Patient endures difficult bone marrow transplant to beat leukemia

In early 2018, Tuscaloosa resident Brenda Peoples was enjoying the slower pace of retirement and falling in love with her future husband, Lovie. Age 64 at the time, she received a shocking diagnosis: leukemia. Now six years later, she credits her new lease on life to a bone marrow transplant at UAB Medicine, along with her positive attitude and support from her family and health care team.

Peoples had complained of chronic fatigue to her primary care doctor, and blood tests revealed a low white blood cell count. She was referred to a hematologist (a specialist in blood disorders), and follow-up testing revealed acute myeloid leukemia, a type of cancer that starts in the blood and bone marrow.

This often-deadly disease causes the bone marrow to produce an excessive number of immature white blood cells, which in turn crowd out healthy blood cells. Common symptoms include fatigue, infection, weakness, and aching bones and joints. Acute myeloid leukemia (AML) is the most common type of leukemia among adults, especially after age 45. The median age at diagnosis is 69.

Peoples had never been in the hospital before, except to deliver her children, and she was generally healthy. “I had slightly high blood pressure, which I was controlling, but that’s it,” she said. “When my doctor said she needed to refer me to a hematologist, that was the first time it crossed my mind to be concerned about something serious.”

Untreated AML can cause death within six months or less, so Peoples was immediately referred to the UAB O’Neal Comprehensive Cancer Center, where she met her primary oncologist Luciano Costa, M.D., who is still her doctor today.

“I was admitted that very same day, having been informed to be prepared for 30 days in the hospital,” she said. “When I got there, I was still in utter shock, but they explained the whole plan in the days while I was getting ready for chemotherapy.”

Bone marrow transplant

Two rounds of chemotherapy were needed to kill the cancer cells, but there was a high risk of the AML coming back. A bone marrow transplant (BMT) offered the best chance for remaining cancer-free in the long term and avoiding more chemotherapy in the future. A BMT involves replacing the stem cells in the patient’s bone marrow with healthy bone marrow stem cells from a donor, and chemotherapy and radiation are given prior to the procedure.

The transplant requires a monthlong stay in the BMT Unit, followed by 100 days of around-the-clock caregiver support at home. Patients must be willing and able to endure the long and difficult process.

“The doctors made it clear that a BMT is just the beginning of new lifestyle that you have to work to get through,” Peoples said. “But I was just thinking, ‘Let’s do everything we can, and take advantage of the latest treatments and care to keep me cancer-free.’ Hearing that I was a candidate for a BMT felt like a blessing to me – in those moments when I wasn’t overcome by drowsiness.”

Her family and husband played a major role, as they would be responsible for her at-home care. Also, Peoples was told that her daughter would be the best possible match for donating bone marrow stem cells. “There was no hesitation from my daughter to be my donor, and her constant support has been a blessing,” Peoples said.

So, after just two weeks at home, Peoples came back to UAB – this time under the care of the Blood & Marrow Transplantation and Cellular Therapy Program. The only one of its kind in Alabama, this experienced team has performed over 3,400 bone marrow transplants since 1991.

Supportive care

Just days after a successful transplant, nurses on the BMT Unit helped Peoples celebrate her birthday with a cake. “The nurses were like mother hens,” she said. “They have a special sense of when you might need your favorite cranberry juice, something to make you comfortable in your bed, pain relief, you name it.”

To make her stay more pleasant, Peoples took advantage of the many supportive care services available at UAB Medicine and the O’Neal Comprehensive Cancer Center. She enjoyed bedside performances from the Music Therapy team, and a dietitian helped her find the most agreeable and healthy food combinations. Her care team even staged a celebration of love between her and her fiancé, which lifted their spirits until they could get married. Once she was cleared to go home, UAB Arts in Medicine had a crafting kit ready for her. “They really treat the whole person here,” she said.

Peoples also developed a close relationship with chaplains from UAB Spiritual Health. “I really think that before someone goes through this treatment, it’s important to get grounded in your spirituality as much as possible first,” she said. “My faith was a foundation for my calm, positive attitude.”

Complications during recovery

Once she returned home to recover from her BMT, Peoples struggled with low energy and other side effects. She needed help from her caregivers in managing her many medications, following a special diet, disinfecting her home to avoid infection, and making weekly trips to UAB. After about 50 days, she developed a magnesium deficiency that required infusions, and she later contracted a cytomegalovirus infection, which is common among BMT recipients and can cause the body to reject the transplanted cells. At one point, a fever required her to stay overnight in the UAB BMT Unit.

“The transplant – getting the stem cells – really just kicks off the BMT process,” Peoples said. “When I got home, the symptoms really hit.”

To make matters worse, Peoples also developed graft vs. host disease, which causes the transplanted cells to attack the body. Short-term symptoms can include mouth sores, skin rashes, abdominal pain, and muscle weakness, and it also can lead to long-term complications and even transplant failure. This required even more strict hygiene at home, along with immunosuppressive medications and oral steroids.

Despite these challenges, Peoples followed her doctors’ instructions to the letter. “No matter what they told me to do, I did it, and I never complained,” she said. “My attitude was that I am part of my care team, so I’ll do my best, like everyone else.”

Better times ahead

After about three months, her condition improved, and she faced fewer complications. She was able to help her husband with small things around the house, and her sister and daughter no longer needed to stay overnight. Her weekly visits to UAB were gradually reduced to once a year, and she lost the weight she’d gained due to taking prednisone, a steroid.

Today, Peoples remains cancer-free, and Dr. Costa tells her that she should be UAB’s “poster child” for how to approach a BMT journey, given how she responded to the many challenges and setbacks.

What advice does Peoples offer to other patients in her shoes? “One, you are getting personalized care at UAB, and you need to do your part to receive it,” she said. “Two, your family support needs to be in place before even considering a bone marrow transplant, because you can’t do it alone. And three, transplant recovery is a challenging new lifestyle that will test your inner strength and faith, but there are better times ahead.”

Learn more about UAB Medicine’s Blood & Marrow Transplantation and Cellular Therapy Program.