What changed What changed my life…my life…

By: Stephane BartonBy: Stephane Barton

Friday: June 17, 2005Friday: June 17, 2005 Saw my primary physician a couple Saw my primary physician a couple

weeks priorweeks prior Blood tests abnormalBlood tests abnormal

Inflammation in the body extremely highInflammation in the body extremely high Had a weird coughHad a weird cough

Went for a chest X-rayWent for a chest X-ray Called back less than 30min after I had Called back less than 30min after I had

left the Radiology officeleft the Radiology office CAT/CT ScansCAT/CT Scans

Emotions…20 years old & Emotions…20 years old & have Cancer…what??!!have Cancer…what??!!

Wondering why me…Wondering why me… This cannot happen to This cannot happen to

me…me… This is not real…This is not real… Your life is ending…Your life is ending… What is going to happen…What is going to happen… How do I tell people…How do I tell people… Lots of crying…Lots of crying…

Monday: June 20, 2005Monday: June 20, 2005 Doctor’s appointment with an Doctor’s appointment with an

Oncology doctorOncology doctor Bone marrow biopsyBone marrow biopsy

Negative…cancer not in bone marrow Negative…cancer not in bone marrow Talked about what will happen with Talked about what will happen with

treatmenttreatment CT ScansCT Scans PET Scan scheduledPET Scan scheduled

MD AndersonMD Anderson Went to Houston, Texas for a second Went to Houston, Texas for a second

opinionopinion Met with a team of doctors who Met with a team of doctors who

reviewed by conditionreviewed by condition Again given choices & different types Again given choices & different types

of treatments to think aboutof treatments to think about Deciding if I would receive treatment Deciding if I would receive treatment

either in Houston, Texas or in either in Houston, Texas or in Charleston, South CarolinaCharleston, South Carolina

Official Diagnosis…Official Diagnosis…

Hodgkin’s LymphomaHodgkin’s Lymphoma

[Hodgkin’s Disease][Hodgkin’s Disease]

Stage 3 advancedStage 3 advanced

Inflamed lymph nodes in the neck, Inflamed lymph nodes in the neck, chest, & abdomenchest, & abdomen

ABVD TreatmentABVD Treatment

8 cycles…16 treatments every other 8 cycles…16 treatments every other ThursdayThursday 1 cycle is 2 treatments over a 4 week 1 cycle is 2 treatments over a 4 week

periodperiod Adriamycin, Bleomycin, Vinblastine, Adriamycin, Bleomycin, Vinblastine,

& Dacarbazine& Dacarbazine

ChemotherapyChemotherapy First couple of treatments the First couple of treatments the

chemotherapy was given through an IVchemotherapy was given through an IV Doctors wanted the inflammation of the Doctors wanted the inflammation of the

lymph nodes in my chest to go down lymph nodes in my chest to go down before an internal port was putbefore an internal port was put

10AM Pulmonary Function Test10AM Pulmonary Function Test 11AM-5PM Chemotherapy started with 11AM-5PM Chemotherapy started with

an hour of hydration and pre-medicine an hour of hydration and pre-medicine to help me relax & go to sleepto help me relax & go to sleep

After ABVDAfter ABVD Not in complete RemissionNot in complete Remission Had maximum treatments of ABVD Had maximum treatments of ABVD

chemotherapychemotherapy Radiation would not benefit meRadiation would not benefit me My doctors decided an Autologous My doctors decided an Autologous

Bone Marrow / Stem Cell Transplant Bone Marrow / Stem Cell Transplant would be the next stepwould be the next step

Again had to decide if the treatment Again had to decide if the treatment would be given in Houston, Texas or would be given in Houston, Texas or Charleston, South Carolina Charleston, South Carolina

Bone Marrow Bone Marrow Transplant Transplant

ProcessProcess

Medical University of South Medical University of South CarolinaCarolina

Hollings Cancer CenterHollings Cancer Center

Charleston, South CarolinaCharleston, South Carolina

OutlineOutline PreparationPreparation Phase I: Collection [Hemapheresis]Phase I: Collection [Hemapheresis] Phase II: High Dose ChemotherapyPhase II: High Dose Chemotherapy

