Cook Children’s Health Care System
801 Seventh Ave.
Fort Worth 76104
Elijah Felton, a 10-year-old with sickle cell anemia, received the 1,000th bone marrow transplant at Cook Children’s Hospital on Sept. 22, but he’s probably not the most recent recipient by now.
Five other young patients with cancer and blood disorders were scheduled for bone marrow transplants (BMTs) at the busy Fort Worth hospital in the weeks following Elijah’s.
In addition, several more children were recovering from their recent transplants when Elijah completed a week of intense chemotherapy to destroy his sickle cells and received healthy stem cells from the bone marrow of an anonymous, unrelated donor.
“Where a transplant 20 years ago would have been the treatment of last resort, this is absolutely not the case today,” said Dr. Gretchen Eames, medical director of Cook Children’s Hematology and Oncology Center. “Now BMT is a very intense treatment that we can offer patients early in their therapy with the hope that we can save more children, and they can live long and productive lives.”
For some children with leukemia, BMTs are the upfront therapy – used after first remission if the patient is at high risk for relapse, Eames said. At the same time some patients can be treated with new, more specific, less toxic chemotherapy agents that zero in on the cancer cells without harming healthy blood cell and healthy immune systems so that a bone marrow transplant may not be necessary.
“Over the years, we have started doing fewer for leukemia patients because some do very well without intensive therapy, and there are fewer side effects,” Eames said. “Research now is certainly centered on the [perfect] therapy before transplant, deciding on intense therapy versus reduced, trying to determine the least amount necessary so there are less long-term side effects – healthier survivors.”
Cook Children’s Bone Marrow and Stem Cell Transplant Program has grown from 15-to-20 matched sibling transplants 20 years ago to 40-to-50 transplants today, mostly from unrelated, matched donors located through the National Marrow Donor Program.
The marrow inside our bones makes all the healthy blood cells our bodies need – red blood cells to carry oxygen throughout the body, white cells to protect against infections and platelets to provide clotting, Eames explained.
Bone marrow transplants are given like blood transfusions, through an intravenous tube. The donor stem cells travel to the recipient’s bone marrow where they engraft, reproduce and are stored until they can begin functioning as mature blood cells, a process that can take several months.
Dr. Paul Bowman performed the first pediatric BMT in the southwest United States on a baby born with acute lymphoblastic leukemia at the old Cook Children’s Hospital 30 years ago. Since then, 1,000 children with leukemias, lymphomas, sickle cell disease, aplastic anemia, immune system and metabolic disorders and brain tumors have undergone the life-saving treatment at Cook.
“None of our patients have to be referred elsewhere from here,” Eames said. “We get them from all over the country, and our team here at Cook has the ability and experience to transplant any patient for any disease where bone marrow transplant may be indicated.
“Overall, about half the bone marrow transplants we do now are for non-cancer diagnoses. We started them for sickle cell back in 1996, and most of those children are doing very well. The transplants can’t undo damage the sickle cells have already done, but sickle cell disease is not still adding to the problems.
“For sickle cell, we used to consider bone marrow transplants only after [the patient develops] multiple complications. Now we know it is much better if the transplant is done very early, while the patient is still a child or adolescent,” Eames said.
Sickle cell disease is an inherited disorder characterized by abnormally shaped blood cells that cause long-term, chronic anemia and pain. It can lead to strokes, blindness, acute chest pain, damage to the immune system and infections. Treatment includes blood transfusions, pain management and infection control.
Elijah was three months old when his sickle cell disease was diagnosed through the routine blood test now given to all infants born in Texas before they ever leave the hospital.
“We learned the screening results by mail three months after Elijah was born [in Bryan], and as soon as we found out, we came straight to Cook. He has been in and out of the hospital ever since,” said Erica Burton, Elijah’s mother. “Anything can trigger an infection. He has had more blood transfusions than I have fingers on both hands.
“He had his first pain crisis when he was 6 or 7 months old,” said Burton, who moved to the Fort Worth area when her son was about a year old and now lives in Cedar Hill. “We moved here to be close to Cook as soon as we knew he had sickle cell and that Cook was the best place in the country to get treated for it.”
Burton said she started thinking seriously about a bone marrow transplant several years ago, when her son was in the hospital for 10 months, and she spent a lot of time talking to other families about the treatment. Then, in August, his whole body locked up with pain and he couldn’t move.
“He temporarily lost circulation to the left side of his brain. There was no permanent damage, but that prompted me to go ahead with the transplant. We just wanted to head off any complications or emergencies that could cause permanent damage down the line. Hopefully this will allow him to have a much more normal life,” his mother said.
“The goal is for this to be a definitive, curative therapy where his body will no longer be making defective blood cells. He will no longer be susceptible to the complications of sickle cell,” Eames said.
In the meantime, Elijah, who loves doing anything outdoors and really wants to play football and be a pilot when he grows up, was feeling pretty puny in the days after chemotherapy and the transplant. He will be in the hospital at least six weeks and be followed closely the next two years.
“He’s a trooper,” his mother and his doctor agree.