Wednesday, December 19, 2012

A Second Birth Day: Stem Cell Transplant

The nurses on the BMT floor wished Esther another happy birthday today. The chemo she received this last week is marrow-ablative. That basically means it completely destroys her marrow. She would likely never recover from this sort of treatment because her body's ability to make basic cells is gone. Her body's ability to create cells was birthed today. For kids (and adults) who receive stem cells or marrow from another person, it really is new life. Their DNA is altered as their basic cell building functions is now run by the DNA of another person. This all still amazes me.

Esther's transplant went well and was for the most part uneventful. Her cells came up out of the liquid nitrogen, frosted. They went straight into a special bath that brought them up to body temperature.

The bag was tiny, my iPhone is bigger than bag and volume in the bag was just 10mL. That is just two teaspoons! In those two little teaspoons were MILLIONS of cells.

The tech from the BMT primed (pre filled the tubing so there is no air in the line when the line is hooked up to the patient) tubing with the cells. The little bit filled the entire line of tubing.

Esther's nurse was busy prepping for this 10mL infusion all morning. She brought in a computer, hooked Esther up to the monitors, and spent a fair amount of time preparing the pumps and tubing for the transfusion. With such a small volume, even just a few drops contain a significant amount of cells, so any amount lost in the tubing can add up to a large loss of cells.

One of the portions of her set up was this syringe. On one end it was connected to the bag of stem cells and the other direction went to Esther. This allowed her to pull the cells from the bag into the syringe and then she could know exactly what volume was drawn from the bag and then put back into Esther's body.

Esther's nurse was again Rebecca. She did a great job! Here she is pulling the cells into the syringe.

Next the syringe was hooked up to a pump and the first bulk of cells were administered to Esther over about 30 minutes.
After the initial infusion of cells, Rebecca pulled saline from a third line on this syringe in order to "rinse" the bag and tubing and then infused those cells and saline over an hour. She then rinsed the bag two more times. The second and third rinse were faster because she could just push the saline in. The idea is to not leave any cells in the bag or tubing.

There was one hiccup. Sometimes in the freezing and thawing process, platelets in the collection will clot and form a particulate in the cells. There is a filter in the bag, but they got passed the filter and went into the syringe. This made it all tricky because it wouldn't be good to infuse a glob of clotted platelets into Esther's body. She did a great job of managing this booger floating in the cells and saline and was able to get all of the cells and trap the glob at the very end. They sent the tubing, bag, syringe, and glob back down to the lab to verify the suspicion it was indeed platelets. You can see the glob at the bottom part of the syringe directly above my thumb.

Rebecca suggested we name the booger. Esther decided to name it "Carla." Carla is also the name of a nurse here whom Esther loves. What a silly girl!

Stem cell transplant complete!

Esther handled everything so well today! There is a preservative that protects the cells during the freezing process. This preservative causes Esther to emit an odor reminiscent of creamed corn, but maybe that creamed corn has sat out a bit too long. It should go away in a day or two, but for now, Esther is quite stinky. You can smell it as you open her door, quite strange.

Praise God for this day and science that is able to treat this cancer! As I was talking with Esther's nurse today, she mentioned that when we first became an oncology nurse over 8 years ago, it was not common for families to choose to not treat neuroblastoma because the survival rate was so poor. In that time, leaps have been made to give these kids a chance and stem cell transplant is one of those big leaps!

Now the job of the cells is to find the empty places where Esther's marrow once lived, engraft there, and begin to create the basic building blocks of physical life, red and white blood cells and platelets. Thank you for praying. I also heard of people fasting yesterday and today, thank you for loving Esther in this was committing yourself to prayer. We are thankful.



  1. Esther just kicking it in bed holding the giant syringe is a great picture!!

    Glad the transplant cells went through! I'm praying that they do their new jobs well! :)

    Man, you guys should save all these blogs posts for her because she could write a wicked paper on Stem / Bone Marrow Cell Transplants for biology class someday....

    Just saying!

  2. So good to see you for a minute. Praise the Lord for her transplant going so well. We will be praying as her body reboots itself. No bugs and lots of cells! We are praying this leg of the journey continues to go well. The end is still far away but each day it draws nearer. Blessings to you all!

  3. Wow, isn't medical technology amazing? I'm just in awe at how this is all figured out and that is can actually heal your sweet baby girl (and may other people too). And such a small about to boot. Praying it all goes smoothly as you rest in the Lord.