TransplantTransplant Phase III: EngraftmentPhase III: Engraftment Phase IV: RecoveryPhase IV: Recovery

PreparationPreparationStatus: Inpatient & Outpatient

Process: 1. “Ice” – normally 2-4 Cycles of Chemotherapy

•I only needed 2 cyclesEnd-state – no active cancer cells

2. Tests – CT Scan, PET, Blood Tests, Bone Marrow Biopsy, EKG, & Pulmonary Function Test

3. Clinical and hospital orientation4. Comprehensive training with pharmacy team

on drugs5. Instructions on at home administration of IV’s &

injections6. Orientation on stages & time line of procedures7. Review of all medical forms and agreements8. Surgical procedure for transfer from internal

port to central venous catheter

Phase I: Collection Phase I: Collection [Hemapheresis][Hemapheresis]

Status: Outpatient

About 3 weeks

Process:1. Cytoxan infusion with pre & post IV hydration2. GCSF & GMCSF injections3. Oral medications started4. Pheresis [Harvest]

•May 30, 20065. Tests – CT Scans, Blood Tests

Complications:1. Possible infections at site of port &/or line2. Blood clot found at site of port, began Lovenox

injections

Phase II: High Dose Phase II: High Dose Chemotherapy [HDC] & Chemotherapy [HDC] &

TransplantTransplantStatus: Inpatient

About 7 days

Process: 1. Kepivance – IV medication for prevention of ulcers

• Dosage over 3 days2. Chemotherapy – several mixes of highly potent drugs

• BCNC, VP16, ARAC, & Melphalan over 6 days3. Transplant [2nd Birthday for every cancer patient!]

Complications:1. High state of protection from outside elements2. Close watch for high or low blood pressure and heart issues3. Critical blood cell counts continue to fall

Phase III: EngraftmentPhase III: EngraftmentStatus: Inpatient & Outpatient

About 2 weeks

Process: 1. Kepivance – Continued from pre-transplant• Dosage – 3 days

2. Continuous oral & IV antibiotics3. Daily blood counts & profiles4. Hourly vitals while inpatient5. GCSF injection – resumes to stimulate cell

growth• Day +7

6. Blood thinner injections - Lovenox

Phase III cont’d.Phase III cont’d.Complications

1. High state of protection from outside elements 2. Ulcers in throat3. No appetite/severe weight loss4. Spiking fevers 5. Administration of critical pain drugs

6. Need for transfusions of whole blood & platelets

7. Hair lost for 3rd time

 WBC

(K/CUMM) Hemoglobin (GM/DL)Platelet

(K/CUMM)

Normal Range 4.800 - 10.800 12.0 - 16.0 140-440

30-Jun 1.840 10.2 117

1-Jul 1.270 10.6 83

2-Jul 0.850 9.5 54

3-Jul 0.290 8.7 34

4-Jul 0.120 9.8 28

5-Jul 0.050    

6-Jul* 0.060 10.0 28

7-Jul 0.050 9.6 34

11-Jul 0.540 3.300 25

14-Jul 1.310 3.800 19

17-Jul 1.270 3.630 20

20-Jul 1.900 3.350 29

24-Jul 2.000 3.460 22

27-Jul 3.130 3.010 16

30-Jul 4.130 3.360 20

2-Aug 5.840 3.170 29

4-Aug* 7.060 3.090 25

8-Aug 1.510 2.810 32

21-Aug 4.600 3.200 52

WBC (K/CUMM)

0.0001.0002.0003.0004.0005.0006.0007.0008.000

30-Ju

n1-J

ul2-J

ul3-J

ul4-J

ul5-J

ul6-J

ul* 7-Jul

11-Ju

l14

-Jul

17-Ju

l20

-Jul

24-Ju

l27

-Jul

30-Ju

l2-A

ug4-A

ug*

8-Aug

21-A

ug

dates

coun

t

Phase IV: RecoveryPhase IV: RecoveryStatus: Outpatient

At least 5 years or as needed

Process: 1. Routine physical exams2. CT Scans, PET Scans

If needed:1. Transfusions of whole blood &

platelets…only irradiated blood products