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Easing treatment
Cancer patients may be eligible for outpatient bone marrow transplants

By REBECCA KONYA

October 2013

Matt Andrews participated in Froedtert’s outpatient transplant program.

Stem cell and bone marrow transplants have come a long way since the early 1970s when physicians first began using the technique to treat patients with advanced leukemia. Today, the life-saving therapy has been expanded to treat other types of cancer that affect the blood, bone marrow and lymphatic system, including non-Hodgkin’s lymphoma, Hodgkin’s disease and multiple myeloma.

What’s more, many patients are now eligible to receive bone marrow transplants on an outpatient basis. Froedtert & The Medical College of Wisconsin first implemented its outpatient bone marrow transplant program in 2009. That year, the outpatient transplant program treated 10 patients. In 2011, the most recent year for which statistics are available, the hospital performed 155 bone marrow transplants on an outpatient basis.

"Our outpatient transplant program is the only one of its kind in the Milwaukee area," says Dr. Parameswaran Hari, a hematologist/oncologist and director of the Adult Blood and Marrow Transplant Program at Froedtert & The Medical College of Wisconsin.
 

Repairing the Damage

High-dose chemotherapy and radiation are standard treatments in the fight against leukemia, lymphoma and other types of blood and bone cancers, but these aggressive therapies kill not only diseased cells but healthy ones too. To replace the healthy cells and bone marrow damaged during cancer treatment, patients often undergo a bone marrow or stem cell transplant.

That was the course of therapy Matt Andrews followed. After being diagnosed with peripheral T-cell lymphoma, a rare and usually aggressive form of cancer, in October 2009, the 34-year-old Greenfield resident underwent multiple surgeries to remove the tumor, followed by radiation then chemotherapy.

After a high-dose course of chemotherapy, Andrews received an autologous stem cell transplant — a process that uses stem cells harvested from the patient’s own bone marrow — to replace the healthy, blood-forming cells that had been destroyed. When his cancer resurfaced last fall, Andrews had a second transplant as an outpatient — this time using stem cells from an unidentified donor.
 

Comforts of Home

Before Froedtert began offering bone marrow transplants on an outpatient basis, the only option for patients in the Milwaukee area was an extended stay in the hospital’s transplant unit — up to four weeks — because of potentially life-threatening side effects. More recently, though, research has shown that infection rates and outcomes do not vary significantly whether people are treated as inpatients or outpatients, according to a 2009 article in the journal Nature.

Today patients have the ability to return home during treatment rather than endure a lengthy inpatient hospital stay.

"We like to refer to our transplant program as home-based," explains Hari.

Receiving a bone marrow transplant as an outpatient helps reduce patients’ costs, which can run several hundred thousand dollars per transplant. But there’s also evidence that patients recover faster at home.

"We don’t know the exact reason why," says Hari. Anecdotally, though, he has found that without the prolonged hospital stay his patients seem to more easily transition back into their normal daily routine.

"As outpatients, people are able to maintain some control when cancer has completely taken over their lives," he says.

Andrews agrees. "Being able to see my daughter and sleep in my own bed put me in a better frame of mind," he says. "To be in my own surroundings made a big difference."
 

Fighting Chance

Performing outpatient allogeneic transplants, which use cells obtained from a donor, on patients with aggressive cancers like PTCL is a relatively new practice since there’s a higher risk of complication, such as graft vs. host disease (a condition in which the donor’s transplanted stem cells attack the patient’s body).

Andrews was among the first patients in Froedtert’s outpatient transplant program to undergo the procedure. Doctors considered him a good candidate since he is relatively young and responded well to the autologous transplant two years earlier.

Nearly a year after undergoing his second outpatient transplant, Andrews hasn’t had a recurrence of cancer.

"Since people with PTCL have a high relapse rate, you’re never really considered in remission," he explains.

Despite the uncertainty of his disease, Andrews is grateful to the doctors and staff at Froedtert’s Cancer Center.

"Everyone was absolutely great," he says. "It was the best experience I could have hoped for."
 







 

This story ran in the October 2013 issue of: