Thursday, September 17, 2009

Stem cells from me, for me

Philippine Daily Inquirer/Opinion/by Ma. Ceres P. Doyo
AVOIDING BEING MAUDLIN, I say, this is as straightforward as I can get:
Few people knew about what I went through from October 2007 to May 2008. During that time I was quietly battling a dreaded threat: cancer. I had lived a relatively happy, healthy lifestyle for many years. And then for some strange reason, I was going “lo-batt.” An enemy had struck. As I had disclosed earlier, I found myself next door to the pre-departure area. (See my four-part series on stem cell therapy, Inquirer, p.1, Sept. 14-17. This column piece is the side bar to today’s Part 4.)
God is the ultimate healer, one of my doctors reminded me. Yes, God worked through close family and friends, and in an amazing way, through persons of science, medicine and faith.

A novel therapeutic option, cellular therapy, was what I had in addition to the three standard therapies or the so-called “slice, poison and burn” procedures, to fight the dreaded C which was not in the earliest of stages.

But I continued to write my columns and a few features, and even went out of town for a story. My way of staying sane. I was never bedridden. But ask me another day about the dark night of the soul and I might tell you.

The plus was cellular therapy, a biological intervention (not pharmaceutical) which utilizes living cells to activate the body’s own immune system to fight cancer. It was not cheap (that’s all I can say). But, as they say, you can’t take your possessions with you. I console myself that in my own way I had participated in the advancement of molecular and regenerative medicine.

Survivor’s guilt notwithstanding, I continue to hope that cellular therapy would soon become affordable for many ailing people, the poor especially, of the developing world. (See today’s Part 4.) For it to be readily available, as in the case of other things cellular that used to be in the realm of science fiction. I say this in all seriousness. Cellular, remember the word.

In my case, stem cell therapy (Dr. Samuel D. Bernal) was the added boost to the radical procedures of surgery (Dr. Augusto Sarmiento), chemotherapy over several months (Dr. Marina Chua-Tan), followed by 30 days of radiotherapy (Dr. Enrico Tangco). For radiotherapy, or the “mopping-up operation,” I drove myself to the hospital every day for 30 days without fail for my 6 p.m. appointment no matter where I was coming from.

Everything was done at The Medical City. Its regenerative and molecular medicine laboratory is indeed something to marvel at.

Cellular therapy process begins with the subcutaneous (under the skin) injection of a granulyte-colony stimulating factor (G-CSF), about 12 to 24 hours before the harvesting of a particular type of white blood cells, the monocytes, from the peripheral blood. The procedure is called leukapheresis. The G-CSF stimulates the bone marrow to produce the granulytes and stem cells and stimulate the release of the cells into the blood.

Monday’s page 1 photo showed me hooked to the leukapheresis machine. This machine selectively collects the monocytes only while the other blood cells and liquid components are returned back to the patient. The procedure takes about four hours. In my case, leukapheresis was done two days after my surgery.

After they are collected, the monocytes are brought to the lab where they are grown using special media to convert them into dendritic cells. These cells are allowed to further mature using a mixture of growth factors and stimulating factors called cytokines. The mature dendritic cells are later fused with the tumor antigen from a tumor bank corresponding to the patient’s primary tumor. The tumor cells are irradiated before the fusion for safety reasons.

The fusion allows the mature dendritic cells to store the tumor membrane information in their memory. As a result, the dendritic cells acquire the ability to recognize and eliminate the tumor cells that they encounter in the body.

In my case, administration was done every three weeks through intradermal injection (two jumbo needles) on both arms. I would watch in wonderment the syringe deliver the light pink fluid containing a trained army. Oncologist Dr. Chua-Tan administered the stem cell injections six times over four months or one week before a scheduled chemotherapy session. She collaborated with Fil-Am Dr. Samuel D. Bernal, renowned stem cell wiz (physician, molecular biologist, lawyer, author and cancer survivor featured in Part 3 of the series.) A personal note: We called him Sammy when we were kids.

One good side effect was an increase in immune levels as shown in my blood chemistry, as well as great energy in fending off the aftereffects of chemotherapy. No nausea, no vomiting. I lost all my hair, of course (ask me about blisters caused by radiotherapy).

In the bigger battle plan that was dendritic cell immune therapy, the dendritic cells were programmed to recognize and zap the enemy cells to smithereens, keep them at bay, minus the collateral damage. Often, I would visualize it like an animation on screen. This was the gentlest procedure of all but by far the most magical.

I haven’t told half of my story, but I have to cut to the chase. In no time I was back on my feet and I hit the ground running, climbed hills, went out to sea, traveled far.

Last April, the portacath (through which chemo was administered), embedded under my skin on the collar bone, was finally removed. I had been wearing it like a badge for more than a year (though I could go swimming with it) long after the chemo had been over. It was no longer needed. I am keeping the thingamajig as a souvenir.

With stem cell therapy, I have indeed stepped into a new frontier, a brave new world of science and medicine.

Joy comes in the morning. All’s clear. I am very well. Ut in omnibus glorificetur Deus.