Strong After Stem Cell Transplant
With age no longer a barrier, 70-year-old Hazel Strong benefits from lifesaving procedure
Ask Hazel Strong how she is doing just over a year after her stem cell transplant and she'll respond, "I feel fine; I have lots of energy." The 70-year-old recently described her typical day: "I was up at 7 a.m. and so far I've been to the bank and three stores. I'm getting ready to clean the ceiling fans. My husband offers to help, but I tell him, 'I'm not sick.'"
Strong, of the Beverly neighborhood in Chicago, had a stem cell transplant at the University of Chicago Medicine in September 2012. Three years earlier the retired assistant principal was diagnosed with T-cell prolymphocytic leukemia (T-PLL), a rare type of leukemia with a poor prognosis.
At that time, her oncologist in the southwestern suburbs, Mauna Pandya, MD, started Strong on a chemotherapy regimen to fight the disease. She tolerated the treatment well and had a good response. But then a bone marrow biopsy a year after diagnosis revealed low red and white blood cells and platelets. It was determined that Strong also had evolving myelodysplastic syndrome, a condition in which the bone marrow does not make enough normal blood cells
Because Strong had done well with the initial chemotherapy and was otherwise healthy and active, Pandya thought she could handle additional aggressive treatment. Pandya contacted Andrew Artz, MD, to request an evaluation for stem cell transplant or other advanced therapy. Artz, an expert in hematologic malignancies, is the leader of the Older Adult Stem Cell Transplant Program at the University of Chicago Medicine.
"Dr. Artz saw Hazel quickly and his communication with me was excellent," Pandya said. The two clinicians worked collaboratively to treat Strong when the T-PLL leukemia recurred in 2011.
Ready for Transplant
Artz agreed that stem cell transplant offered Strong the best chance for a cure. This well-established treatment involves transplantation of healthy stem cells from blood or bone marrow to replace a patient's diseased cells. Until recently, the lifesaving therapy was not considered for patients over 60 years old. But today, Artz explains, functional age is more important than chronological age when evaluating a patient for the procedure.
"It's not how old the patient is, but rather age-associated conditions that define transplant-readiness," said Artz, who collaborates with specialists in geriatric oncology to assess older people considering the procedure. After evaluating Strong for such issues as her overall health, physical functioning, medications, mobility and family support, Artz's team deemed her "suitable for transplant."
On September 13, 2012, Strong was admitted to the University of Chicago Medicine's dedicated stem cell transplant unit. As a first step, she underwent conditioning treatment — specialized chemotherapy designed to eliminate the diseased cells in her body. A week later, she received healthy stem cells from an unrelated donor (this type of transplant is referred to as allogeneic) who had been identified through the National Marrow Donor Program. The transplanted cells began to grow and started producing healthy blood cells.
Inpatient recovery went smoothly for Strong. "I was in the hospital for three weeks and never had any pain," she said. "The nurses were super fine. They really cared and they always made sure I was all right." Except for some weight loss, she continued to improve during the months after the transplant.
Today, Artz follows Strong regularly for signs of complications or cancer recurrence. As with all of his older patients, he also monitors her closely for infection. "Hazel is doing great," he said. "We don't expect any complications to occur. While we won't relax until two to three years out, with each passing day it becomes less and less likely the disease will return."
Older Adult Stem Cell Transplant Program Offers Coordinated Care
In response to the growing number of individuals over 60 now considering stem cell transplant, the University of Chicago Medicine created the Older Adult Stem Cell Transplant Program — a collaborative program offering coordinated care for these patients. The hematologists/oncologists on the stem cell transplant team partner with geriatric oncology experts in the Specialized Oncology Care and Research in the Elderly (SOCARE) clinic to assess, evaluate and monitor older patients. Together, this corps of specialists identifies issues that could interfere with the outcome of a stem cell transplant and designs an individualized care plan for each patient.