MUSC’s BMT program exceeds expectations for one-year survival in new report

Up, up, up, above the setting sun, smashing down into the trampoline and then up, up, up again, Kasen Fenn Murdaugh bounced and flipped with exuberance on a crisp January afternoon after a typical day of first grade.

Fenn, 7, likes Sonic the Hedgehog. He likes driving the golf cart to his grandmother’s, who lives nearby. Like many an active kid, he’s already broken an arm and a leg.

While he remembers the broken bones – not that they’ve slowed him down – he doesn’t have much memory of the biggest medical event of his young life: a stem cell transplant in 2020 after his leukemia relapsed.

Fenn may not remember, but his mother, Kahilu Murdaugh, certainly does.

 

So does Michelle Hudspeth, M.D., director of the Adult and Pediatric Blood and Marrow Transplantation and Cellular Therapy program at the Medical University of South Carolina.

“I’ve always said that trying to plan a transplant is like trying to plan a wedding for a million guests in about six-weeks’ time,” she said. When the COVID-19 pandemic hit, “everything that we did became exponentially harder.”

The BMT team, which encompasses both MUSC Hollings Cancer Center and MUSC Children’s Health, buckled down. They developed new processes to make sure that patients got what they needed. They focused on keeping patients healthy post-transplant, the time when they have zero immune protections, despite the pandemic raging across the U.S.

Their hard work had results.

A new report from the Center for International Blood and Marrow Transplant Research (CIBMTR) lists MUSC as one of 12 transplant centers across the U.S. that performed better than expected during the evaluation years of 2020 through 2022. The report covers 172 centers that performed allogeneic transplants in that time period.

“I think it really has to do with intentional, tireless advocacy for our patients. It’s something that’s very much within the fabric of the program, and we just escalated that, particularly in those COVID years."

Michelle Hudspeth, M.D.

Allogeneic transplants involve transplanting a donor’s stem cells into a patient as a treatment for blood cancers, sickle cell disease, bone marrow failure syndromes and more.

CIBMTR calculates each BMT program’s expected one-year survival rate based on that program’s patients, taking into account a variety of factors, including age, co-existing diseases, donor type, disease stage and more. Centers are then rated as underperforming, performing as predicted or overperforming. The MUSC program was rated as overperforming.

Hudspeth was gratified by MUSC’s strong performance.

“I think it really has to do with intentional, tireless advocacy for our patients. It’s something that’s very much within the fabric of the program, and we just escalated that, particularly in those COVID years,” Hudspeth said.

When you’re pregnant, there’s a pandemic and your child needs a bone marrow transplant

Fenn was first diagnosed with leukemia in 2019 when he was 18 months old.

There was one weekend when he was acting puny; Kahilu, who was in nursing school, figured he was coming down with a virus.

“Nothing too crazy, but he had a fever that I couldn't get to break unless I gave him Tylenol and ibuprofen at the same time – and couldn't even really break it all the way,” she said.

 

That Monday, she dropped him off at her mother’s and headed to school. Before she had even gotten on the interstate, her mom called her.

“‘Where are these bruises from? He's got bruises all over the place,’” her mom said. “My mom took his pants off to change his diaper, and he had all these little bruises all the way down his legs from us grabbing his legs to change his diaper,” Kahilu said.

Worried, Kahilu made an appointment with the pediatrician and asked for bloodwork to check for leukemia. After an exam, the pediatrician’s office told her that Fenn would most likely need to be seen at MUSC Children’s Health. They could either do the bloodwork at the pediatrician’s office, then have the pediatrician call with the results and send the family to MUSC, or the family could go straight to MUSC. Kahilu chose to go straight to MUSC.

At MUSC, Hudspeth broke the news that it was, indeed, leukemia.

“That was March 19. He went in for his port on the 20th and started chemo on the 21st,” Kahilu said.

Fenn got through treatment and was entering the maintenance phase of chemo when COVID started to enter the public consciousness.

