Thursday, January 18, 2001
By Anita Srikameswaran, Post-Gazette Staff Writer
A celebration of life after bone marrow transplantation accompanied yesterday's official opening of the region's largest center dedicated to the procedure.
About 125 transplant patients, their family members, and hospital staff attended the event at the University of Pittsburgh Medical Center's Shadyside Hospital. Leukemia survivor Roberta McCollums, 30, of Hillsville, presented a 16-by-20-inch work done in cross stitch to the unit. She spent a month creating the piece, which lists the names of 101 bone marrow transplant patients around an image of the world.
The work will adorn the new unit on the hospital's seventh floor, which is equipped with 27 private rooms. During a tour, McCollums and others remarked that the space looked far more comfortable and attractive than the wards of their experience.
"I bet the insurance companies love this," cracked one man.
McCollums was 16 when she was diagnosed with acute lymphoblastic leukemia. She had passed out twice at school, but had felt fine otherwise. A visit to the doctor and blood tests revealed that she was on the brink of death.
The doctors "thought I was a goner, that's how bad I was," McCollums said.
After bouts of chemotherapy and radiation, a remission and a recurrence, and another round of medical treatment, doctors recommended the bone marrow transplant.
So in July 1987, McCollums took medicine that killed both the cancerous and healthy cells of her bone marrow. Her sister provided a small amount of replacement marrow, drawn from the hip bone. The donated marrow was pumped into McCollums' vein, just like a blood transfusion, and soon made new, healthy cells to replenish her blood system.
Thirteen years later, she is free of cancer.
However, there was a downside. The donated bone marrow cells attacked McCollums' tissue, in a complication called "graft versus host disease." McCollums has had severe and chronic problems with GVHD and is permanently disabled as a result.
Her sweat glands were scarred, so she no longer sweats. Because of that, her body cannot cool off appropriately, leaving McCollums at risk for heat stroke and therefore death. Ovarian damage prevents her from having children and she must take hormone replacement drugs. Arthritis and gastrointestinal problems have also plagued her.
"I'm limited," McCollums acknowledged. "All the plans I did have are down the drain."
Yet she felt fortunate to be alive, and credited the bone marrow transplant for saving her.
The procedure has steadily improved over the years, said Dr. Andrew Yeager, who heads the new unit at Shadyside.
Yesterday's event was intended to honor McCollums and other early bone marrow transplant recipients and remember the "fires through which they've walked," Yeager said.
While McCollums' only chance for a transplant was a sibling who had matching tissue, now, about a quarter of all transplants come from a registry of people who are willing to donate their bone marrow to strangers.
Also, taking marrow from the hip is being replaced by a more comfortable technique in which bone marrow precursor cells are collected from the bloodstream.
Once McCollum had her transplant, visitors and staff had to put on gowns, masks and shoe covers because of concerns that infections would be passed to her while she had no white blood cells to defend herself.
Greater knowledge has since demonstrated that handwashing and masks are sufficient to inhibit the spread of infectious disease, giving patients and families more freedom on the transplant unit. And, better detection and treatment of infectious complications after transplant have contributed to improved outcomes.
More options are available in anti-rejection drugs and a better use of them has helped reduce the incidence of GVHD.
Patients no longer spend six weeks in hospital before and after a transplant. Instead, they may be admitted a week before they receive the transplant and usually go home two to three weeks later, Yeager said.
Bone marrow transplantation is used primarily in the treatment of cancers such as leukemia and lymphoma. It can also be effective for people whose bone marrows don't function properly, such as those who have aplastic anemia.
Doctors are now studying the procedure as a treatment for autoimmune disorders such as lupus, scleroderma and multiple sclerosis.
The new unit combines
a bone marrow transplant program from UPMC-Shadyside, the Pitt Cancer Institute's
program at Montefiore Hospital and the practice of Oncology Hematology