When is the ideal time to collect stem cells?

[Music] what's involved in the stem-cell collection process so patients need to get certain you know blood tests done get their hearts and lungs checked out through echocardiograms and lung function tests to kind of meet the basic requirements of going through a stem-cell transplant once they've gone through that process and you know we have a thumbs up from their respective insurance companies as well there's generally a central line place you know it's it's usually an upper body central line which will be utilized for the stem-cell collection process you know in the old days of the bone marrow transplantation we actually did go to the operating room and take a leader of your bone marrow then we would do the chemotherapy and give you back your bone marrow we called it a bone marrow transplant but actually now the correct terminology is the hematopoietic stem cell transplant and the reason for that is that we learned that we don't need the entire bone marrow to restore your bone marrow we actually just need the stem cells that live in your bone marrow and so we've learned how to stimulate those cells in the bone marrow with these drugs called growth factors or granite-like colony-stimulating factors or g-csf also called granik's also called neupogen these cells will actually lead to the the cells to divide and eventually leave the bone marrow and that may be sufficient to actually then start collecting the cells but in many patients if you want to collect especially for two transplants often that's not sufficient and we give a second drug called cleric safor which actually basically removes the anchor of the stem cells in the bone marrow and allows them to float away into the blood and so we're basically pushing the cells out into the into the bloodstream so that we can then collect them through the through a catheter through the peripheral blood who administers the growth factor shots so that actually depends on payer issues it can be performed by the patient it can be performed by a caregiver it can be performed at physician's office and oftentimes this is related to reimbursements whether or not the neupogen can be supplied to the patient directly or needs to be administered in the physician's office when you have a certain sufficient number of cd34 cells in the bloodstream and you've made calculations that alright if the cd34 counts get to this number I would be able to collect this many amount of stem cells that's when you bring patients in to the a Freese's Center and that central line is hooked up to an ephah rhesus machine which functions very much like a hemodialysis machine the actual collection process is performed on something called the phoresis machine which is basically a machine where blood from the patient is removed it's circulated through tubes without actually touching the machine but through sterile tubes inside the Machine there's a centrifugation process where the white cells or the wood that contain the stem cell population are removed and the blood is returned back to the patient then that type of procedure typically takes three to four hours a day and generally patients can collect sufficient stem cells anywhere between one and five consecutive days of this type of phoresis procedure so the blood flows through that machine the Machine plucks out the stem cells and stores them away in the bag and then once that process is done the stem cell processing lab processes those stem cells and freezes those bags for future use and those stem cells can be used five 10 15 20 years from now given how the process is nowadays then we wait for another week or 10 days and patients are brought in to either the hospital or in the outpatient setting to get high-dose melphalan and then a day later they get parts of their stem cells or you know that we have been collected back so that's that's you know how the whole process kind of flows how many stem cells are collected that is a very good question and that's something that you should ask normally there is a minimum number of stem cells that is required to restore your bone marrow function after a transplant and that's usually about two million cells most of us like to give a little bit of a cushion in case not all of the cells are perfectly viable so we tend to give at least a three to five million cells and that is for one transplant myeloma is the one disease where sometimes a second transplant is helpful both a following immediately following the first transplant and called that tandem transplants or perhaps in the future at a time of relapse and so for the most part you should be collecting for at least two transplants why might I be asked to choose tums during my son's the harvest so when you are harvesting as your blood is going through all this tubing in through all you know all through the Machine the collection process you will actually lose a lot of electrolytes calcium and magnesium and potassium and so the the phoresis nurses will be replacing you to prevent you from having you know cramping and sort of tetiny and all these uncomfortable things that you can experience because of the loss of those electrolytes so tums of course being giving you calcium back [Music]