Sandy Hirsch was diagnosed with blood cancer in 2009, and a year later, she spent several weeks at Duke University to get a bone marrow transplant that wasn’t available in Charlotte.
Today, the 65-year-old multiple myeloma patient is celebrating the opening of an adult bone marrow transplant unit at Carolinas Medical Center. It means patients like her will no longer have to travel hours for treatment and be away from home for weeks at a time.
“It’s wonderful,” Hirsch said last week. “What a joy it would have been to have it in Charlotte and to keep my family around me.”
The 16-bed, $10.5 million transplant unit – the fourth such program in North Carolina – opened Jan. 22 at Carolinas Medical Center, the flagship hospital in Carolinas HealthCare System. Until last week, Charlotte was the largest U.S. city without an adult bone marrow transplant program.
It’s just a short walk from the hospital system’s Levine Cancer Institute, which opened in 2012 and has since hired nine specialists in hematologic oncology, or blood cancer. They come from some of the most prestigious U.S. medical centers, including the Cleveland Clinic and Johns Hopkins University.
“We’ve recruited a cadre of physicians with expertise in all of the hematologic malignancies and nonmalignant hematologic diseases,” said Dr. Belinda Avalos, vice chair of the institute’s Department of Hematologic Oncology and Blood Disorders.
Patients “should feel very confident that they’re in good hands if they come here for care,” she said.
The first nine patients have moved into the unit, and officials say it will be filled soon because demand is great.
“We have a waiting list already for transplants, at least a dozen on the list,” said Dr. Edward Copelan, the department chair.
Copelan, who previously worked at the Cleveland Clinic, came to Charlotte in 2012 with his wife, Avalos, who previously worked at Ohio State University. They were recruited by Levine Cancer Institute’s director, Dr. Derek Raghavan, who came to Charlotte a year earlier, also from the Cleveland Clinic.
Their goal is to create a program that will not only provide quality care for patients and their families, but also to attract clinical trials to advance the understanding of blood cancers and give patients access to the latest, still-experimental therapies.
Already, the institute’s specialists have launched eight clinical trials involving patients with multiple myeloma and lymphoma. And they expect to begin eight more in the next few months.
One of the proposals, by Dr. Jonathan Gerber from Johns Hopkins, is to study the so-called “leukemia stem cell,” a stubborn “mother” cell that sometimes survives even after chemotherapy destroys the “daughter” cells, which constitute the bulk of leukemia cells. In the study, researchers will determine which patients have “mother” cells remaining and should go on to have bone marrow transplants. Those who don’t have “mother” cells remaining would not be candidates for transplants.
“It’s one of the advantages of having people who really sub-specialize in specific diseases,” Copelan said. “They’re able to get cutting-edge trials that you want to get. … To provide this in Charlotte is a game changer.”
Out of the bubble
Bone marrow transplants, also referred to as stem cell transplants, are used to treat patients with blood cancers.
Transplants enable leukemia patients to tolerate higher-than-normal doses of chemotherapy that kill their stem cells – young cells that eventually form white and red blood cells and platelets that are important to the immune system. After chemotherapy has killed their own stem cells, the patients are “rescued” by infusions of healthy stem cells from matching donors, Copelan said.
Some patients with lymphoma or multiple myeloma can be their own stem cell donors. In these “autologous” transplants, stem cells are removed from the patient’s bone marrow and frozen while the patient receives high-dose chemotherapy. Later, the healthy cells are restored.
During and after chemotherapy, patients become susceptible to infection because their immune systems become very weak. That’s why, in years past, patients were essentially kept inside a sterile bubble.
Copelan and Avalos both remember the days when they poked their arms through holes in a curtain that surrounded the patient’s bed. “You never really touched the patients,” Copelan said.
Newer transplant units are nothing like that. Copelan said research showed “it was no better” to keep patients in a bubble than to let them move around in a “positive-pressure environment” with purified air.
At the CMC unit, in renovated space on the hospital’s fourth floor, air flows out of the patient rooms into the hallways and out of the unit, instead of recirculating. There are 12 air changes each hour.
The unit’s 12 patient rooms and four intensive-care rooms look similar to other hospital rooms. The ICU rooms are connected to the hospital system’s virtual ICU in Mint Hill, where extra sets of eyes and ears can monitor patients in addition to nurses and doctors on the floor.
Down the hall and around a corner, there’s an “apheresis” unit where six people at a time can donate blood. Adjacent to that is a laboratory where stem cells are processed and frozen until needed.
On a recent tour, Copelan and Avalos also emphasized features, such as an exercise room, family lounge and laundry room, aimed at making family members and caregivers comfortable during treatment and recovery, which can last up to six weeks. Each patient room also has a sofa that pulls out into a bed so family members can sleep over.
“It’s very patient and family-friendly,” Copelan said.
Experience is key
Carolinas Medical Center had offered autologous bone marrow transplants to adult patients in 1995, but the program lasted for only about 10 years. Children can get bone marrow transplants at Levine Children’s Hospital in Charlotte.
But recently, the nearest centers for adults have been at Duke University Health System in Durham, UNC Hospitals in Chapel Hill and Wake Forest Baptist Medical Center in Winston-Salem.
Leaders of those centers say they welcome the Charlotte program even though it might affect their referrals.
“There’s probably enough work that needs to be done,” said Dr. Nelson Chao, head of Duke’s adult blood and marrow transplant program.
But Chao said any new program “has a learning curve. Physicians are important, but the nursing staff is probably equally, if not more, important. Time will tell how it evolves. We all started from somewhere.”
Dr. Tom Shea, director of the bone marrow transplant program at UNC, said: “There’s nothing that spurs friendly and productive competition better than to have a good new group of people setting up a program … Getting quality care close to home is always a good thing for patients. For a lot of people who need this kind of service, even traveling to Chapel Hill or Durham is a challenge.”
Shea said he and Copelan have known each other for years. In fact, Shea said Copelan and his colleague, Dr. Edward Kim, who came to Charlotte from M.D. Anderson Cancer Center in Texas, visited Chapel Hill recently to talk about “potential collaborations.”
Shea said he was impressed with the Charlotte group’s new electronic medical record that allows doctors anywhere in Carolinas HealthCare System to easily identify which of their cancer patients might qualify for clinical trials.
“It sounded like it was pretty slick,” Shea said. “I’d be surprised if Dr. Copelan and his team wouldn’t put together a very solid program.”
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