What a Difference a Year Makes

Veatrice Harris wasn’t afraid of battling cancer. She leaned on her faith, her family, and her UNC caregivers to face the toughest year of her life. Now, thanks to an innovative procedure called a 50/50 bone marrow transplant, Veatrice has renewed hope for 2015.

What a Difference a Year Makes click to enlarge Veatrice Harris calls her team of caregivers her “UNC family.” (L to R) Monique Clayton, RN, BSN, clinical trials study coordinator; Veatrice Harris; her husband Jonathan Harris; and Jack Zhang, RN, BSN, clinical trials study coordinator.

It was July of 2014, and Veatrice Harris was checking items off her very long ‘to-do’ list.  As a missionary in her place of worship, Gaston Missionary Baptist Church in Gaston, NC, she had a calendar full of activities planned, and she was looking forward to a visit with her three grandchildren who were on summer vacation.  But her annual physical was also on that list of things to do, so she kept her appointment with her internist, Jonathan Jack, MD, of Roanoke Rapids, where she and her husband Jonathan live. Veatrice was feeling well, so she was surprised when Dr. Jack seemed concerned about her bloodwork. 

“Your white cell count is down, and we don’t know why,” he explained after a thorough examination and an extensive review of her labs.  “I’m going to refer you to Dr. Mahendra Patel, who’s an oncologist here in Roanoke Rapids.  He’ll run some tests, and we’ll find out what’s going on.”  

Veatrice didn’t know it yet, but her summer plans were about to change.

The Cancer Journey Begins

The next few weeks for the Harris family were filled with doctor’s appointments, various medical tests, and lots of prayers.  Dr. Patel believed Veatrice had leukemia, but he referred her to medical oncologist Timothy Brotherton, MD, clinical director of the UNC- Hillsborough Campus hematology-oncology clinic and infusion center, for a second opinion.

“Dr. Brotherton agreed with Dr. Patel’s diagnosis, and after a biopsy confirmed that I had leukemia, he admitted me to the N.C. Cancer Hospital on August 4, 2014,” says the 63-year-old.  “He told me to plan on being away from home for quite a while.”

Veatrice’s biopsy showed she had pre-existing MDS, or myelodysplastic syndrome.  In MDS, some of the cells in the bone marrow are damaged and have problems making new blood cells, leaving the person without enough normal blood cells and with low blood counts.  MDS can turn into a fast-growing cancer of bone marrow cells called acute myeloid leukemia, which is what happened to Veatrice.  When this type of leukemia, also known as AML, occurs in a patient with MDS, it is usually very aggressive and is only rarely curable.

Because of the nature of Veatrice’s cancer, combined with the fact that she was over the age of 60 and considered at increased risk for a poor outcome with traditional chemotherapy, she was eligible for a clinical trial.  According to Veatrice’s leukemia specialist, Joshua Zeidner, MD, UNC Hematology/Oncology, the type of chemo used in the clinical trial she enrolled in is called CPX351, which is a unique formulation of two traditional chemotherapies.  During the trial, 50 percent of participants were randomly chosen to receive CPX, while the other 50 percent received the standard treatment.  Veatrice was thrilled to receive the experimental drug.  “However, after 14 days of taking CPX, a biopsy showed that Veatrice still had leukemia in her bone marrow,” says Dr. Zeidner.  “So she received another round of CPX, and we were pleased to see her go into remission.” 

“Dr. Shea and Dr. Zeidner took such good care of me while I was sick,” Veatrice says. “Words can’t express how thankful I am to everyone who played a role in helping me get well.” 

Following the clinical trial, Veatrice went home in October, and she was able to enjoy the holidays with her family.  But even though tests showed there was no leukemia in her bone marrow, Veatrice’s blood counts didn’t rebound as they should.  “Most patients’ blood counts recover within about 40 days after chemotherapy,” Dr. Zeidner explains.  “That wasn’t the case with Veatrice.  It took nearly four months for her white cell count to improve, and her platelet count never fully recovered, even without any leukemia present in her bone marrow.”

