200th Transplant Milestone for Miami Cancer Institute: Collaboration Is Key in Caring for Blood & Marrow Patients

A blood or bone marrow stem transplant (BMT) provides advanced treatment options to patients suffering from life-threatening blood cancers like leukemia, multiple myeloma, non-Hodgkin lymphoma or Hodgkin’s disease. On a recent spring morning, Andrew Septimus James received a hematopoietic allogeneic transplant, becoming the 200^th patient of Miami Cancer Institute’s BMT Program, a part of Baptist Health.

For patients like 67-year-old Mr. James, who is battling a rare bone marrow malignancy called myelofibrosis, transplant day ― better known as Day 0 ― is a celebration of sorts, a possibility for life. But what many patients and their families don’t realize is the collaboration that is necessary between the inpatient and outpatient Miami Cancer Institute teams as they ready for the procedure ― and care for these fragile patients for months to come.

The Institute began offering autologous stem cell transplants (cells from the patient’s own body) in 2018 and in 2019 began its allogeneic (donor cells) transplant program. The program received full accreditation from the Foundation for the Accreditation of Cellular Therapy (FACT). FACT-certified programs meet rigorous quality and safety standards.

Typically, patients are identified as transplant candidates after coming through the Institute’s Hematology/Oncology Clinic. “When that happens, it really sets the wheels in motion,” said Estivaly Rodriguez, MBA, quality operations manager, Blood & Marrow Transplant Program.

“The donor search coordinator begins working to find a match and the nurse coordinators are setting up all of a patient’s pre-transplant testing, such as EKGs, blood work, dental screening, colonoscopy, mammogram and a slew of other tests to make sure there are no underlying conditions,” she said. In addition to clinical staff, there are financial coordinators to help with insurance issues, data managers, psychosocial services and others involved.

Donor stem cells can come from anywhere around the world and precise timing is required for everything to fall into place perfectly. When donor cells arrive, Guenther Koehne, M.D., Ph.D., deputy director and chief of Blood & Marrow Transplantation and Hematologic Oncology at Miami Cancer Institute, and his team take action. Dr. Koehne, a pioneer in the field, developed a technique to manipulate donor cell collection in the lab prior to transplantation to reduce the potentially harmful complication of graft-versus-host disease.

Guenther Koehne, M.D., Ph.D., deputy director and chief of Blood & Marrow Transplantation and Hematologic Oncology at Miami Cancer Institute.

“The timing is essential,” said Shelli Chernesky, DNP, MBA, director of nursing for the Blood/Marrow Transplant and Oncology Service. “The patient receives medication, the cells have been prepared …everyone is in place. It’s like passing the baton during a race. Everyone has a role; everything is in motion and the hand-off requires communication and coordination.”

The nursing team on 6 Hope, a specialized unit dedicated to stem cell transplant patients, begins caring for the patients when they are admitted just prior to transplantation. The patients undergo what’s known as conditioning, which involves chemotherapy and/or radiation to prepare the patient’s body and immune system to accept the donor-derived stem cells.

On the day of the procedure, patients are often surprised at the entourage in the room. “Up to 12 people are there, including one or two physicians, advanced practice providers such as physician assistants and/or advanced registered nurse practitioners, multiple registered nurses that include clinical staff, leaders and the educator, laboratory staff, pharmacists and even pastoral care for the blessing of the cells if the patient wishes,” Dr. Chernesky said.

The spacious rooms become a home away from home for patients and families as they wait for the donor cells to make new, healthy blood cells. During this time and the ongoing recovery, visitors are limited and screened as patients are at high risk for viruses and infections. The inpatient and outpatient teams are the patient’s and family’s support system and cheerleaders throughout the journey.

“They really become like family to us,” Dr. Chernesky said. “There can be a lot of bumps on the road after the transplant until engraftment. The entire team is monitoring them 24/7, including eICU. Patients go through a lot and their spirits can get low. We are always on the alert for any physical or mental change. While maintaining the resilience of the BMT patient, we keep the patient and their family on track with the vision for discharge.”

During their hospital stay, patients are encouraged to take part in art and music therapy, as well as exercise ― while in their rooms and with expert guidance from a physical therapist. Daily discussions take place involving the interdisciplinary team of experts that includes many specialty physicians and advanced providers, nurses, dietitians, pharmacists, social worker and the patient experience team. Specially trained environmental workers follow strict infectious disease cleaning protocols to keep patients safe, along with certified nursing assistants ― our clinical partners acting as hygiene heroes for our patients.

Rooms on 6 Hope are large to help decrease feelings of isolation and stress that can come from a long hospital stay, and they are equipped with refrigerators, microwaves and large bathrooms. Patients typically remain in the hospital for two to three weeks after the transplant if there are no serious complications. Even after discharge, patients like James, who is from Hallandale, must remain close to the hospital for up to 100 days in case of emergency.

Follow-up for transplant patients includes regular milestone check-ups and can extend years from the procedure date. Ms. Rodriguez and Dr. Chernesky admitted that the outpatient and inpatient staff members love when patients return just to visit or send them emails with photos of them on family vacations.

“When you see them at their lowest and then see them overcome that, it is very satisfying,” Ms. Rodriguez said. And, when the unthinkable happens and a patient loses their battle with cancer, it hits the entire team hard.

“These are very complex patients who require a very comprehensive and collaborative approach to care,” Dr. Koehne said. “I am proud of our inpatient and outpatient teams who are working together for the benefit of our patients. The teamwork and dedication they have is remarkable and is a big reason our program has been so successful from the start.”

For more information on Miami Cancer Institute’s Blood and Marrow program, click here.