After three months of chemo therapy followed by a mas- tectomy to combat a fast-spreading rare form of breast cancer, Deborah Riley wanted to know what more she could do.

The 46-year-old Hanahan police officer and grandmother of two wanted to give herself the best possible chance at surviving without a recurrence.

"I knew there were no guarantees, but I wanted to prolong my life as long as I could,” she said. On the advise of her oncologist, Arthur E. Frankel, M.D., associate professor of medicine, Riley opted for a bone marrow transplant.

On Dec. 1, 1997, several hollow needles were inserted into Riley's hip bones to remove her healthy marrow. The marrow was immediately frozen and stored until she was ready for it again. During the next five days, Riley was hospitalized at MUSC Medical Center where she received ultra-high doses of chemotherapy to kill any cancer cells that might still remain. If left in her body, her marrow could not have withstood the powerful chemo.

Riley was then released to a nearby hotel, where she stayed until just before Christmas. Seven days after Riley's marrow was removed, it was replaced in an outpatient procedure similar to a blood transfusion. She visited Hollings Cancer Center each morning to see her doctor and get any medicines or other treatments she needed. Then she returned to the hotel, which became her home away from home.

Through it all, Riley's husband, Tony, a sergeant with the Berkeley County Sheriff's Department, served as her specially trained caregiver. “He was with me 24 hours a day, and saw me go through a lot of stages,” she said. “He took my temperature and blood pressure, inserted my IVs, gave me my medicines and kept a chart of everything.” Always, the Rileys were in contact with MUSC's bone marrow team, which was ready around the clock to help if needed.

Today, Riley feels good and has returned to work. “I'm gradually getting my taste buds back,” she said. “My strength isn't the greatest yet, but it helps to get back in the swing of things. Sitting around the house was driving me crazy.”

Her bone marrow transplant was definitely a milestone in Riley's life. But little did she know at the time that it was also a milestone for MUSC. Riley marked MUSC's 300th bone marrow transplant procedure.

Although MUSC began its marrow program in 1987, Riley is one of roughly 60 patients to undergo transplantation in the hospital's outpatient program. Riley's procedure is called an autologous transplant, meaning that her own marrow was used. Another kind of transplant, called allogeneic, uses marrow from a sibling or other donor. MUSC's allogeneic outpatient program was the first of its kind in the world.

Not too long ago, bone marrow transplant patients—both autologous and allogeneic—went through transplantation and recovery in total, sterile isolation, said Debra Frei-Lahr, M.D., assistant professor of medicine, who performed Riley's transplant. Also, the old way of doing things was costly and many insurance companies wouldn't cover it. MUSC believed there was a more cost-effective way of performing bone marrow transplantation—one that is also easier on the patient. “We've shown it's possible to do,” Frei-Lahr said.

“MUSC started a pilot program that condensed all patient care to daytime hours, said Colleen Cavanaugh Kovacs, R.N., senior bone marrow transplant coordinator. At first, the patient's days were spent in the treatment suite at Hollings Cancer Center, and nights were spent on a special floor of the MUSC Medical Center. The program involved using a “Non-hired” care giver, usually a member of the patient's family—like Tony Riley—who was trained to care for the patient at night, perform basic nursing duties and detect problems that required the expertise of medical personnel.

Gradually, the program moved out of the hospital, and the patient and care giver were allowed to stay in a local hotel “with more freedom to come and go,” Kovacs said.

Finally gone are the stereotypical sterile gloves and masks, and the “boy in a bubble” mentality, Kovacs said. “In the old days, patients used to be here for six weeks and they literally couldn't put their heads out the door or touch anybody. We'd have windows in the wall of the room, and somebody had to watch that patient every minute. Then, all of a sudden, we told them, ‘OK, you can go home now.’ They had severe separation anxiety. We don't have that anymore because they're independent of us throughout the whole thing, and they're so well-educated about how to assess problems and what to do about them. They're also secure in the fact that they can always reach us if they have problems when they go home.”

MUSC's bone marrow program is recognized nationally by other hospitals and recently won the highest award given by the Trident Area Community of Excellence. But the most important indicators are the patients who have benefitted from the program. Survival rates are at or better than the national average. Meanwhile, the world of bone marrow transplant continues to evolve. Soon, marrow transplants will be used to treat autoimmune diseases such as rheumatoid arthritis, diabetes and scleroderma.

Editor's note: The article is reprinted from Checkup newsletter, produced by MUSC Creative Services.