HSCT in Moscow, Day by Day

Doesn’t time fly? It seems only yesterday that I was preparing to go to Moscow, yet tomorrow will be three weeks since my return.

I have written enough about my experiences at the A.A. Maximov center so, today, we’ll take a look at how HSCT progresses, step by step.

The following is reproduced from the Moscow clinic’s instruction schedule. I hope that you find it interesting.

Meals:

8.30 – 9am          Breakfast

12pm                     Second breakfast

2pm                       Lunch

6pm                       Dinner

Steps of Treatment

Stem cells stimulation – 4 days (sometimes 5-6 days, depending on the results of stem cell collections) in combination with infusion of steroids at 11am (1 dose – 200 ml liquid for 20-40 min).

Also, patient takes 1 antacid pill twice day 30 mins before food (before breakfast and before dinner).

G-CSF stimulation injections (subcutaneous) at 11 pm and 3 am.

Insertion of special catheter in neck for stem cell collection and chest X-ray control.

Collection of stem cells (for 1 or 2, sometimes 3 days), (we need to collect 2 or more million hematopoietic stem cells per kg of body weight) .

Removal of neck catheter and insertion of new catheter for chemotherapy and further treatment.

Chemotherapy (4 days).

1-2 days of rest (receiving only supportive medication infusions twice a day).

From the beginning of chemotherapy: patient takes oral medications 3 times a day (antiviral, antibacterial, antifungal, PPI gastro protection).

Pills for breakfast —  1 antacid pill before food. Other pills — after food. Pills for lunch — 1 pill after food. Pills for dinner — 1 antacid pill before food. Other pills — after food. Patient has additional oral medications on Mon, Wed, Fri — co-trimoxasole (2 white big pills — morning, evening). Patient has 2 supportive medication infusions in the evening.

Food Allowed during treatment: Most food from outside the hospital is suitable.

Foods to be Avoided during treatment: Fresh fish, e.g., sushi, raw meat, un-pasteurised milk or milk products, see note below. Fast food outlets, fresh vegetables and fruits.

Day of transplantation. Patient should avoid food after 12 pm on this day. Nurses Will clean and prepare room for transplantation.

Isolation. Patient should never leave the room. Patient should keep the glass door closed. Medical staff 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 solution for mouthwash (mix half of cup of red solution with cap of water). Patient should use provided clorhexidine solutions for washing body — big bottle for genital area and small for legs/arms/body. Our staff will change bedding and wash clothing every day.

A patient must inform medical staff immediately of any problems or changes in condition.

Food Allowed during Isolation: Tinned food, e.g., vegetables or tuna, Bread, Coffee, Tea, Dried fruit, Fruit Juice, Spices, herbs, Lollies/sweets, Nuts — roasted and salted. Processed food, e.g., muesli bars, packets of soup, noodles, Milk and Yoghurt conforming to hospital standards.

Food Restrictions during Isolation: Fresh vegetables and fruits, Milk and Yoghurt products that don ‘t conform to hospital standards. Raw nuts, toasted muesli — unless it is microwaved first – Fresh fish, e.g., sushi, raw meat.

Patient receives one infusion of Rituximab (for 5 hours) after recovery of leukocytes (1 or 2 days before discharge).

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