Bone marrow transplants are usually reserved as a last-resort for cancer.
For Mike Keener and Muthu Kumar, two patients at Duke's Adult Bone Marrow Transplant and Stem Cell Transplant clinic, transplants meant sacrificing their work and family life for a treatment that was not guaranteed to ameliorate their condition.
Today, they're glad they took the risk.
Already having beaten cancer once, 52-year-old Keener went in for his annual physical four years ago, only to find out that his battle was not yet over. In 1999, he was diagnosed with chronic lymphocytic leukemia, a bone-marrow cancer in which too many white blood cells are produced.
"I'd busted through three years on the previous cancer and to come to find out you've got leukemia..." Keener said, trailing off. "I'm sick and tired of being sick and tired," he added.
Keener connected with patients and doctors from all over the country in order to educate himself on all the options available for his condition. He became interested in one less conventional treatment, the mini-allogeneic transplant, which boasted the potential of a long remission or even a cure.
The prospects for such a treatment, however, were unlikely, doctors told Keener, as they concluded he was not a candidate for the grueling transplant. He was too old and the risk of damage to his liver, lungs and other organs was too great.
"The window for treating leukemias and lymphomas is incredibly small," said Dr. Nelson Chao, director of the Adult Bone Marrow Transplant and Stem Cell Transplant Program. "Generally, transplants are only offered to younger patients."
In spite of the odds, Keener had no intention of giving up, his wife Michelle said.
"Sometimes you just have to say no to doctors," said Mike Keener, who turned down a Charlotte-based oncologist and a Chapel Hill doctor, who had both suggested limited treatments involving chemotherapy.
In 2001, Kumar was similarly stunned to learn of his diagnosis of an aggressive form of Non-Hodgkin's lymphoma--in which tumors develop from white blood cells throughout the lymphatic system--when he went to the hospital complaining of chest pains and general weakness. Unlike Keener, he immediately began chemotherapy, but the treatment quickly began to lose effectiveness on his tumor and he relapsed.
"After the relapse, I had very little hope," Kumar said. "I felt like I almost went to the end of the road." Both Kumar and Keener turned to Duke's clinic for promising treatment options.
Doctors at the clinic believed it was possible to perform a bone marrow transplant procedure that would offer them the possibility of a longer-lasting treatment option than chemotherapy.
Recent advances in therapy procedures have allowed the pool of patients eligible for a transplant to increase and give more patients a second chance at life.
Although at its conception the procedure was riddled with spotty success, the risks involved in the transplant procedure have since been reduced as new drugs and therapy techniques continue to push the science further.
Less than six years ago, 30 to 40 percent of patients with CLL like that of Keener's died from this transplant, but the mortality rate associated with the procedure is now less than 10 percent, said Dr. David Rizzieri, Keener's physician.
Kumar was deemed a candidate for an autologous bone marrow transplant--the least risky procedure currently available to patients, in which the patient's own stem cells are reintroduced once chemotherapy has eradicated all bone marrow.
When an opportunity for Keener to undergo the transplant materialized, one of his sisters eagerly agreed to suffer the debilitating procedure of having cells from her bone marrow harvested for him.
The actual transplantation, Keener described, was anticlimactic, a nonevent.
"I think you want to feel something happen," he said, "but all that actually happens is they hang an IV bag on a pole and in half-an-hour, the treatment is over."
Then, the waiting game began.
As the days following the procedure progressed, Kumar and Keener's improvements, however, were markedly less than spectacular.
In addition to contracting a virus after his July 2002 transplant, Kumar suffered from insomnia, lethargy and other side effects during his two-month hospital stay. Keener described how his bones ached as though he had the flu and how he felt "crummy" during the first 25 days after transplantation.
Although Keener was lucky enough to not contract a post-operative virus, he has not yet experienced long lasting improvements.
However, Sept. 2--Day 42 in Keener's eyes--was a good day for him. More alert than he was on day 17, when the drugs had altered his mood and slowed his thinking, he is now beginning to regain his energy and can finally sleep and eat full meals.
"Things are settling down, emotionally and physically," he said during a trip to the clinic on the six-week anniversary of the transplant. "The nausea is gone."
Keener's fate, however, remains to be determined. He visits the clinic every day to have his blood counts monitored, in the hopes that his sister's cells have taken root in his body.
"It's been a rollercoaster, and that's what they told us it would be," said Michelle Keener.
Keener said one of the hardest parts of cancer was sacrificing the joys of seeing his grandson, who is in daycare and therefore carries too many germs to visit him.
In spite of Keener's daily struggle against the cancer, he maintains a positive, although realistic outlook on his prognosis and chances for recovery.
"This time it's been shaky. I'm just trying to take it a day at a time," he said. "We don't look too much beyond tomorrow." Despite his undergoing treatment, Keener said he has about five years to live.
The outlook for Kumar is more optimistic. As of January 2003, he has regained all his energy, is no longer on medication and even found a new job two months ago.
"I had almost decided I wasn't going to make it," Kumar said. "But this BMT thing is a miracle--right now, I'm completely confident that I've been cured."
Kelly Rohrs and Liana Wyler contributed to this story.
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