Munira Premji

Taking in the Fall Harvest at Niagara-on-the-Lake

Autumn (aka Fall) is my favourite season.  It is a time of harvest and heralds the start of growth anew.  So, with a few days off between cancer treatments, Nagib and I took off to Niagara to enjoy the Fall scenery.


As the leaves begin to change colour and farmers’ markets fill with barrels of apples, tomatoes and red-hot chili peppers, I am going through a transformation of my own — I am beginning the process for the mobilization (i.e. getting together), collection (harvest) and reinfusion (transplant) of my stem cells.

So, what are stem cells anyway?  Stem cells are thought to be the origin of all blood cells.  They live in the bone marrow, and are capable of reproducing themselves and producing red and white blood cells as well as the platelets that make up the components of blood.

After having gone through eight weekly treatments of chemotherapy (CyBorD) for the Multiple Myeloma, I’m ready for my transformation.

Stem Cell Mobilization

Today, Monday, October 1st, I was given an aggressive dose of cyclophosphamide –   four times the strength of the chemotherapy treatments I have been getting so far.  I have been told that I will be very sick from this chemo for a few days, and I have been given preventative medicine to help me cope.  Later this week, I will be receiving daily injections of Neupogen that stimulates the bone marrow to produce more stem cells and release them into the bloodstream.

The Collection Procedure

Stem cell collection is scheduled to take place starting next Tuesday, October 9th.  This is a fascinating process.  First, a simple blood test determines whether there are enough stem cells circulating in the bloodstream.  We are looking for 2 million stem cells per Kg of weight.  (You do the math!).  If there are not enough stem cells, I go home and continue the Neupogen injections and keep coming back to the hospital every day until there are enough stem cells to harvest.

The stem cells are collected through a “Quinton” line.  A Quinton line is a plastic tube which is surgically inserted into a large vein in the neck.  (Oh no, another poke!).  The technique for collecting stem cells from the bloodstream is known as “apheresis”.  A cell separator device (the apheresis machine) is used to collect blood through the Quinton line, separate the stem cells and return the remaining blood back into the body through my existing PICC line (which is in my left forearm).

Each session takes approximately four to five hours, and may be repeated for two to five days until enough stem cells are collected for two transplants.  (I’m told they will be collecting 200 million of these little guys).  At this point, the Quinton line is removed and I go home to wait.  The stem cells, light pink in colour, are frozen until it is time to transplant them into my body.

As there are only a limited number of transplant beds available in hospital, and there are many patients awaiting stem cell or bone marrow transplants, I may have to wait for up to two months.

In the meantime, I may begin a third cycle of weekly chemotherapy treatments (each cycle is four weeks) and I will undergo a battery of tests:  Dental exam (by oncology dental specialists at PMH), Pulmonary Function Test (to assess the functioning of my lungs), MUGA Scan (X-rays of the heart) and Echocardiogram (ultrasound of the heart).  All of these tests are to ensure that my organs are functioning well, and to provide a baseline for comparing any changes that may occur after the transplant.

On October 22nd, I’m scheduled for a minor surgical procedure to insert a Hickman line (a double-lumen catheter) which is inserted into a large vein in the chest, below the collarbone.  It is the most secure method to administer chemotherapy, draw blood tests and to reinfuse the stem cells.  My PICC line, which has served me faithfully for four months, through thick and thin, at home and on vacation, in and out of water, will be removed at this time.

The Transplantation process

The transplantation process begins with admission into Princess Margaret Hospital, as soon as I get “the call”.  On day 1, a high dose of Melphalan (another more powerful chemotherapy drug) is infused.  The purpose of this chemotherapy is to wipe out all of the red and white blood cells and platelets in my bone marrow.  On day 2, the transplant doctor brings back my frozen stem cells and thaws them in a warm water bath!  Once thawed, the stems are reinfused through my Hickman Line, similar to a blood transfusion.

I’m told that the thawed blood will cause me to smell like corn for 24 to 48 hours!  Another reference to the Fall season (LOL).  This is because the chemical used to preserve and protect my cells during the freezing process (dimethylsulfoxide) smells like corn.  Thank Goodness!  It could have smelled like Hydrogen Sulfide (get it?).

