Archive for Tuesday, January 26, 1993

MENDING MEASURES

January 26, 1993

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— Six-year-old Matthew Meredith pushes a stuffed, spotted dog in a toy stroller through the halls of the Cancer Center at the University of Kansas Medical Center.

With his dark hair and impish eyes, Matthew looks as if he should be outdoors playing Teen-age Mutant Ninja Turtles, not walking the halls of a hospital cancer center. But the Topeka boy has acute lymphocytic leukemia and is recovering from bone marrow transplant surgery.

He began a treatment regime last August that replaced his diseased bone marrow with healthy bone marrow from his younger sister, and thanks to a new medical center program, he was able to stay close to home sometimes even at home while having most of his treatments.

Matthew is one of the first patients admitted to the medical center's new pediatric bone marrow transplant program.

PREVIOUSLY at the medical center, bone marrow transplants had been offered to pediatric patients only on a limited basis, although an adult bone marrow transplant program was established in 1977.

The full-time pediatric program became effective with the completion of a pediatric bone marrow transplant team headed by Dr. Debra Smith, pediatric hematologist/oncologist and bone marrow transplant specialist, who arrived at the medical center in July.

A graduate of Paseo High School and the University of Missouri-Kansas City School of Medicine, Smith completed her pediatric hematology/oncology fellowship and advanced training in adult and adolescent bone marrow transplantation at the University of Texas M.D. Anderson Cancer Center, Houston, and in pediatric bone marrow transplantation at the Fred Hutchison Cancer Research Center in Seattle.

"IT'S VERY important to have a program like this in Kansas City," she said. "Kansas is a relatively poor state and a large number of children are uninsured. There are lots of places that won't take what Kansas Medicaid pays for this type of treatment."

Smith explained that before the new program went into effect, most Kansas children needing the treatment were sent to the University of Nebraska and the University of Minnesota for treatment.

"Some were going to the Fred Hutchison Cancer Research Center in Seattle," Smith added, "and one went to Yale."

It is a big deal if you have to go to another state, according to the doctor.

"Not only is it unsettling for the child to be in a strange environment," Smith said, "but you have to pay for transportation and sometimes a place to stay. Here, if you're from the Kansas City area, you can stay at home during some of the treatments."

SMITH SAID SHE personally knew of families who had to pay as much as $1,500 a month for apartments to live in while family members were being treated at the Hutchison Center in Seattle.

Through the new KU program, two types of bone marrow transplants now are offered "related allogenic," which involves a related donor as the source of healthy bone marrow, and "autologous," which allows patients to serve as their own donor while their disease is in remission.

"We're not approved for an unrelated donor program yet," said Smith. "It might be two or three years before we can get that aspect going."

In either of the two approved procedures, she said, the patient's own marrow is destroyed by chemotherapy.

"In an autologous transplant, some of the patient's marrow is removed, frozen and saved," Smith said, "and after the chemotherapy, it is returned to grow."

SHE SAID FOUR children currently were working on transplants through the program, and two had had the transplants, Matthew and a teen-age boy. Both are doing well.

Candidates for pediatric bone marrow transplants may have a variety of cancers, including acute myeloblastic leukemia, neuroblastoma, brain tumor, Ewing's sarcoma and acute lymphoblastic leukemia with at least one relapse.

According to Smith, it is hoped that a bone marrow transplant will increase survival in patients with acute myeloblastic leukemia by 40 percent over traditional chemotherapy.

Bone marrow transplants also can help with the treatment of tumors, neurologic disorders, lymphomas and breast cancer in adults.

The average length of stay for a child is 100 days, but all those days are not neccessarily in the hospital because the doctor encourages children to be with their families as much as possible.

MOST CHILDREN in the program are actually hospitalized from 28 to 40 days, two to three weeks of which are spent in a protected environment called a laminar air flow unit. The unit prevents infection in the patient while new bone marrow is growing.

"They are very susceptible to illness after their new bone marrow is transplanted," Smith said. "Until it starts to grow, the patient needs to be protected from germs. So they go into this enclosed environment."

The patient remains in the unit until his or her white blood cell count returns to the normal range, Smith said, for these cells fight infections in the body.

"Matthew was really good while he was in there," Smith said. "He only made his father return once at 2 a.m. because Matthew thought he forgot to tell him good night."

Smith said bone marrow transplants in children differ from those in adults in terms of long-term care and side effects.

"CHILDREN TEND TO do better than adults with bone marrow transplants, depending on the type of transplant that you do," Smith said. "The biggest difference is long-term follow-up.

"All children transplanted under age 12 will have growth problems and may require growth hormones. (Also), because a child has a longer life span than an adult, a child who has a bone marrow transplant is more likely to develop heart/lung and cataract complications."

Despite the success so far, the need for unrelated donors, especially minorities, will grow as the medical center moves toward doing that type of pediatric bone marrow transplant.

There are several patients who don't have matches within their families and can't transplant their own bone marrow, Smith explained.

"Even though there is some discomfort in the donation procedure, you can save a person's life," Smith said.

For more information on how to donate bone marrow, a person can call the Heart of America Bone Marrow Donor Registry at 816-333-0305.

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