Portland, Ore.

OHSU Center for Hematologic Malignancies reaches milestone after 15 years of service 

The Adult Bone Marrow Transplant program of the Oregon Health & Science University Cancer Institute has performed its 1,000th stem cell transplant for a 63-year-old patient from Bandon, Ore. Caring for patients who live 200 miles away reflects the program's broad reach across Oregon and southwest Washington, as well as the increasing number of older patients receiving transplants.

Daryl Barnes, who received his own cells back after chemotherapy, returned to his home in the southern Oregon coast two weeks after the transplant and mowed his lawn five weeks later. Such activity is possible when a patient's own stem cells are used.

However, in an "allogeneic" transplant that uses the cells of others, post-transplant care requires long term administration of medications by catheter and orally, while maintaining a protected environment to decrease the risk of infection. OHSU requires such transplant patients to be within 30 minutes of the hospital during the first 100 days.  

As a result, Barnes' swift return home contrasts with the experience of Barbara Erickson, 53, Salem, who spent more than three months in an apartment near OHSU following her transplant in which she received bone marrow from a sibling in 1994.

Jodie Hall, 32, Hillsboro, who received a transplant from an unrelated donor, went to her parents' home from the hospital and resumed work on her nursing degree at OHSU just eight months after her transplant in 2003. She'll receive her nursing degree in December.

The OHSU program is in the top 20 percent by volume for stem cell transplants to treat blood diseases such as leukemia in the United States, performing its first transplant just 15 years ago.

"We clearly have accomplished our mandate of meeting the needs of patients with blood disease in Oregon and southwest Washington," said Richard Maziarz, M.D., director of the Adult BMT Program in the OHSU Cancer Institute, and professor of medicine (hematology/ medical oncology) in the School of Medicine. "Our medical team has performed tremendously in the care of our transplant patients over the years."

Citing great advances in treating leukemia and other blood diseases over the last decade, Maziarz, who took over the program in 1992, noted the development by OHSU's Brian Druker, M.D., of Gleevec to treat chronic myeloid leukemia (CML), reducing the need for those patients to have transplants, and the increasing use of mini-transplants that reduce the intensity of chemotherapy required. Druker is a Howard Hughes Medical Investigator and JELD-WEN Chair of Leukemia Research in the OHSU Cancer Institute.

Maziarz observed that the advancing age of the patient population is a challenge. At the outset, stem cell transplants were performed mostly in younger patients, but because cancer is also a disease of the aged and people are living longer, transplants are now considered for patients well into their 70s.

When young people were the primary transplant recipients, caregivers and support were available from within the family. But as patients age, they sometimes have little or no family to provide the support necessary for a successful long-term recovery.

"We're particularly proud of the work our doctors and nurses accomplish in ensuring that the transplant patient receives not only the intensive medical support but all aspects of care, which speed the recovery process" Maziarz said.

"But full recovery still requires strong support in the community where the patient lives," he said. Such support can take the form of assisted-living or other long-term care facilities, when families and the community aren't able to provide the support at home.

Barbara Erickson recalls family and friends being with her constantly as required by the treatment program during her three months in the apartment near OHSU. "When people asked what they could do, I invited them to stay with me," she said. "And they did."

Barbara, who underwent the second allogeneic transplant after Maziarz arrived, is a frequent visitor to the transplant program's facilities, but her purpose differs. Since her transplant, she has focused her creative talents on beading and she displays her work at OHSU and elsewhere. Even when she's not at OHSU, her work is visible on the staff's ID tags, all of which are colorfully bordered with her beadwork.
 
Jodie Hall, diagnosed with acute myeloid leukemia during her second term at nursing school, received her transplant eight months later in July 2003. She says she watches her energy level carefully because she knows her immune system is not as strong as it once was.

But her activity level is daunting. Besides the rigors of nursing school, Jodie volunteers with the Leukemia & Lymphoma Society where she is a first connection volunteer - calling and being available to others diagnosed with blood disease. "That was a healing mechanism for me," she said.

She raises money for the nonprofit through several activities, including walking half marathons. Having just completed one 13-mile walk, her next one will be in Anchorage, Alaska. Jodie also speaks on behalf of the society, talking about cancer, particularly blood cancer, and how to communicate with health care providers.

She acknowledges looking forward to her nursing career, where she hopes to specialize in cardiology or oncology, starting right after completing her degree in December.

Barnes is marking his own milestones in the short time since his transplant. Besides mowing and edging the lawn, Barnes is growing back his moustache, though he notes ruefully, "Now, it's mostly white." And he's just added lettuce back to his diet. "Nice to be able to have salad again," he says Barnes and his wife, Bonnie, have lived in Bandon since 1964. He travels to Coos Bay for regular checkups with his oncologist.

The Adult Marrow Transplant program has satellite clinics in Medford and Bend, where OHSU doctors travel monthly to meet with recovering patients and evaluate patients who have been diagnosed with a blood disease.

Maziarz noted the program's active participation in multi-center studies and its 10-year relationship with Doernbecher Children's Hospital and Legacy-Good Samaritan Hospital in the collaborative venture of the Northwest Marrow Transplant Program. Together they have performed about 1,500 transplants.

"The success of the program also has contributed to the establishment of the OHSU Center for Hematologic Malignancies in which we have committed to the care of blood cancer patients at all phases of disease," said Maziarz, who is the medical director. Druker is the center's research director.