Tom Corwin is the Health Reporter for The Post and Courier. He is a graduate of the University of Missouri and has covered science, medicine, politics and state legislatures for newspapers in Missouri, Tennessee, Georgia, and South Carolina.
Even though her son was very sick from the chemotherapy to treat his leukemia, Kahilu Murdaugh of Walterboro knew he was in the right place.
His doctor at the Medical University of South Carolina once left a fancy event at a moment's notice to come back to the hospital to check on him. So Murdaugh is not surprised the program's patients have proven to have one of the top survival rates in the country.
The MUSC Blood and Marrow Transplant Program was recently recognized as one of 12 out of 172 centers to significantly exceed its expected one-year survival rate for its very ill patients. That the period covered was during the COVID-19 pandemic, and while MUSC's pediatric program was moving into a new hospital, makes it even more noteworthy.
The MUSC program was cited by the Center for International Blood and Marrow Transplant Research as one of the top performing programs in terms of the survival of its patients. The center looks at that rate compared to what would be the expected survival of those patients based on a number of factors, such as their disease state, age, type of donor and so forth. For the time period between 2020 and 2022, the survival rate was 78.9 percent compared to an expected survival rate of 71.1 percent.
"We were obviously very excited about that because at the end of the day that's what we're driving for," said Dr. Michelle Hudspeth, director of Adult and Pediatric Blood and Marrow Transplantation and Cellular Therapy. "That's what our patients and families want. We want patients to be cured, and we want them to be thriving."
MUSC is a combined program, with both adult and pediatric transplantation under one administration, and was one of a handful to earn the distinction, she said. That this also occurred during the threat of the pandemic is an added degree of difficulty, Hudspeth said.
The program cares for "the most immune-compromised patients" and sometimes had to look overseas for matching donors at a time when travel was greatly restricted. That's what happened to Fenn, where the first two potential donors he matched with were in Europe but, because of the travel ban, "there was no way that we could get someone over here to do the bone marrow donation," Murdaugh said of her son.
During the pandemic, while many health care services were declining, the demand for cell therapy and transplantation was actually increasing, Hudspeth said. More and more patients were receiving a type of immunotherapy called CAR-T therapy, where immune cells are removed and altered in such a way that they can then be reinjected to target, for instance, cancer cells. And the number of conditions and patients that could receive cell therapy, such as sickle cell disease patients or those with immune deficiencies, were also expanding.
"We are touching not only cancer, but many other significantly devastating diseases, and really able to give children their lives back," Hudspeth said.
MUSC's is by far the largest program in South Carolina doing allogenic, or unrelated, cell transplants, according to NMDP, which tracks those donations. For 2021-22, MUSC did 128, compared to 33 at Prisma Health-Upstate Cancer Institute and five at Roper Hospital. MUSC is also the only pediatric program.
One reason the national and international programs track one-year survival is patients who need those transplants have most often been through intensive treatment before they get to the point where they need those transplants, and that intensive treatment continues up to the point where they receive the donation.
For example, Hudspeth said, those who receive organ transplants like kidneys are often very sick before but once they receive a new organ are much healthier very quickly. But in stem cell transplant, it is very different. Patients like Fenn receive intensive chemotherapy or radiation therapy to wipe out the existing cells to clear the way for a transplant.
"So we're actually making patients much sicker and much worse before the transplant process," Hudspeth said. The team caring for those patients has to be highly skilled because they "really are managing multi-organ issues for patients who've already undergone quite a quite a bit of therapy and quite a bit of care," she said.
That complex care also comes with the outside complications of family life, and in Fenn's case it involved difficult timing.
In March 2019, he had been running a "weird fever" that didn't respond to medication so his mother dropped him off with her mother as she drove to take her final exams in nursing school. Before she got there, her mother called to ask "where all the bruises on his legs were coming from." A quick online search brought up leukemia, so she detoured to meet them at the pediatrician, who sent them for bloodwork at MUSC. That was when the family met Hudspeth, who told them it was leukemia and that Fenn needed to be admitted to the hospital.
"And that we were going to be staying for a while," Kahilu Murdaugh said.
Fenn was diagnosed with acute lymphoblastic leukemia, a common childhood blood cancer, but he also had Philadelphia chromosome, a rare complication that makes his case high-risk. Fenn, then just 18 months old, endured rounds of chemotherapy and at one point developed painful neuropathy, where the drugs damaged nerves in his feet.
"It bothered him so bad he went back to crawling," his mother said, "and he would pick his feet up so his feet wouldn't touch the ground."
That thankfully passed, but the chemotherapy continued. Fenn and the family made it through COVID's arrival the following year, and Murdaugh graduated from nursing school that August.
And then his bloodwork showed the cancer had returned, and this time his best chance was a bone marrow transplant.
His mother was also in her second trimester with his little brother at that point.
After the first two potential donors in Europe were ruled out, and a third declined, they got lucky with the fourth in October 2021. But Fenn again had to endure intensive chemotherapy before the procedure. And afterward, even after leaving the hospital, the family had to stay in a hotel in Mount Pleasant to be closer to MUSC in case of complications.
But luckily when Murdaugh went into labor it was close to her OB/GYN at East Cooper Medical Center.
Fenn, now 7, is fine and energetic, playing with his younger brother, 4-year-old Kashton, even as his mother keeps a close eye on any rashes or moles because Fenn is now at a higher risk of skin cancer.
Her vigilance was matched by MUSC's during his care, she said. One night in the hospital as Fenn was still undergoing chemotherapy, his condition took a turn for the worse and suddenly there at his bedside was Hudspeth and another physician, all dressed up.
They left the gala "and in their ball gowns and heels came to the hospital to put their eyes on him," Murdaugh said.
And that was actually not that unusual. The night of his transplant, despite a long delay, the nurse who was supposed to be on her day off stayed to watch over him, and Hudspeth stayed, as well. That seemed to be standard operating procedure.
"It was always 'all hands on deck,' " Murdaugh said. "Very one-on-one, very patient-specific."