Non Hodgkin's Lymphoma


 János Czipri  

Autologous Peripheral Stem Cell Transplant May 2004

Preliminary to the Auto SCT, I had to have 2 lots of IVE Chemo and my own stem cells collected, so it took a lot longer than I anticipated.

I have had my Hickman line inserted under local anaesthetic, on 5th May 2004, and started the IVE Chemotherapy. (SCT day -76) This went on for 5 days non-stop, and then I had (Neupogen) Granulocyte-Colony Stimulating Factor injections for 5 days.

On top of the fluids being pumped into me, I also had to drink gallons of water, literally. They also wanted to know my fluid balance, so they measured every drop going in and coming out.

Granisetron, one of the anti-sickness drugs was responsible for my constipation of two days, so they have started me on Sodium Docusate & Henna, hoping for a bit of relief tomorrow.

For those interested, the IVE chemotherapy consists of:

Day 1. 
50 mgm/sq.m Epirubicin in 100 ml saline over 10 mins. 
200 mgm/sq.m Etoposide in 1000 ml saline over 2Hrs. 
1.8 gm/sq.m Mesna in 100ml saline over 10 mins. 
3.0 gm/sq.m Ifosamide in 1000 ml saline over 22Hrs. 
5.4 gm/sq.m Mesna together with the Ifosamide

Days 2 & 3. 
200 mgm/sq.m Etoposide in 1000 ml saline over 2Hrs. 
2.2 gm/sq.m Ifosamide in 1000 ml saline over 22Hrs. (70% of Normal Dose) 2.2 gm/sq.m Mesna in with the Ifosamide (70% of Normal Dose)

Day 4. 4.0 gm/sq.m Mesna in 1000 ml saline over 12Hrs

Other drugs in tablet or capsule form: 250 mgm Ciprofloxacin 2x daily. 50 mgm Fluconazole 1x daily. 200 mgm Acyclovir 4x daily. 1 mgm Granisetron 2x daily. 2 mgm Dexamethasone 2x daily. 300 mgm Allopurinol 1x @ night. 300 mgm Phenytoin 1x @ night.

Set-backs and Progress

After the constipation came the diarrhea, perhaps I shouldn't have had those laxatives after all. I started passing blood, so I had to go back to hospital for tests. Evidently I picked up some bacteria, so I have to take yet another antibiotic, 400mgm Metronidazole 3x a day for 7 days. Then they sent me home with some Codeine, which is not only a painkiller, it also helps to stop diarrhea.

After a few days at home I had to return to hospital for daily blood tests, to see if my White blood cell counts have reached a minimum level of 1.0 before they can start Stem Cell collection. In the meanwhile I had to give myself daily injections of 300 MU Neupogen, which is a Granulocyte-Colony Stimulating Factor, it helps to mobilize the Stem Cells.

After another three days the White blood cell counts have suddenly went up to 4.6 and we could go ahead with the Stem Cell harvest. (SCT day -63) They take blood from one arm of the Hickman line, pass it through a centrifuge, which separates the blood into various layers, it collects the Stem Cells and returns the rest back through the other arm of the Hickman line. It took about 4 hours, but we managed to collect 9 million Stem Cells per Kg body weight, a total of 720, 000, 000 Stem Cells! These are then frozen and ready for the transplant. I must say I was very pleased as some people have to return time and again to get the 5M/Kg, which is the minimum they like to go with.

I saw Dr Andy Haynes, my Haematologist, to find out the next plan of action. I am to have another IVE, to reduce the tumour burden even further. Then a CT-scan to make sure that we achieved a minimum of 50% reduction. If not, then I am in for a third IVE, if yes, then comes BEAM, which is the high dose chemo, to kill all the blood cells, followed by the actual transplant.

IVE - 2

It was all going so well! I was to have the second IVE, as soon as there was a hospital bed available. In the meantime, my Hickman Line needed a clean out, but as the nurse was doing the last flush, the line started to leak, a spurt going right up in the air, we sprung a leak. The doctor on duty said, that I would need a new Hickman Line putting in. So without much ado, he proceeded to give me a local and pulled the line out. I never felt a thing. The same day they put in my brand new Hickman Line, on the other side of chest, ready for my second IVE starting the next day. (SCT day -48)

The chemo was much the same as before, only this time I had the hiccups and some tummy ache, it wasn't until I got home that the stomach cramps started, still, I was only sick twice in the night.

I have got my appointment for the CT-scan for next week, and I am seeing the specialist the week after. I am just hoping that I won't need a third IVE, just the BEAM chemo, followed by the actual Stem Cell Transplant. It would still mean another 2 months, minimum before I could return to work.

