about keeping in touch with me and telling me what they knew, etc.), I got a pre-op call on Thursday for the placement of my temporary line (placed Monday morning, out on Tuesday morning). One of the last questions she asked was who was driving me home after the procedure on Monday? I said, “What? I need to be driven home???” Because it’s a short visit and I was assured I would feel good enough to drive home on Tuesday I am traveling up myself. So just another wrench in the works. My final decision is to still go by myself, if I have time I’ll walk the mile to Brigham and Women’s Hospital and then Uber back to the hotel. Tuesday I’ll drive and park at Dana Farber.

Friday late morning I got a call that they had a verbal on my M-spike and it was 2.4 – yay? 🙂

I will get treatment (“bridging therapy”) at Smilow December 9th and the 16th, the same regimen I was just on (Carfilzomib, Cytoxan, and Dexamethasone).

Hope to get some actual dates for the rest of the CAR-T cell therapy on Tuesday.