Veatrice’s physicians agreed that what she really needed was a bone marrow transplant (BMT), and they had to act quickly.  Low blood counts frequently predict a poor prognosis, and they knew her cancer was likely to come back within just a few months based on the chromosomes found in her leukemic cells. But to do the BMT, doctors needed a stem cell donor for Veatrice. 

“Normally, we look for a donor who matches the patient's tissue type, specifically their human leukocyte antigen (HLA) tissue type, which is much more complicated than matching blood types,” explains Dr. Zeidner.  “The closer the match between a patient's HLA markers and the donor’s, the better for the patient.  So Veatrice’s siblings were sent a swab test kit.  They simply swabbed the inside of their cheeks to gather cells, and then sent their samples back to UNC.”

Unfortunately, none of her siblings were a good match.  Veatrice’s options were dwindling. 

A 50/50 Donor

Although no perfect donor matches were found for Veatrice, Dr. Zeidner knew he had to act quickly and discussed the option of a haploidentical transplant with the Bone Marrow Transplant team. Dr. Zeidner had experience treating patients with haploidentical transplants during his training at Johns Hopkins Hospital and was particularly excited about this type of transplant for Veatrice.

“It’s called a ‘haploidentical transplant,’ which means a half-match,” says Tom Shea, MD, director of the UNC Bone Marrow and Stem Cell Transplantation Programs.  “Using this procedure, which was developed at Johns Hopkins, a patient’s parents or children could be suitable donors.  Rather than wiping out a patient’s immune system before transplanting donor bone marrow, we administer just enough chemo to suppress the immune system, which keeps the patient from rejecting the donated marrow without harming their organs. As a result, the side effects are much milder.  This procedure also greatly expands the potential donor pool, making more patients eligible for this type of transplant.”

On January 6, 2015, Veatrice began a round of standard induction chemotherapy, and seven days later, her daughter Tiffany Harris Mitchell came from Danville, Virginia to be her donor.  The transplant only took a few hours, and Tiffany was able to go home that same day.

In the world of cancer, a patient’s transplant day is called ‘Day 0’.  That’s when the countdown began for Veatrice.  “After a one-month stay in the hospital, I was required to stay in Chapel Hill (near the cancer hospital) as an outpatient for two months because that’s when I was at the highest risk for infection,” she explains.  “So on February 5, my husband Jonathan and I moved into the SECU Family House right down the street from the hospital.  It was a wonderful home-away-from-home.”

As the weeks passed, Veatrice got stronger, and blood tests showed that all the cells in her immune system were her daughter’s, which is exactly what Dr. Shea wanted.

“There was no graft rejection, which is when the patient’s immune system tries to fight off the donor cells, and no graft-versus-host disease, which is when the donor cells (the graft) attack the patient (the host),so we were happy about that,” says Dr. Shea.  “It really was a textbook response, and Veatrice’s recovery went extremely well.”

On April 24, 2015, Veatrice and her husband held hands as they rode the elevator up to the second floor of the N.C. Cancer Hospital.  “It was Day 100, my tentative ‘go-home’ day,” says Veatrice.  “But first, I had to go to the Bone Marrow Transplant clinic to have blood work done and to see Dr. Shea.  I was excited, just filled with anticipation.”

After reviewing her test results, Dr. Shea told Veatrice the good news: there’s no sign of cancer.  Tears of joy were followed by hugs and words of thanks. 

“Dr. Shea and Dr. Zeidner and all these other people in my UNC Lineberger family took such good care of me while I was sick,” Veatrice says.  “Words can’t express how thankful I am to everyone who played a role in helping me get well.”

As Veatrice and Jonathan made their way through the cancer hospital corridors and headed to their car for the ride home to Roanoke Rapids, the couple repeatedly stopped to chat when greeted by members of Veatrice’s caregiving team. ‘Congratulations!’ they said when they heard she is cancer-free. 

“See, they all know me,” she said with a grin as she posed for a candid photo with two members of her clinical trial team.  “UNC is like no other place I’ve ever seen, and I’m convinced they are successful because they truly care for people.  I’m forever grateful to them and to God.”