Department of Hematology and Cellular Therapy

STAGES
OF
TREATMENT

(AHSCT)
Duration of stages
Day 1-4
Day 1-4
Examination and final decision
Day 5-8
Day 5-8
Stem Cell Mobilization

Day 8-9
Day 8-9
Stem Cell Harvesting
Day 9-12
Day 9-12
High Dose Immunosuppression
Day 13
Day 13
Stem Cell Reinfusion
Day 14-27
Day 14-27
Hematological & Immunological Recovery - Isolation
Day 29-30
Day 29-30
MoAb-Rituximab And Discharge
Day 30 - 365
Day 30 - 365
Rehabilitation + Consolidation treatment for high risk group

1
Stem cells stimulation
Stem cells stimulation - 4 days (sometimes 5-6 days, depending on the results of stem cell collection).
Granulocyte-colony stimulating factor (G-CSF) 10 µg/kg.b.w./day
(2 subcutaneous injections 11 pm and 3 am) in combination with steroid infusion (Methylprednisolone 500 mg) at 10am-11am (200 ml liquid for 20-40 min intravenous infusion).
Also patient takes one antacid pill twice a day 30 mins before food (before breakfast and before dinner).
The most common side effects are:
  • Bone pain
  • Headache
  • Bad sleep
  • Fever and other flu-like symptoms

2
Dialysis insertion
Insertion of special central venous catheter (dialysis) in external jugular or subclavian vein under ultrasound control for stem cell collection.

Then chest X-ray control of catheter position.

3
Harvesting of stem cells
Collection of stem cells (1-3 days).
To rebuild immune system, we need to collect more than 2 million hematopoietic stem cells per kg of body weight (>2 x 106/kg/b.w. CD34+ HSC).
Stem cells collection (harvesting) takes 5-6 hours (7-8 am – 1-2 pm).
Autologous stem cell harvesting is performed by Haemonetics MCS+ multicomponent collections system or Spectra Optia Apheresis System.

4
Removing dialysis
Removing of dialysis catheter and insertion of new ordinary triple-lumen catheter in external jugular or subclavian vein under ultrasound control for chemotherapy and further treatment.

5
Chemotherapy
Chemotherapy passes within 4 days
+ 1 for vacation
Duration of pre-transplantation period (scheme #2)
Chemotherapy
The main morning infusion of Cyclophosphamide with supportive medicine and hydration (3 L of normal saline) takes 3 h (usually 10 am – 1 pm).

Second and third infusions (mesna uroprotection, nausea prophylaxis)
– in 4 and 8 hours after the first one.

From 1 st day of chemotherapy we start antiviral,
antibacterial and antifungal prophylaxis:
  • Ciprofloxacin 1000 mg/d
  • Fluconazole 200 mg/d
  • Aciclovire 1200 mg/d
  • Co-trimoxazole (Bactrim) 960 mg/d
The most common side effects is:
  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation
  • Oropharyngeal mucositis
  • Alopecia
  • Pancytopenia (low leucocytes, hemoglobin)
  • Hemorrhagic cystitis
  • Fever
TRANSPLANTATION DAY
  • After finishing chemotherapy, we start stem cell infusion at 1pm and finish at 3 pm.
  • We recommend not to have meals after midday (12 pm), you can drink as much as you want.
  • We remove the cryopreservation bags individually from liquid nitrogen and place them immediately in the water bath and thaw it.
  • When thawed (-2-3 minutes), we infuse it as quickly as possible
  • Together with stem cells, we give fluids (3-4 L of saline), antihistamine, steroids and other symptomatic medications as needed.
  • Also, we monitor heart rate (ECG), blood pressure, respirations, body temperature.
  • Another side effects are pungent/tomato taste and smell, red-stained urine.
  • We ask to urinate in special bag to assess a color of urine after stem cell reinfusion.