Then it’s up to my transplanted stem cells to engraft (begin to grow and produce new cancer-free cells).  This entire process will require me to stay in hospital for up to 3 weeks (thankfully not in isolation most of the time), during which my low blood counts may require additional blood transfusions.

By December, I look forward to coming back home transformed into a new – albeit tired – Munira, all bundled up and ready to tackle the cold and snow of the winter season!


  • Anonymous , October 5, 2012

    Our dear Munira: I have been following your blogs since day one, with great interest, admiration, sorrow and tears in my eyes, and with prayers for your pain free speedy recovery.

    Your writing seems like you are giving us a story of a third person, who is undergoing this painful tragedy. But in fact you are the person in the story. This shows your highly courageous and commendable attitude. In another words, you are riding the frightening cancer, enjoying yourself every moment and are in full control.

    We all your good wishers and specially who are going through such agony should take a page from your blog/s. It is a common but a very true phrase, which says that God helps those who help themselves. You are the living symbol, and I have no doubt that He, the Almighty Lord, who is the most powerful, Merciful and All Knowing is and will come to your rescue and get you through this in one piece, healthier and stronger.

    I join all your good wishers to pray unto Him, that He give you a happy, healthy, prosperous long life so that you enjoy playing with your great grand children. Amen.

    By the way, your Autumn blog with a charming and beautiful you, proves my point that you are reallly riding your cancer happily and with style, having full control over it. SABASH Munira!

  • mylegacytoyou , October 4, 2012

    My favourite season and my favourite voice! You look absolutely radiant Munira! Fall is your colour! Love you very, very much in your pumpkin orange chic. Thank you for the detailed account of the transplantation process. I had so many questions and all of them were answered in your comprehensive tale of what goes on where, why, and how in the world! Did I tell you lately, how much I admire your writing style?
    After reading this, I will always think of the stem cell transplantation process in the fall and harvesting terms, instead of it being an inconceivable complicated process in real. Just like them apples and the peppers in the pictures, I will pray for your precious stem cells to overflow in their baskets when being collected for making a new and a revitalized you. I wish you much fertility and strength to produce them in billions!

    Love you loads,

  • Pascale , October 3, 2012

    Automn is my favorite season too. During fall season, all the nature is preparing to go for winter and then hibernate. Even if everithing looks quiet then, the nature is still full of life and preparing for the coming seasons. Your body and mind will follow this cycle. Your second life is coming to you Munira, one step at the time, with a lot of people surrounding you with love and support. I’m already excited to hear from you all projects you will decide to undertake in few months. Thinking of you. God speed dear Munira.

  • Anonymous , October 2, 2012

    Courage is resistance to fear, mastery of fear – not absence of fear.”
    ― Mark Twain

    Courage is grace under pressure.”
    ― Ernest Hemingway

    God will not look you over for medals, degrees or diplomas but for scars.”
    ― Elbert Hubbard

    Thinking of you in Satado week as well, May Mowla bless each and every one of us


    tags: courage
    tags: courage

    • Premji Family , October 2, 2012

      Thanks for some great quotes on courage Salome. Munira

  • Anonymous , October 2, 2012

    Munira, it’s very helpful to read the details of your next procedures. I think about you every day, and look forward to hearing how you are progressing through your treatments. It is amazing to me how you are the same strong, positive person you always have been, yet at the same time, you also seem transformed. When you have finally finished your treatments, you should write a book, you have an amazing “voice”! If you are up to a visit when you are in Princess Margaret, I would love to see you. – Hugs, Patti Kurgan

  • Anonymous , October 2, 2012

    Thanks for the tutorial in stem cell transplantation and your personal experience. I think i’m learning more from you than reading an academic paper. Your blogs are something some of us look forward to, they are there to change us in more than one way.
    Your courage, strength and spirit is truly admirable and prayers go out for everyone that has to go through trying times. God knows we need that more than anything.
    Love, hugs and good thoughts,

    Shehnaaz and Karim Dhanani

    • Anonymous , October 2, 2012

      Wow, that’s quite the procedure!! Hugs and hugs and hugs every step along the way. And extra hugs on the days you smell like corn 😉

      • Premji Family , October 2, 2012

        You are so funny! I am going to remember you when I smell of corn! Thanks for all the extra hugs! Munira

