Isita has started her stem cell harvest. Her blood is even now being fed into the apheresis machine, a centrifuge which separates out the red cells, plasma and ‘buffy coat’. This strangely-named last bit made up of white blood cells and stem cells is what they are collecting. 

It is touch and go whether they will get enough. The tests carried out over the past couple of days were on the borderline. Encouragingly, this morning’s white blood cell count had increased strongly. This is a good sign but we are still waiting on more precise tests about the actual stem cell levels. We will know by six o’clock this evening whether we have to repeat the process tomorrow. 

If after two days, they still need more, we will shift to plan B, which is to administer a light dose of cyclophosphamide – one of her chemotherapy drugs. This will initially lower her white blood cell and stem cell counts, but as her body activates to replenish them, the addition of further GCS-F hormone injections should cause her to over-shoot – making another harvest possible in about 10 days.

The situation right now is better than it looked earlier this week when we were disappointed not to be able to go straight ahead. The prospects have improved thanks to some more GCS-F and the addition of a further drug which helps to release the cells. The poor nurses had to wake us up at midnight and six to administer these injections to the minute for best effect. Isita was immensely brave, as it would have been a pretty rotten experience even for an adult.

It has not been the best couple of days for the poor girl. Not only because of this continued series of injections which she hates and fears, but also because she had to go under general anaesthetic yesterday for the vascath insertion. At the same time, the surgeons carried out new bone marrow aspirates and trephines – bone samples – to check that cancerous cells haven’t started to spread through her body again. The trephines are uncomfortable for the first day or so and the vascath is a bit gruesome.

On the positive side, Isita has her ‘bravery party’ tomorrow afternoon. This has been arranged thanks to the generous intervention of the Rays of Sunshine charity which grants wishes to seriously ill children. Isita missed out on a proper birthday party in February because she was at St Mary’s and feeling pretty sick at the time. So she wished for a replacement. This amazing charity has arranged everything. If – as we think – she has more apheresis tomorrow, she will go straight from the treatment to the party. Everyone in the hospital knows that the party is non-negotiable, as all are agreed that for keeping her spirits up it is an essential part of her treatment.