By Pat Carragher - August 22, 2022
In part two of our two-part series on Drew Garabo’s cancer journey, we explore how stem cell transplants are used to help patients whose testicular cancer doesn’t respond to standard chemotherapy. Click here to read part one and learn more about how Garabo’s journey brought him to Moffitt Cancer Center.
Testicular cancer isn’t the most common form of cancer, but it is often treated successfully. According to the American Cancer Society, about 1 of every 250 men will develop testicular cancer during their lifetime. Chemotherapy is the standard treatment course for testicular cancers that have spread to the lymph nodes because of its high success rate and decreased risk of cancer coming back after the testicle is removed. But what happens in the rare instances when standard chemotherapy doesn’t work?
Drew Garabo is one of the few patients that knows the answer all too well. The radio host was diagnosed with stage 2 seminoma last August. It’s a type of testicular cancer that begins in germ cells. A stage 2 diagnosis means that the cancer has spread to the lymph nodes. Garabo had his right testicle removed, then underwent four weeks of standard chemotherapy. His lymph nodes not only failed to shrink, but also had grown significantly. It was time to explore other options.
“Typically, when somebody gets diagnosed with testicular cancer, we remove one or both testicles and then that is it. The cancer doesn’t come back and it’s a pretty high cure rate,” said Dr. Taiga Nishihori, an assistant member in the Blood and Marrow Transplant and Cellular Immunotherapy Department at Moffitt Cancer Center. “In some rare cases, things go in a different direction. The cancer doesn’t respond to initial chemotherapy or comes back then we’re in a little trouble.”
The next step for Garabo was two rounds of high dose chemotherapy and stem cell transplants.
For years, stem cells would be taken from the bone marrow, but modern technology allows doctors to extract just the cells, leaving the bone marrow intact. Before the stem cells are taken out, patients are given a growth factor through their white blood cells. Doctors then use a special machine to collect blood-forming stem cells from the patient’s bloodstream. Those stem cells are then frozen and stored.
“This is an autologous transplant using a patient’s own cells, so we’re not looking for a donor,” said Nishihori. “It’s a process that’s a combination of high dose chemotherapy and the bone marrow rescued by their own stem cells.”
"It’s a process that’s a combination of high dose chemotherapy and the bone marrow rescued by their own stem cells."- Dr. Taiga Nishihori, Blood and Marrow Transplant and Cellular Immunotherapy Department
Once the stem cells are frozen and stored, the patient will then receive high doses of chemotherapy.
“That will knock a patient’s bone marrow down,” said Nishihori. “Hemoglobin is low, platelets are low and then comes transfusions and antibiotics before we give the stem cells back to rescue the bone marrow.”
After the transfusion, the stem cells settle in the bone marrow and start making new blood cells over the next few weeks.
“To go through this process has been mind-blowing and eye-opening to be honest with you,” said Garabo. “I know I’m the patient, but at the same time, sometimes I feel like I’m on the outside looking in. The whole concept of taking my own stem cells, storing them, zapping me with high dose chemotherapy and then replacing those stem cells in me, it’s incredible that we are able to do that.”
A stem cell transplant is a complex treatment and it’s not without its risks. Transplants sometimes require a long hospital stay and can come with its own set of side effects.
“Recovery takes time,” said Nishihori. “Fatigue can be a big issue for some patients. There can also be issues in the gastrointestinal tract. Nausea, vomiting, diarrhea, fevers and infections are all typical, but over time patients will recover.”
Garabo recently shared on Instagram that he has been experiencing neuropathy in his feet as a result of his treatments and has been undergoing physical therapy to help rehabilitate.
“The nerves are inflamed or damaged, and my feet feel like they’re numb, tingling and/or encased in wet cement 24/7,” said Garabo. “If you suffer from neuropathy like I do, then you know my pain. There’s hope for us! If you don’t, then feel extra grateful for your feet today. Sometimes, you don’t know what you’ve got until it’s gone.”
Garabo is due for follow-up scans in October. While he’s hopeful his lymph nodes will have shrunk completely, he knows that there’s a chance that more treatment is in his future.
“I assume radiation is on the table. I assume surgery is on the table,” said Garabo. “But right now, I feel great and for the next few months I’m just going to live life.”