In August 1999, Pastor Robert Duncan had learned his non-Hodgkin's lymphoma was no longer in remission. A friend referred Duncan, 61 and a resident of Westville, Ind., to oncologists at Rush-Presbyterian-St. Luke's Medical Center in Chicago. Rush physicians told him he could receive a stem cell transplant through the hospital's newly established OutPatient Transplantation (OPTion)“ program.
Patients, like Duncan, who need a stem cell transplant may qualify to receive their care in this outpatient setting rather than through an expensive inpatient hospital stay that often lasts for two to three weeks.
Patients of the OPTion program stay in an on-campus apartment located just within walking distance of the intensive ambulatory care unit adjacent to Rush's inpatient unit. The three-room apartment is equipped with a kitchen, room to sleep four, and air purifiers to reduce risk of infection in the living room and the bedroom. Rush requires the patients to be accompanied by a caregiver during their stay in the apartment in case of emergency. If complications arise, patients move into the adjacent hospital immediately. Duncan is only the second patient to stay in the apartment through this program.
"Patients can now receive optimal, sophisticated medical care while resting comfortably in a home-like setting," said medical oncologist and director of the Rush Bone Marrow Transplant program Hans Klingemann, MD, PhD. Once it is determined that a stem cell transplant is the best treatment option, the search for a stem cell donor begins. There are two types of donors: allogeneic or a donor other than the patient, or autologous or a self-donor. According to Klingemann, the ideal donor is a same sex sibling. In Duncan's case, his donor was his older brother Harold.
To prepare the body to receive donor stem cells, the recipient undergoes chemotherapy and/or radiation days prior to transplant.
Once the ideal donor is identified, the donor undergoes a four-to-five day process to prepare the donor stem cells for collection. On the day of the transplant the donor undergoes apheresis, the process that separates the stem cells from the rest of the blood's components. This process requires blood to be drawn from the donor then filtered through a machine that isolates the stem cells for infusion into the recipient. The blood's other components are then infused back into the donor.
On that same day of the infusion, the patient receives the donor stem cells through a catheter that is placed in a major vein in the chest. Following this, the patient is monitored and remains in the outpatient apartment for a two-week period, during which the patient is at the highest risk for infection. This less expensive option has patients and payors alike satisfied with the lower costs. "I have received wonderful care from the staff at Rush. Because I have never been hospitalized before, I did not look forward to a two-or three-week hospital stay. The residential quarters provided home-like amenities and made my stay more comfortable," said Duncan.
The Bone Marrow Transplant program at Rush recently received accreditation from the Foundation for the Accreditation of Hematopoietic Cell Therapy (FAHCT). Rush's bone marrow transplant program is fully accredited for allogeneic and autologous marrow and peripheral blood progenitor cell transplantation, including cell collection and laboratory processing. To date, only 18 transplant centers across the country have received this level of accreditation from this comprehensive standard-setting program.
Rush-Presbyterian-St. Luke's Medical Center includes the 809-bed Presbyterian-St. Luke's Hospital; 154-bed Johnston R. Bowman Health Center for the Elderly; Rush University (Rush Medical College, College of Nursing, College of Health Sciences and Graduate College); and seven Rush Institutes providing diagnosis, treatment and research into leading health problems. The medical center is the tertiary hub of the Rush System for Health, a comprehensive healthcare system capable of serving about three million people through its outpatient facilities and eight member hospitals.