Then, in the summer of 2020, the leukemia returned. Fenn had to be admitted to MUSC Shawn Jenkins Children’s Hospital, which had opened only months earlier, for a 28-day continuous infusion of immunotherapy.

After that, he returned home for about a week and then went back to the hospital for the transplant. In an allogeneic transplant, the patient gets strong doses of chemotherapy and radiation to completely kill off their own bone marrow. Then, donor cells from someone who is a close match are infused. When all goes well, the donor cells set up shop within the bones as if they were their own and begin producing healthy blood cells.

 

The National Marrow Donor Program (NMDP) has an international network to provide matching services, connecting patients and donors across the world. But with COVID, transporting lifesaving donor cells became, at times, impossible. Fenn’s first and second match donors fell through. The third match had a major blood type incompatibility, and the bone marrow product required special processing coordinated through the NMDP Biobank.

Fenn received his new stem cells on Oct. 13, 2020. Three days later, he turned 3.

When patients are discharged from the hospital after a transplant, their health must be closely guarded. Because their bone marrow, which produces immune cells, was killed off, they have no working immune system. They’re as vulnerable as newborns – even more so because they don’t have antibodies from their mothers.

Kahilu was fierce in safeguarding Fenn’s health.

“COVID didn't really change anything with our life because we were already used to wearing masks all the time. We were already used to being sheltered from everybody. I was such a helicopter mom. Like, if you had a sniffle? Goodbye. Don't come over,” she said.

Fenn had to stay within 30 minutes of MUSC for 100 days after the transplant. Because the family lives in Walterboro, Fenn and Kahilu stayed in a hotel in Mount Pleasant, with family coming to visit when possible. To top it off, Kahilu was pregnant.

“We were living in the hotel when I went into labor. My sister had flown in from Idaho to stay with us because Kyle worked – because even though we had all this going on, bills still had to get paid. So he worked, and he would come and stay with us on most weekends, then he'd go back to work on Monday,” she explained.

So, in the middle of the night, Kahilu got herself to the hospital and welcomed Fenn’s little brother, Kashton.

Increasing communication to ensure care

Caring for Fenn and the other BMT and cellular therapy patients – adults and children – during the pandemic meant the team needed to increase attention on every step of the process.

Hudspeth said the “overperforming” rating reflects how everyone on the team worked together and with teams across the hospital system.

“Within the bone marrow transplant and cellular therapy team, we are very dependent on the cryopreservation lab, which is the stem cell processing lab, as well as apheresis, all of which require highly specialized staff and were very, very short-staffed during this time period,” she said.

The apheresis team helps to collect stem cells from the bloodstream.

“For many years, we've done what we call quality rounds, where the BMT and cellular therapy team goes and sits down once or twice a year with all the places across MUSC that our patients touch – the ICUs, the ER, the pharmacy, etc.,” Hudspeth said. “And we really just ramped that up during this time period. We focused on our key partners, apheresis and the cryopreservation lab, and we started doing in-person rounds with them every other week. BMT and cellular therapy leadership met with the ‘boots on the ground’ in those areas to say, ‘What can we do to help?’”

The process is even more complicated because MUSC is one of the few programs for both adults and children. Adult patients are cared for through MUSC Hollings Cancer Center, the state’s only National Cancer Institute-designated cancer center, while children are cared for by MUSC Children’s Health, which has been ranked among the best hospitals in the U.S. for children with cancer. 

 

"We recognize that every patient who comes to us is somebody’s everything."

Michelle Hudspeth, M.D.

Hudspeth said the BMT and cellular therapy team, which includes patient coordinators, nurse coordinators, data coordinators, financial coordinators, a quality manager and advanced practice providers and physicians, is laser-focused on patients.

“We recognize that every patient who comes to us is somebody’s everything,” she said.

Fenn hasn’t quite hit the five-year mark since his transplant, but he’s getting close. In the meantime, he’s surrounded by a close-knit family that showers him with love. And on a January afternoon, preparing for little brother Kashton’s birthday, that’s all he needs.

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