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BMT Program performs 700th transplant  by Heather Woolwine Public Relations The MUSC Blood and Marrow Transplant Program (BMT) completed its 700th transplant for patients with benign and malignant hematological disorders, and Bluffton resident Debbie Cook, a dental hygienist, was the 700th patient.   “It’s incredible what they can do here and the caring and loving staff were not only concerned about me, but they were also (concerned) about my family. They explained the transplant process in depth. …I’ve never been to a medical doctor who explained something that much and I felt they prepared me the best they could about how, why and when.”   Cook underwent an autologus stem cell transplant and said she was excited to learn that she was the 700th patient. She has completed her transfusions and, within another few months, will be able to go back to work and mingle safely amongst crowds without fear of infection. “I’m excited about the future and excited about a second chance,” she said.   The program began in 1987 and now boasts decades of experience among the team of physicians, nurses, coordinators and social workers. All specialists on the team have input into case management providing patients with comprehensive cancer and transplant care. MUSC has the only unrelated-donors program in the state and it is the only location in the state for pediatric cord blood transplants.   A patient’s treatment progress depends upon the type of bone marrow transplant that he or she will receive. Autologus transplants have been performed for 400 patients at MUSC and those patients were eligible to receive their own stem cells harvested prior to a high dose of chemotherapy and radiation therapy. Allogeneic patients (300) had a donor identified from their family, the National Marrow Donor Registry, or the Cord Blood registry, and then proceeded with high doses of chemotherapy and radiation therapy followed by the transplantation of the donor cells.     Physicians use increased doses of chemotherapy and radiation for blood diseases and cancer because regular doses rarely are effective. Once the bone marrow is damaged, rates of complications as a result of chemotherapy or radiation increase if the bone marrow is not replaced, which sometimes results in death. If physicians remove healthy stem cells prior to treatment, they then can replace the diseased cells that are killed off by the treatment with healthy stem cells afterward. Stem cells grow much faster than other cells and heal the body much quicker.   “High dose chemotherapy/radiology therapy followed by transplant support can be the only curative treatment for patients with blood cancers,” said Debbie Frei-Lahr, M.D., director of the combined adult/pediatric BMT program. “More patients are eligible for transplants with the numerous stem cell sources that exist now, and in addition, we’re studying reduced intensity preparative regiments that allow older or more infirmed patients to be considered for treatment not previously available to them.”   This new phase of bone marrow transplant studies conducted countrywide are beginning to show that more moderate doses of chemo and radiation therapy can be used with a transplant and still have a good success rate. “It opens the doors to patients previously thought ineligible for transplant and high chemotherapy because high doses could cause fatality in elderly patients. Things look good in the short-term, but we’re still identifying whether or not the cure rate remains the same as those who take the high doses,” Frei-Lahr said.   Different criteria exist for those who must undergo a bone marrow transplant depending on the stem cells' location. To receive one’s own cells for transplant, a patient’s bone marrow cannot be overrun with disease; the age eligibility varies; and health problems must be minor. A patient undergoing this type of transplant could recover to good health in 30 to 60 days. For those patients who must find a matching bone marrow donor (allogeneic), he or she must be in better health compared to autologus patients; and their age makes a difference in their eligibility—decisions for those older than 60 years are made on a case-by-case basis. However, it seems that these patients may have another option with the reduced regimen. For those who receive donor cells, the rate of recovery is highly varied and can last a year or more.   Patients who undergo an allogeneic transplant have a 25- percent chance of matching bone marrow with a sibling, and the chances vary from person to person when talking about cord blood or bone marrow donor registries. The chances of finding a donor are more difficult for minorities. “It can be much more complicated to find them a match because of their genetic history,” Frei-Lahr said. However, some minority patients with sickle cell anemia have had successful outcomes with the BMT.   “Bone marrow transplants take a lot of time on behalf of the patient in terms of work, school, etc., as well for those who must care for them. It’s important to inform the patients what they may be facing during recovery and the time it might take so they can make all the necessary preparations possible,” Frei-Lahr said.   MUSC is both a donor center, which harvests here and sends elsewhere; and a transplant center, which harvests elsewhere and sends here. These services are not always found in the same facility. “We have to work hard and work together to make it all work,” Frei-Lahr said.   The Foundation for Accreditation of Cell Therapy (FACT) is used to help donor centers police themselves. MUSC received its FACT reaccreditation earlier this year, after the initial accreditation four years ago. Experienced nurse practitioners, transplant coordinators, nurses, pharmacists, data managers  and social workers are necessary for a successful program. “This specific group of physicians, nurses, coordinators, pharmacists, etc., is the best group I’ve ever seen working in transplant. They work so hard to educate the patient and their family and get them through it,” Frei-Lahr said.   Frei-Lahr performs adult bone marrow transplants along with Robert Stuart, M.D., and Larry Afrin, M.D. Julio Barredo, M.D., Jackie Kraveka, M.D., and Mary Ellen Caviler, M.D., all perform pediatric transplants.   In terms of the future of bone marrow transplants, Frei-Lahr and her group are part of a pioneering effort to perform outpatient transplants.   “It’s a comprehensive outpatient program, and we spent a lot of time figuring out how to provide bone marrow transplants safely in the outpatient setting and how to train the family to be that necessary support for the patient,” Frei-Lahr said.   Part of that process will be establishing the Larry Parker Miracle House through the efforts of former patient Larry Parker and his wife, Linda.   “By offering outpatient services and then a place to stay in town while receiving treatment, it’s more cost effective for insurance—anything to save a medical dollar is a good thing. Patients who participate in it really seem to like it. Nobody wants to be in the hospital.”   The ultimate reward for Frei-Lahr and her colleagues is to see their patients recover and move on with life. “It’s so rewarding to see them coming back for check-ups and see them living their lives. We watch our pediatric patients growing up, people adopting children and moving on.”   To donate bone marrow, call 1-800- Marrow-2. You can also donate cord blood for stem cell harvesting at a child’s birth, or save and store it in various places throughout the country for one family’s use.     Friday, Aug. 11, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.