Still Skiing at 82 After Stem Cell Transplant 

Dienna Lehner grew up in a Massachusetts town with a small ski hill and a rope tow.  

“It was hot dogs, tomato soup, and an outdoor fireplace,” she recalls. “And it was Nirvana.” 

Later in life, she opted to spend her winters in Park City, Utah, to enjoy big mountain skiing. The conditions have been mild this year, but last year she skied all season – which is notable because in 2023, at age 79, she underwent a stem cell transplant for acute myeloid leukemia (AML), a difficult-to-treat form of blood cancer. 

“Back then, their cutoff for stem cell transplants was 78,” says Lehner, who is now 82. “But they decided to give me a chance.” 

Over the past several decades, the age cutoff for stem cell transplants has slowly risen from the 40s and 50s to the 60s and 70s. More recently, Robert Soiffer, MD, chief of the Division of Hematologic Malignancies at Dana-Farber, has successfully performed outpatient transplants on patients who were 80 years of age. Several advances in care and treatment have made this expanded access possible. 

“The average age of patients getting blood disorders that require transplantation is in their late 60s,” says Soiffer. “We weren’t serving the population that really needed the therapy, so we needed to find ways to reduce the challenges associated with the procedure so more people can benefit.” 

Daniel DeAngelo, MD, PhD, chief of the Division of Leukemia at Dana-Farber, initially diagnosed and treated Lehner, and then partnered with Soiffer to discuss a possible transplant. Today, Lehner is currently disease-free and visits Dana-Farber every six months for monitoring.  

“We love going to Dana-Farber,” she says. “Everyone we meet, from the parking garage attendants to the elevator assistant, right to the top, is welcoming, cheery, and compassionate.” 

Expanding Access 

About twenty-five years ago, Soiffer and other physician-scientists began doing reduced intensity transplants for some patients. The approach uses lower doses of chemotherapy prior to the transplant to suppress the immune system enough for the donor stem cells to take root, or engraft, into the bone marrow. With this reduced intensity approach, more people can tolerate the treatment, including some older adults. 

With lower-dose chemotherapy comes a risk that some of the patient’s bone marrow stem cells will remain and fight against the donor’s unfamiliar cells. This rejection of the transplant is called graft-versus-host disease (GVHD). 

In the past decade, however, Dana-Farber investigators have also improved GVHD prevention. Treatment today includes a drug called cyclophosphamide, given after transplant, which has decreased chronic GVHD, the kind of rejection that lingers.  

“It’s made a big difference in quality of life,” says Soiffer. “Particularly for older patients who can tolerate less in terms of side-effects.” 

In addition, Dana-Farber’s Older Adults Hematologic Malignancy program offers support that caters to the needs of older adults. The program connects patients to physicians who can help patients manage any medications they take alongside cancer treatment, as well as other needs such as physical therapy, home visits, and support with decision-making. 

“These changes have made a big difference for patients,” says Soiffer. “We want older patients to receive available treatments if desired, but we have to be wise about how we are supporting them.” 

Choosing Transplant 

When Soiffer first met Lehner, he noted her fitness and vitality immediately. He’d never transplanted someone her age but saw no reason not to consider it.  

“I’m in good shape, stronger from going to the gym and keeping myself active,” she says. “I enjoy all arts and crafts and am a seamstress, a gardener and a potter.  In recovery from my stem cell transplant I’ve really been enjoying paint-by-number. It’s quiet, colorful, meditative, and healing.” 

Since Lehner’s transplant, Soiffer’s team has performed successful transplants on people of age 80. Dana-Farber also offers stem cell transplants to patients as outpatients, meaning they are not required to stay in the hospital for treatment.  

Lehner, in contrast, was admitted to the hospital for several weeks for her treatment, and the transition back home was challenging. 

Outpatient treatment enables patients to go home or to a local hotel after their infusions, where they can be more comfortable, more active, and more likely to sleep well. Some patients do need to be admitted to the hospital to manage side effects, but in most cases, much of the treatment time is still spent as an outpatient. 

“They are more comfortable and mobile in their own environment and are less likely to lose fitness and become disoriented,” he says. “We think being an outpatient can be a real advantage for our patients, particularly for older patients.” 

Life after transplant 

When Lehner returned home 23 days after her transplant, she was overwhelmed by medications and exhaustion. Her husband, John, managed the household and also helped by creating a multi-page spreadsheet to help her stay on top of the doses. This kind of caregiving is essential for patients after a stem cell transplant, says Soiffer. 

Lehner is also part of a Dana-Farber patient support group that meets each month via Zoom to exchange stories and advice.  

“We learn so much from each other and are so supportive of each other,” says Lehner. “It has been lovely.” 

Looking ahead, she and her husband will travel to Europe this summer. She plans to go to Helsinki, Finland, to connect with an exchange student she hosted in the 1980s and has arranged to meet with her stem cell donor who lives elsewhere in Europe. 

“I am so very appreciative of the care beyond words that I have received at Dana Farber and for the beautiful days to come,” says Lehner.