      • Premji Family , October 2, 2012

        You are so funny! I will remember you when I am smelling of corn! Th aks for the hugs and the extra hugs! Munira

    • Premji Family , October 2, 2012

      Your comments mean the world to me particularly as you are in the medical field. I was so naive before my diagnoses. Now I am becoming more knowledgeable about lymphoma and myeloma. And that is only 2 of some 250 cancers. Thank you for your prayers for strength. Munira

    • Premji Family , October 2, 2012

      Your comments mean the world to me particularly as you are in the medical field. I was so naive before my diagnoses. Now I am becoming more knowledgeable about lymphoma and myeloma. And that is only 2 of some 250 cancers. Thank you for your prayers for strength. Munira

    • Premji Family , October 2, 2012

      Shehnaaz and Karim — Your comments mean a lot to me as I know you are in the medical field. Before my diagnoses, I was so naive about cancer. Now I know a little about lymphoma and myeloma. That’s 2 out of some 250 cancers! Thanks for your love, hugs and good thoughts. I hope the boys have settled well in school! Munira

  • Anonymous , October 2, 2012

    Munira, you are living example of super woman – you have so much to offer and share with us all – inspiration as well as getting educated. I say Science and religion do mix – miracles and research have brought many wonderful results for you and all Cancer patients – let’s pray to Mawla to continue giving you and your family the strength through this journey.
    Mebs, Zoe and Rosie

    • Premji Family , October 2, 2012

      Thanks so much for your perceptive and thoughtful comments about science and religion. II am so hanging in there and I do look forward to sharing what we are learning via the blog. These are things I wish I knew so I could better prepare. Hope Zoe is going great at school. I miss you guys, Munira

  • Dilshad Nathoo , October 2, 2012

    WOW!! First of all you look fantastic…HOT MAMMA!! Secondly, what a great biology/science lesson, extremely fascinating what the wonders of science can do. I got tired just reading about it so I can’t imagine how exhausted you must be. All I can say is for the next little while, and I know you love people around you, please be careful and stay safe from all the germs floating around right now. Your body will be at an extremely vulnerable state of picking up the most minute germs. We are all praying for you and that you have wonder woman strength to get you through this. Allah is always with you, watching over you and giving you the strength you will need. Ameen.
    We are with you always in mind, heart and spirit throughout your journey.
    With lots of love,
    Arif, Dilshad, Nareesa and Tahara

    • Premji Family , October 2, 2012

      Dearest Dilshad. Where have you been? I have missed you and your comments on the blog. Welcome back! Yes October will be a doozy of a month, but I am actually looking forward to the deama and activity. It feels like I am living in y own Soap Opera! Thanks for your support and friendship. I was supposed to be really sick today and tomorrow but am doing quite well. So I know God is watching over me. Would love to find out what’s happening in your life. Munira

  • Vicki Cotter , October 2, 2012

    You continue to amaze and inspire (as well as educate) me. I am sending wishes that nothing will be as hard as you have been told to expect. And I’m sending love.

    • Premji Family , October 2, 2012

      Vicki. Your prayers were definitely answered. I was supposed to be sick as a dog yesterday and today. In fact. I was quite well. A bit tired, but I was up and about. I love connecting with you via the blog! Much love. Munira

  • Anonymous , October 2, 2012

    Munira, reading your blog inspires me to fight with my treatment too. I need to tell you, you are a very strong woman with strong Imaan. You will definitely make it through. Mowla is with you and with all of us.

    • Premji Family , October 2, 2012

      Thanks so much for your kind words. I am not very strong. I do think that when you are put in a situation like you and I are put in, you find strength from somewhere. I also pray for your good health and recovery. Munira

  • Anonymous , October 2, 2012

    Hi Munira,

    Fall is my favourite season too! Wow, it appears you are going to be a very busy lady for the next 3 months. I am going to wear pink everyday for the month of October- whether it be clothing or jewellery, in support of your light pink stem cells!


    • Premji Family , October 2, 2012

      Yes I will be one busy lady in October! That’s just such a nice gesture to wear pink in october. Honestly, until a month ago, I had no idea that stem cells were pink. Everyday is a new learning! Munira

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