The Bone Marrow and Stem Cell Transplant Center at Winship Cancer Institute of Emory University in Atlanta is celebrating its 5,000th patient receiving a bone marrow or stem cell transplant. Started in 1979, the Winship program is the oldest and largest in the state of Georgia and has transplanted patients with leukemia, lymphoma, multiple myeloma, myelodysplastic syndromes, myelofibrosis, aplastic anemia and sickle cell anemia.
Today, the transplant experience is easier for patients and outcomes have improved because of advances in anti-rejection drugs, reduced chemotherapy conditioning, better medicines for treating nausea, better methods for collecting stem cells, improved supportive care, and much shorter stays in the hospital. For some of WInship's 5,000 patients, transplant was the only treatment option. For many, it has provided decades of cancer-free survival.
Bone marrow transplantation began at Emory with a strong leukemia program and two hematologists with a vision. One of the co-founders of the program, Elliott Winton, MD, is still a practicing physician and researcher with the Winship hematology team. Winton and (now retired) hematologist Ralph Vogler, MD, saw the promise of bone marrow transplantation early on, at a time when it was being tried at only a few cancer centers around the country.
Winton points to a milestone report that came out in 1977 from the Fred Hutchinson Cancer Center in Seattle, showing long term survival for 13 of 100 patients with acute leukemia. "It may seem like a small number, but those were people with end-stage disease with no other treatment options, so it was a breakthrough. Most of our patients with acute leukemia and aplastic anemia were dying as a consequence of those diseases," said Winton.
Winton traveled to other cancer centers to learn the necessary procedures, such as bone marrow harvesting. Only a handful of patients were transplanted in the earliest years, but the program had a dedicated team of doctors and nurses and in 1991, Emory made a major commitment to its growth by hiring Rein Saral, MD, a bone marrow transplant specialist from Johns Hopkins.
"We brought in a team of people who worked in the laboratory and people who were translational physicians, who took what we learned in the lab and put it into clinical practice to improve outcomes for patients," said Saral, now Professor Emeritus of hematology/oncology.
"We all felt that you needed a critical mass of physicians, nurses, advanced practitioners, and ancillary staff, and we were given that opportunity by Emory. It was an exciting time. We took off fairly rapidly over a year or two and built a highly competitive clinical program, but just as importantly we really enhanced the pre-clinical, scientific components of the program."
The growth period of the 1990s brought in Edmund K. Waller, MD, PhD, from Stanford, now the current director of the Bone Marrow and Stem Cell Program, and Amelia Langston, MD, medical director and section chief of the Program.
"I was hired to help build the scientific platform to support stem cell transplantation. I love this work. It's a chance to do translational science in the best way, taking lessons learned from patients into the lab setting, and using science to make clinical care better," said Waller.
One of the greatest strengths of the program has been a group of highly skilled, dedicated nurses, several who have been in the BMT unit from the beginning. Early on, patients stayed in the hospital for as much as two months at a time. Emily Bracewell, RN, who has been in BMT for 37 years and is now director of the hospital unit, says nurses worked hard to keep patient spirits up, especially when they were isolated in their rooms for long stretches.
"It was a team effort. We had weddings, holiday parties, we had one nurse who put tacks on the bottom of her shoes and tap danced down the hall," said Bracewell.
"One of the best things about working in BMT is you get to know the patients, their families, their real lives. You develop a really strong bond with them," said Mitzi Smiley, RN, BMT Unit Charge Nurse with 35 years of experience.
The Winship transplant team is internationally recognized for its research and treatment of blood cancers and disorders. The 5,000th patient milestone represents a depth of expertise and experience in performing autologous, allogeneic, and bloodless transplants, for both blood cancers and disorders like sickle cell anemia.
"Our doctors have had years of experience in treating patients and each of us has transplanted hundreds of patients. We've seen every possible condition occur and we've gained a familiarity with the problems of transplants and the ways to address those problems and restore patients back to health," says Waller.
Elliott Winton is gratified to have started a program that has been so successful and expanded exponentially over its 37-year history. "This is death-defying treatment. If we can cure somebody, particularly somebody with many years left of good quality of life, that's one of the biggest thrills of my career."