My second IVE chemotherapy consisted of:

Day 1.

No Epirubicin! (I've reached my lifetime limit of Anthracycline drugs) 
200 mgm/sq.m Etoposide in 1000 ml saline over 2Hrs. 
1.8 gm/sq.m Mesna in 100ml saline over 10 mins. 
3.0 gm/sq.m Ifosamide in 1000 ml saline over 22Hrs. 
5.4 gm/sq.m Mesna together with the Ifosamide

Days 2, & 3.

200 mgm/sq.m Etoposide in 1000 ml saline over 2Hrs. 
1.8 gm/sq.m Mesna in 100ml saline over 10 mins. 
3.0 gm/sq.m Ifosamide in 1000 ml saline over 22Hrs. 
3.0 gm/sq.m Mesna together with the Ifosamide

Day 4.

4.0 gm/sq.m Mesna in 1000 ml saline over 12Hrs

Other drugs in tablet or capsule form, some for up to 2 weeks after the chemo:

Co-trimoxazole 2x 960 mgm twice a week Colistin 1.5 mgm 3x daily Ciprofloxacin 250 mgm 2x daily. Itraconazole 100 mgm 2x daily. Acyclovir 200 mgm 4x daily. Granisetron 1 mgm 2x daily. Dexamethasone 2 mgm 2x daily. Allopurinol 300 mgm 1x @ night, for 2 nights Phenytoin 300 mgm 1x @ night, for 1 night.


The CT-scan showed that the tumours have shrunk by more than 50%, so I don't have to have a third IVE. Hurrah !!! As soon as there is a bed available they are going to give me the high dose chemo, BEAM, which takes about 4 days, then there will be 1-day rest, followed by the return of my stem cells. I will probably have to have 1 week in isolation, before being allowed home. They usually recommend 3 months of rest before returning to work. The immune system needs that long to recover. The last thing I would want is to catch something nasty like chicken pox!

I am just hoping that the bed will available sooner than the 2 months they said, I would have to wait.

The Transplant

Well, I have had the Autologous Peripheral Stem Cell Transplant and everything is going well. It wasn't as bad as I expected, but it was a pretty uncomfortable few weeks.

I got the appointment for the 14th of July, but as they didn't have a bed available, I didn't get to start the treatment until the following day. (SCT day -6) The BEAM chemo started with 582 mgm BCNU (Carmustine) over 2 hours, then each of the following 4 days I had 2x 388 mgm Ara-C (Cytarabine) and 388 mgm Etoposide. On the 6th day it was 276 mgm of Melphalan, this causes problems in the mouth, so for the 10 mins it took for the infusion, I had to suck ice! I did have anti-sickness IV so I was not physically sick. Also everyday I was given 2 lots of antibiotics, intravenously.

Wednesday, 21st of July (SCT day 0) is a red-letter day, it was then that I had my Stem Cells put back. I had blood tests every day to monitor the Neutrophils, which eventually went down to zero. That was the most anxious time, hoping that they will start to rise again, luckily they did, or I wouldn't be here to tell you about it.

I did have to have 2 blood transfusion and some platelets. On (SCT day 4), my temperature started to go up, so I had to have more IV antibiotics, but then they decided, that it must be a fungal infection which causing the temperature, so I had an IV drug called Abelet. (SCT day 4) This gave me violent shakes, which they managed to control with Pirtion, but not for 15 mins, during which I was shaking so much, that I thought my head would come off! So the next day when I had to have some more Abelet, they gave me the Pirtion beforehand to prevent the shakes. It didn't work, it was even worse than before, so I refused to have any more of the stuff. Instead they put me on another anti-fungal drug, called Variconazole, which gave me hallucinations, you can't win!

When they stopped giving me all those nasties, my temperature promptly returned to normal, marvelous. (SCT day 12) my blood counts reached the necessary minimum values, so I was allowed to go home. There are still a few niggly things, like diarrhea, swollen ankles, ruined taste buds and low appetite, but I am sure that in another week or so, things will be almost back to normal.

I am just hoping that all this was worth it and I am going to get the promised 5 years of remission!

Other drugs used during SCT:

Ciprofloxacin, 2x 250 mgm - oral Itraconazole, 2x 100 mgm - oral Aciclovir, 4x 200 mgm - oral Colistin, 3x 1.5 mu - oral Maxalon, 3x 10 mgm - oral Lanzoprazol, 1x 30 mgm - oral Sucralfate, 3x 1gm - oral GCSF, 1x 100 mgm - injection Meropenem, 3x 1gm - oral Vancomycin 1x 1gm - oral Amiloride, 1x 10 mgm - oral Granisteron, 1mgm - IV

János - August 2004



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