Possible adverse reactions:
  • Nausea
  • Coughing
  • Vomiting
  • Flushing
  • Fever
  • Dyspnea
  • Chills
  • High or low blood pressure
  • Allergy
  • Low or rapid ventricular rate

6
Isolation period
  • Patient should never leave the room.
  • Patient should keep the door clos will clean the room every day.
  • Patient's suitcases will be removed.
  • Patient should heat up food (approx. 10-20 seconds) in the microwave before consuming.
  • Patient should use a special for mouthwash (mix half of cup of red solution with cap of water).
  • Patient should use provided chlorhexidine solutions for washing body – alcohol-containing for legs/arms/body, water-based - for genital area and head.
  • Our staff will change bedding and wash clothing every day
    Rehabilitation of immunne system
    A patient must inform medical staff immediately of any problems or changes in condition.
    We monitor blood pressure, heart rate, body temperature 3 times a day.
    Patient usually has supportive infusions – natrium saline, electrolytes, low-dose dexamethasone twice a day, G CSF (subcutaneous shot, once a day at 3 pm) to decrease length of neutropenic phase.
    Additionally, we can use intravenous antibacterial, antivirus, antifungal medications when needed.
    We provide blood component transfusion when hemoglobin or platelet level is too low (Hb<80 g/L, Plt< 20 x 109/L).
    Patient has 5h Rituximab infusion on D+10-D+12.

    AFTER HSCT TREATMENT

    WE RECOMMEND
    To avoid contacts with sick people
      • Like flu or chicken pox.
      • There are no special restrictions for sexual life if partner is healthy.
      • We recommend to use contraception during year after AHSCT
        To wear mask in public places
          • To wear mask during first 3 months in public or crowded places (arriving/departure areas, supermarkets, metro etc.)
          • There is no risk to be in contact with pets if they are healthy
          • There is no risk to be in contact with family members if they are health
            Avoid vaccinations
            In vast majority of cases we don't recommend vaccinations
            • Antiviral
            • Antibacterial
            • Antifungal prophylaxis after lymphoablative protoco.
            Patient immune system has memory, additional vaccination can cause relapse of autoimmune process.

            Health monitoring
            Monitoring of blood tests:
            • total blood count
            • biochemistry screening - serum urea
            • electrolytes
            • creatinine
            • calcium
            • uric acid
            • blood sugar
            • Liver function tests
            • C reactive protein
            Monitoring temperature of body
            • To monitor body temperature every evening during 1 month.
            • In case of any signs of infection patient must go to hospital.
            • No matter with or without high temperature (>37.5C)
            • Fever without signs of infection - patient must go to hospital
            Posttransplant rehabilitation
              • GP (or hematologist) examination in 2 and 4 weeks after the disсharge.
              • Observation of neurologist or rehabilitation doctor physiotherapist.
              • Public places like public swimming pools, gyms, health centers
                Food restrictions
                We recommend to be careful with fast food, to avoid raw fish, meat (sushi, carpaccio
                etc) within the next 3 months after discharge.
                • Fresh fruit and vegetables, milk products are available.
                • All food supplements, vitamins which patient used before are available
                  SPECIAL THANKS TO ALEX GREEN!
                  This is probably a terrible violation, that we have placed in our boring description such cool and stunning reportage videos from Alex...

                  But we just couldn't resist as they are filled with amazing humor, intelligence and objectivity at the same time.

                  We believe that his courage, willpower and vision will help many people to take a step towards to a better life.

                  Alex you are the best!!!


                  Sincerely yours,
                  AHSCT RUSSIA Team.
                  Link to the page with the full story of Alex's journey for HSCT to Russia
                  Anastasia Panchenko
                  Administrator of the Department of Hematology and Cellular Therapy
                  Moscow, Russia

                  Hi, Alex, How are you?
                  Would you mind if we put your story on the website?
                  Alex Green
                  The author and the main character of HSCT journey to Russia "Let'sGetRid.com"
                  Leatherhead, England

                  Hey Anastasia,

                  I'm really well thank you - as always now! It was great to see you and Dr.F in Birmingham, both looking so well.

                  Thank you for your message, my friend told me about the page - it was absolutely amazing to see, I'm so pleased that see my video and story as something worth using.

                  Honestly it means so much to me - you're more than welcome.

                  And I promise to finally (!!!) update it with how I'm doing now. 😉

                  Thank you the kind words at the end of the page, they really made Jen & I smile.

                  (and it's absolutely not a violation, do feel free to use everything. It's the very least I can do for you all)

                  Forever grateful x