“Knowing a great deal is not the same as being smart; intelligence is not information alone but also judgment, the manner in which information is collected and used.” – Dr. Carl Sagan
Don’t you just LOVE how there are at least two names for every drug you are on! ARGH!
- aka Filgrastim
- aka G-CSF
- aka growth factor shots
Ok, so Sarah asked me some questions this morning about this as her hubby is getting ready to get ready to begin the stem cell collection process.
“Are Neupogen® shots painful?”
Filgrastim is a human granulocyte colony-stimulating factor (G-CSF) – Patient Information .pdf
It is used to facilitate a couple of things when being treated for Multiple Myeloma and utilizing Stem Cell Transplant to treat. Your first introduction to it will most likely be in the leading up to collecting your own stem cells. You will receive chemotherapy to attempt to kill and beat down the MM in your bone marrow as much as possible. This will take your immune system down to dangerous levels of non-existence. When that happens Neupogen® is used to bring your stem cells back up to fighting levels by using this growth factor to help to stimulate an accelerated production of your white blood cells first to help you be able to fight modest infections that you might have to contend with. When they are using them to simply bring you up to a higher level of white blood cells it is one shot a day generally. When you are in the collection process it will be two a day, generally. Each facility may be a little different, and I can only address it from what I’ve learned having gone through it with Dave in Little Rock and then what I have heard from others in other places.
So in terms of collection, what is happening and what can you expect?
Well they are trying to build up enough of your stem cells in your bone marrow, starting from near zero, that are not infiltrated with Myeloma. And they want to get you producing them in large numbers and very quickly. The shots hurt, unless you have a patient, experienced, nurse, who understands that the slower she goes the less burning you will feel. So if it is really painful, it does not have to be, and you should tell the nurse to slow down as it is hurting. If he/she doesn’t comply, get a different nurse. It is a very slow process to get a painless shot, and you can imagine its not fun for them to bend over and take a L-O-N-G time to push the plunger in. But you should insist.
Typically they give them in your belly and you WILL end up with one big black and blue belly by the time all is said and done.
Then what? Well, they will keep giving you two a day shots until you are “ready to collect”. This occurs when your WBC gets up over 2.0 and then they will begin to run a “pro-COUNT” test CD-34 on your labs. This is an assessment run on your blood that is collected on a given day in the lab when they decide you might be ready. They are visually estimating through a microscope how many stem cells are running around your blood stream available for them to grab. They are looking for tens of thousands of stem cells in your blood to extract. So they won’t do this assessment until your WBC begins to get back up over 2.0 and then they will check everyday. They won’t stop giving you the growth factor shots until you are sent for collection.
When your stem cells are building up in the bone marrow and spilling out into the blood stream at a magnitude that is now ready for collection of millions of stem cells from your blood, you can experience some mild to serious bone pain. As I understand the mechanism, in my lay terms, they are multiplying like crazy in your bone marrow and when it gets crowded they spill out into the blood stream. As that is occurring it can cause some aching in your bones of some significance. I liken it a little to a woman’s first birthing experience. You have read all the books, taken all the classes, but you don’t know exactly what it will feel like, how it will present for you and to what level of pain it will go. So when you suddenly find yourself or your loved one in a lot of bone pain, its easy to forget that is exactly what is supposed to happen and its good news.
Dave was sitting in the lounge chair and he just started writhing around, trying to get comfortable, I noticed he was grimacing and I said, “Are you OK?” He was lifting his pelvic up off the chair with his arms trying to find a better position. Finally he started to get scared as the pain intensified and the aching moved up into his torso, back, shoulders. It was over a few hours. I said, “I’m pretty sure its from the shots Dave, you are probably ready to collect your stem cells.” He wanted me to call the hotline, so I did and yep, that’s what it was and it is good news, take some more pain meds, get as comfortable as you can and come in early tomorrow. So we did.
Once the collection starts (apheresis), the bone pain goes away almost immediately for most people. It’s sort of like the steam valve on a tea kettle opening wide and letting all the steam out. When they hook you up to the arcane looking mechanical contraption, it is very quickly siphoning off all those stem cells running around your blood stream, giving the ones packed in the bone marrow room to move out. When this happens the pain begins to recede rather nicely. (What I understand is that it takes your blood in, spins it, the cells get separated out in the spinning process and then they return your blood back to you. The coolest part of the whole thing, is that any residual Myeloma cells not obliterated from the chemo will die in the freezing process for storage. So when they are reintroduced for assistance in your recovery they are myeloma free.)
I hope this information is helpful! Thanks Sarah for asking me to write about it.