In the aftermath of a breakthrough bone marrow transplant, Bryce Maretzki hurts and heals
and finally gets good news
Second of two parts.Several hours after Bryce Maretzkis bone marrow transplant at the Western Pennsylvania Hospital, Dr. Richard Shadduck stopped in to see his patient.
"If spunk has anything to do with it, you should do just fine," said Shadduck, 61, squeezing Maretzkis foot.
At the request of Maretzkis mother, Audrey, Shadduck autographed the now-empty plastic bag of bone marrow donated by an anonymous mother of two children.
Maretzki, 35, of Dormont had waited six years for a breakthrough that would allow him to undergo a transplant without the benefit of perfectly matched bone marrow. Now the protocol he desperately needed to help him fight chronic myelogenous leukemia was available, and in 12 minutes the transplant was complete.
It was March 13. We Maretzki, his friends and family celebrated.
Maybe it was too soon.
Within 24 hours Maretzki, an avid runner who had completed 29 marathons and eight ultra-marathons, became so sick that heavy doses of pain killer did little to ease the sharp pains.
Doctors pinpointed a bacterial infection but had trouble finding drugs to attack it. He had undergone six days of radiation and chemotherapy treatments the week before to rid his body of the diseased cells, but was left with a burned esophagus and lesions on his liver and gallbladder.
A week after the transplant, Maretzki still lay in his seventh-floor hospital bed writhing in pain. His father, Andrew, 72, a plant biologist, and his mother, Audrey, 63, a researcher and professor with a specialty in nutrition at Penn State University, took turns staying with their son, as did his girlfriend, Samantha Roth, 29.
Maretzkis brother Craig, 33, a veterinarian in Davis, Calif., had moved here temporarily. He relieved his parents each night.
On this Friday, Audrey Maretzki watched helplessly as doctors monitored their patient. Bryces fever rose. The pain and nausea intensified.
Craig grabbed his brothers chart as he walked into the room. He washed his hands at the door, as all visitors were instructed to do, and put on a face mask.
"They dont know what this is," Audrey said.
Craig read the chart, put it down and went over to sit by his brother. That was all he could do. Wait.
"I dont know which is worse," said Audrey, herself a breast cancer survivor. "Watching Bryce lying there like that, or watching Craig in pain because he cant do anything for him."
To cure Maretzki of this slow-growing cancer and rid his body of the genetic defect associated with chronic myelogenous leukemia, the Philadelphia Chromosome, Maretzki needed a bone marrow transplant.
For years, he hit roadblocks in finding a donor for new bone marrow, the soft, spongy material responsible for making blood cells. He could find no one not even on a worldwide bone marrow donor registry of 5 million people who had the six antigens, or proteins, that lined up with his marrow.
For most of that time, Maretzki felt well. He even ran the Honolulu and New York City marathons after his diagnosis.
But doctors warned him that the proliferating leukemic cells would soon overtake his body, and he would die.
Then last year, Shadduck, director of the Western Pennsylvania Cancer Institute, directed Maretzki to Dr. Suzanne Ildstad at the Allegheny University of the Health Sciences.
The surgeon, known for transplanting a baboons bone marrow into the body of a human AIDS patient, had recently perfected a technique of using poorly matched bone marrow.
With new technology, Ildstad sorted out a rare cell, which she called the facilitator cell, that could assist in the engraftment of bone marrow. Her ultimate goal was to take solid organs, like hearts and lungs, and put them into recipients while reducing the likelihood of rejection without drugs.
Her first 23 patients became those with leukemia who needed bone marrow transplants to survive. All were in advanced stages of the disease. The new bone marrow engrafted, but the patients died.
Maretzki, her 24th patient, appeared to have the best chance for survival. While his leukemia cells were proliferating, he had not advanced to the last the blast crisis phase of the disease.
About 10 days after Craig put down the ominous report on the chart, Maretzki rallied. The fever subsided, the lesions healed.
Shadduck said that the bone marrow was engrafting, and Maretzkis blood type was gradually shifting from his blood type of B positive to A, which is the donors blood type.
Shadduck released him.
Several days later, a dejected Maretzki was readmitted.
Doctors were concerned that Maretzkis new bone marrow would reject its new environment and that it would develop into the hideous and fatal graft vs. host disease.
Unlike a heart transplant, for example, in which the body can reject the organ, the bone marrow (the graft) accepts or rejects the body (the host).
And it was still too early to know whether the transplant had successfully erased the Philadelphia Chromosome. the genetic chromosome abnormality associated with chronic myelogenous leukemia.
Maretzki again was able to return home, but his future was as uncertain as ever. He couldnt run but took long walks with his brothers Dalmation, Dalmatian, Isabelle.
He returned part time to his job as a special assistant for policy and planning at the Allegheny County Department of Human Services. Every other day, he went to West Penn in Bloomfield for blood tests.
"I cant think about what might happen," a dejected Maretzki said. "Im just not feeling well. I cant concentrate. I feel like the drugs Im taking are messing with my mind. I dont have much strength. I cant sleep, and Im still spiking fevers."
Early last week, Maretzki said that things had improved for him physically. "Im feeling good. Im tired a lot. I cant run yet, but Im OK." Finally, on day 100, the three-month mark after the transplant, Maretzki underwent another painful bone marrow biopsy. The word he longed to hear was "disease-free."
"We use terms such as disease-free survival, " Shadduck said. "In general, if youre free of the disease at two years after the transplant, then you probably have a 95 percent chance it will never return. But were not at two years yet. Were not at one year yet."
On Wednesday, July 15, there were two messages on my voice mail, one from Renee Yasko, West Penns bone marrow transplant coordinator, and the other from Maretzki:
The Philadelphia Chromosome was gone. No leukemic cells could be found.
"Yes, he is disease-free," Shadduck confirmed later. "Thats excellent."
Subdued, Maretzki said that, of course, he was pleased with the results.
"Ive been on a roller-coaster ride too long for me to get really excited about this," Maretzki said. "The peaks were too high, and the valleys, well, they hurt so much. I dont know what to think right now. Its so overwhelming."
In six critical years, technology and scientific theories had come together.
Doctors warn that Maretzki still is not cured; the next several years are critical for the healthy development of his white and red blood cells. His new bone marrow could spontaneously reject its surroundings. Maretzkis body is still susceptible to infections.
But with last weeks findings, Maretzki is ready to move on.
"Its good information," Maretzki said. "Very good information."