When Liz Bowen first learned she would need a stem cell transplant, she had no idea she’d be making history as the first outpatient stem cell transplant patient in New England.
Bowen, 55, was diagnosed with cutaneous T-cell lymphoma, a rare form of skin lymphoma, in 2017. Her care team at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) immediately enrolled her in treatment, including radiation therapy and participation in a pair of clinical trials. The therapies relieved some of Bowen’s pain and itching, but did not put her into remission.
The next year, the U.S. Food and Drug Administration approved the drug mogamulizumab-kpkc, a monoclonal antibody, for rare types of lymphoma — including Bowen’s. After only a month on the drug, the results came back: her cancer was in remission.
“After all I had been through, it was such a relief to hear I was in remission,” recalls Bowen. “And for the first time in a long time, I was feeling really good.”
It was good news for Bowen, but her care team knew they couldn’t stop there: to further ensure that Bowen stayed in remission, they would need to add a stem cell transplant to her treatment plan. A stem cell transplant would replace the damaged and destroyed cells in her bone marrow with healthy cells, regenerating the blood cells and rebuilding a “new” immune system to better recognize and attack the lymphoma.
For the transplant, Bowen met with Corey Cutler, MD, MPH, medical director of the Adult Stem Cell Transplantation and director of the Ambulatory Transplant program at DF/BWCC, to discuss the logistics of an allogeneic transplant — a process in which a patient receives stem cells from a matching donor. In this case, they would be from Bowen’s sister.
While the stem cell transplant procedure isn’t new, what made Bowen’s case unique was that she had the option to enroll as the inaugural patient in DF/BWCC’s new ambulatory transplant program, the first of its kind in New England. The program is designed to reduce, or even eliminate, hospital stays for a portion of patients set to undergo reduced-intensity conditioning.
A less toxic treatment
A reduced-intensity allogeneic transplant, also known as a “mini”-transplant, is a modified form of the procedure that uses lower, less toxic doses of chemotherapy. Reduced-intensity transplants suppress the recipient’s immune system enough so the donor stem cells can take root — or “engraft” — there. The transplanted stem cells can then produce millions of healthy white blood cells, which mount an attack on the cancer cells that remain in the body. This is a phenomenon known as the graft-versus-leukemia effect.
“The goal of the outpatient transplant program is for patients to get their transplant without ever seeing the inside of a hospital,” notes Cutler. “This way, they can relax and recuperate in their home or local lodging with their caregivers.”
By participating in the program Bowen could forgo the typical process of being admitted to the hospital for four days of conditioning chemotherapy prior to transplant, and instead return home after each day of preparatory chemotherapy. She would also receive her new stem cells in the outpatient clinic and return for follow up appointments. Delighted with the idea of being able to finish every night in her own bed, Bowen leapt at the opportunity.
However, before she could start the process, she had one personal milestone she needed to celebrate. In June, Bowen headed down to Charleston, South Carolina to attend the wedding of her eldest daughter.
A big success
The following month, Bowen officially became DF/BWCC’s first ambulatory transplant patient. Looking back, she says she could not have been happier with her experience; the entire staff went out of their way to ensure she felt safe and comfortable.
“Being able to be in my own bed, surrounded by my things and the people I love, was amazing,” explains Bowen. “Everyone on my team took such good care of me, and I cannot say enough good things about all of them.”
“We are proud to be the first ones in New England to offer this program,” says Cutler. “Going forward, I believe this is something that patients not only want but may even seek out.”
Cutler’s team will now look to learn from and build off their recent success. As a result of Bowen’s outcome, they are scheduling more outpatient transplants with qualified patients.
With the transplant complete, Bowen has turned her attention to November 2020, when the family will head to New Hampshire to celebrate the wedding of their other daughter. In the meantime, doctors will continue to monitor Bowen for any side effects. She will regularly meet with her oncology care team and has a standing daily supportive care appointment that she can use if needed. This can be for anything from anti-nausea medication to administering additional fluids.
“We went into this with a big wedding, and we’ll be coming out of it with a big wedding,” laughs Bowen. “If you have the option to use this program, I’d encourage you to do so. I know it gave me a much better quality of life leading up to the transplant.”