This month, Greenville Health System (GHS) commemorated the 1000th patient transplanted by the Blood and Marrow Transplant (BMT) Program. I started working in the BMT Program in August 1992 and have known each transplant patient, administering many of their stem cell infusions. The program was started in January 1992 with only a handful of patients having completed transplant when I joined.
The basic processes of stem cell transplantation (SCT) have always included mobilization, collection, processing and storage of stem cells, as well as preparation of chemotherapy drugs, high dose chemotherapy administration and reinfusion of stem cells. In the early years, these were done under one roof with Susan Funk and me handling the procedures, mixing of chemotherapy agents, overseeing patient care and taking call after hours without a cell phone. We only had a pager and would have to find a phone to use at a business when away from the office or our homes. At that time, our only method for stem cell mobilization (the process for stimulating proliferation of stem cells) was to administer chemotherapy and shots to deliver growth factors. Collection of stem cells was started when the white blood cell count recovered to 1000. As the date for starting collection was not predictable, we would do apheresis (stem cell collection) every day except Sunday. One patient required nine days of collection, yielding 52 bags of stem cells, resulting in over eight hours of infusion each day for two consecutive days to give them all back! Eventually, we transferred the apheresis procedure to other entities, but we continue to manage the patient collection process from the initiation of the injections to the completion of the collection. Some patients would undergo outpatient stem cell reinfusion in our office with same-day admission to the hospital for recovery, after which they returned to us for follow up for a number of weeks. On my first day of work, we took care of our outpatients in the morning and then drove to Greenville Memorial Hospital with a cooler of stem cells on liquid nitrogen to reinfuse a patient being transplanted as an inpatient. Now, stem cells are transported in a dry shipper with a secure regulated control of the temperature to colder than minus 150 degrees centigrade until ready to be infused.
I look back on those early days as a transplant nurse with fond memories; yet over the 25 years I have had the privilege of serving this special population, I have seen a lot of program growth and change. We started the program transplanting patients with breast cancer, non-small cell lung cancer, hematologic cancers, ovarian cancer and testicular cancer. Today, research has shown transplantation to be most appropriate for those with hematologic cancers such as lymphoma, leukemia or multiple myeloma. In 1996, Susan Webb took over as manager of the BMT program and has led us through years of change by achieving and directing the highest standards of care. In 2001, we became the first FACT (Foundation for the Accreditation of Cellular Therapy)-accredited site for autologous (self-to-self) transplantation in South Carolina. We spent the first nine years caring for autologous transplant patients and following allogeneic (donor-to-self) transplant patients living in our area who received transplants elsewhere. On July 12, 2001, we performed our first matched-related allogeneic transplant. In 2002, Kim Seeley joined our team and became our BMT coordinator for allogeneic transplants. We performed our first matched-unrelated allogeneic transplant in March 2015 at GHS, and since October 2015, we have performed allogeneic transplants with half-matched donors that are referred to as haploidentical transplants. Most recently, in December 2016, we achieved the milestone of FACT accreditation for allogeneic transplantation.
Even though many changes have occurred during my 25 years, our commitments to patient safety and quality of life have remained steadfast.
In the last 21 years, we keep our eligible autologous patients in the outpatient setting for high dose chemotherapy and recovery. Home is generally more comfortable for most; however, there is a time and place for hospitalization, and patients are admitted at the first indication of a need for closer monitoring. Our allogeneic transplant patients present a challenge and are followed in our clinic as long as they are on immunosuppression or need close monitoring, which could be from one year to two years or longer.
The caliber of the BMT program today is reflected in Susan Funk (who went on to become a Nurse Practitioner and oversees the management of our transplant patients to this day), Susan Webb and Kim Seeley who have all been an integral part of our transplant team from the early years. We would not have the transplant program we have today without them, our GHS hematology/oncology physicians that led the way and others including nurses, coordinators, data managers, regulatory/compliance, research, financial and our very own transplant pharmacist. I am blessed to have been associated with these people and look forward to the new advances that are coming our way with stem cell transplantation.
There is never a day that I fail to learn something, but my greatest joy and accomplishment is caring for our patients and helping them recover and resume their lives.
Carolyn Vaughan is a transplant nurse in GHS’ Blood and Marrow Transplant Program, which includes the outpatient unit at the Eastside office of the GHS Cancer Institute and the inpatient McCrary Blood and Marrow Transplant Unit at Greenville Memorial Hospital. For more information on the1,000th patient to receive a stem-cell transplant at GHS, visit http://wspa.com/2017/10/06/greenville-memorial-celebrates-1000th-stem-cell-transplant/. For more information about the BMT program, visit www.ghs.org/healthcareservices/cancer/clinical-programs/blood-marrow-transplant-program/
CUTLINE: Gwen King, her family and staff — including Carolyn Vaughan, far left in the middle row — celebrated what Mrs. King called her re-birthday earlier this month just before her stem-cell transplant, complete with sparkling apple cider, gourmet cupcakes and birthday streamers and balloons.