Multiple myeloma can be treated with different chemotherapy regimens. A treatment, known as Arkansas treatment, includes an autologous stem cell transplant. “Autologous” means that they collect the patient’s own stem cells before the final cycle of chemotherapy. They then return these stem cells to the patient after a high dose of drugs is given during the final cycle of chemotherapy. Unlike bone marrow or stem cell transplants that require a donor’s marrow or stem cells to match those of the patient, an autologous transplant is not required. They collect the patient’s own stem cells that are eliminated from the body and from the effects of high-dose anticancer drugs. Because they have been collected, extracted, and stored, stem cells are not present in the body during the administration of high doses of drugs. When high-dose drugs are no longer a danger to good blood cells (usually about 48 hours later), the stem cells can return to the patient’s body, where they can resume their normal functions and produce new blood cells.
After the chemotherapy week of the third cycle (the planned time for this procedure), the patient must visit the cancer clinic daily. Since the goal is to perform this entire procedure on an outpatient basis, the patient may be required to move to a hotel room near the cancer clinic. This allows the patient to remain relatively isolated from other people during a period when their blood counts (and immune system) are particularly low and allows them to live close to the clinic. It is very convenient and usually much, much less expensive than a hospital stay.
The actual collection process usually takes place at a local hospital, but all preparatory steps can be done at an appropriate cancer clinic. All of the procedures discussed in this article are performed on an outpatient basis. Collection generally takes place during daylight hours at the hospital, so patients can return to their homes or hotel rooms at night.
For the Arkansas Treatment, chemotherapy cycles are generally scheduled one month apart; it depends on the patient. In the Arkansas Treatment, chemotherapy occurs over the course of a full week. During the second week, fluids are given as needed and an office visit with the oncologist is scheduled. The third and fourth weeks are expected to be the patient’s recovery time before the next cycle begins.
When doctors decide that it is time to collect stem cells from a patient, some changes will be made to the chemotherapy routine. The first week of chemotherapy, when the various drugs are administered, remains the same. Depending on the chemotherapy drugs administered, portable pumps can be connected to the patient’s port to provide chemotherapy 24 hours a day from noon Monday to noon Friday. After the first week of the chemotherapy cycle in which stem cells must be collected, the schedule is different. On Monday of the second week, the patient should generally report to the cancer clinic (or hospital) every day. During these visits, nurses monitor blood counts (which will generally be quite low) and administer injections of a drug that stimulates the body to produce stem cells. The drug they use to stimulate the body to make more stem cells also stimulates the entry of new cells into the bloodstream. Injections of that medicine are given every day until the collection is complete.
During this second week, the patient may not spend much time in the clinic. The nurses will test the patient’s blood; provide appropriate fluids as needed; give the injections to stimulate the production of stem cells; and send the patient back to their hotel room to rest. Staying isolated in a hotel room minimizes the chances of getting an infection from a sick person (which could easily happen in a hospital). This week you can spend a lot of time lying down watching TV, sleeping and doing almost nothing.
Before the collection process, the white blood cell count must exceed a certain threshold value, and then when the white blood cell count is correct, the number of stem cells in the bloodstream must also exceed another threshold value. They usually plan for the collection to start on Tuesday of the third week of the chemotherapy cycle. The day before the collection begins, they will collect blood samples and, if the white blood cell count is good, they will collect an extra vial of blood. This extra vial will be sent to the local blood bank to count the number of stem cells present. If the count is high enough, the patient will be instructed to report the next morning to the designated collection room at the designated collection facility (usually a local hospital).
Arriving at the stem cell collection room early in the morning, staff must first insert an appropriately sized central venous catheter. This usually takes place in an operating room and the insertion is done by a doctor. After insertion of the catheter (a relatively short procedure), the patient will be returned to the collection room and connected to a stem cell collection machine. They generally collect stem cells from early in the morning until about 3 in the afternoon. If more pickups are needed, they will continue the next day.
During stem cell collection, the patient will be confined to a bed in the collection room. The patient can eat, sleep, read, watch television, listen to the radio, work on the computer, etc. The only requirement is that the patient remain in the immediate vicinity of the collection machine, which means that the patient is generally confined to bed. Usually this makes for a comfortable and relaxed day. Depending on how many stem cells are collected during that day, the patient may receive another injection to encourage the body to produce more stem cells, and will be scheduled to return to the collection room the following morning. Collection can continue for 5 days, at which point the central venous catheter must be removed. It is a temporary insertion, valid for a maximum of 5 days. So it is possible that patients can spend five days in the collection room attached to the continuous centrifuge that separates the stem cells from the rest of the blood.
The machine used to collect the stem cells is a continuous centrifuge. Stem cells are small and lightweight, so they float to the top when they are spun in a centrifuge. This allows them to be separated and collected easily. The inlet line to the machine is connected to a lumen of the patient’s central venous catheter. After the blood passes through the continuous centrifuge and the stem cells are separated and collected, the remaining blood flows through a heater to heat it to the appropriate temperature and is then returned to the patient through a second lumen in the central venous catheter.
At the end of the day, all the collected stem cells are sent to the local blood bank where they are analyzed and counted, mixed with preservatives, and stored (frozen). The goal is usually to collect 10 million stem cells, enough for two transplants of 5 million each. Some patients only need to spend one day collecting stem cells. Others spend the entire five days collecting stem cells. It depends on the patient. After the collection of the stem cells, the central venous catheter will be removed and the patient will be discharged to leave the hotel and return home.
Experience has shown that the patient can spend little more than a week in a hotel room near the cancer clinic. It will be conveniently located and will generally be a two bedroom suite so that a caregiver can monitor the patient. Since this is a relatively complicated procedure and the body must cooperate with various medications, as well as produce a large number of stem cells AND expel them into the bloodstream, there are many complications that can prolong the collection process or prevent it completely. The process described in this article is typical of the stem cell collection process that is part of the Arkansas Treatment for Multiple Myeloma. Every patient is different, but for this treatment process, this article describes the planned schedule of events and the planned set of results. Although actual results may differ, the events and processes just described are typical.
