Patient Story: Mary Ternullo
Mary Ternullo's Bone Marrow Transplant
Mary Ternullo, 73, always enjoyed digging in her gardens and planting flowers. She never dreamed that her own life would one day depend on the transplanting of stem cells from a far-away donor, along with expert medical care at the Blood Cancer, Bone Marrow Transplantation and Cellular Immunotherapy program at the Cancer Center at Beth Israel Deaconess Medical Center (BIDMC).
Ternullo is a resident of Plymouth who worked as a dental administrator for 17 years. She maintained a healthy diet, exercised and thought she was in “perfect health.” Until the summer of 2013, that is, when she developed chest pain and experienced severe fatigue.
In August, she was alarmed by heart palpitations and was rushed to South Shore Medical Center, where blood work was done and she was given “the most shocking news”: In addition to atrial fibrillation (irregular heartbeat), she had a high percentage of blasts (immature blood cells) — and that meant leukemia, a cancer of the blood.
The next stop was the Emergency Department at BIDMC. The staff did more blood tests and admitted Ternullo to the Bone Marrow Transplant (BMT) unit, where a bone marrow biopsy was performed to assess blast count and chromosomes. The diagnosis was acute myeloid leukemia (AML).
Then came a family meeting. Her medical team — including Malgorzata McMasters, MD, who became Ternullo’s hematologist/oncologist — explained the need to begin chemotherapy and initiated a search for a donor for an “allogeneic” stem cell transplant, which uses someone else’s cells.
Finding the Right Match
Timing was critical. Ternullo started seven days of chemotherapy followed by administration of several antibiotics and blood products while her white blood cells (which fight infection), red blood cells (which carry oxygen) and platelets (which prevent bleeding) were dangerously low.
At the same time, BIDMC initiated the testing of Ternullo’s human leukocyte antigen (HLA) type by sending her blood sample to the American Red Cross. The HLA type is used to identify a bone marrow donor match.
Following a month of induction therapy, Mary Ternullo was thrilled to learn she was in remission and would be discharged. But she was anxious about whether the right donor could be found.
According to Denise Cummings, RN, BMT Nurse Transplant Coordinator, the best donor is a sibling with the same HLA type. None of Ternullo’s close relatives had the same type as Mary, so attention focused on tapping into the Bone Marrow Donor Program, which maintains an international registry of candidates.
"The best unrelated match for Mary was a younger man with the same blood type and matched HLA type,” says Cummings, explaining that women who have been pregnant may have unwelcome antibodies. “Also important is the donor’s commitment, since some change their minds.”
While the search was on, Ternullo was readmitted to BIDMC for a week of “consolidation” chemo to prevent relapse.
Shortly thereafter, BIDMC narrowed the field of donors, coordinated further testing, and found their man: Dr. Robert Luckner, a neurosurgeon from Germany, who was 38 at the time (with Ternullo at right).
“Gratification and gratitude — that’s how I’d summarize my experience with Mary,” said Luckner in an email from across the sea. “I wanted to help save a life, and I’d do it again and again. The process is not too complicated, and more donors are needed to increase the worldwide database and help save more lives. I am connected to Mary forever.”
Exchanging Cells
The transplant was scheduled for November 2013. Ternullo had a final round of chemotherapy, called conditioning, prior to transplant. Then came a one-hour intravenous stem cell transfusion to replace damaged cells with healthy ones.
After the stem cell infusion came a challenging month of recovery in the hospital. During this time, while Ternullo’s immune system was compromised, special precautions were taken to prevent infection. Aside from McMasters, Cummings and other medical professionals, only members of Ternullo’s family were allowed to visit.
After three weeks of blood work and careful monitoring, Ternullo was discharged, but she didn’t go home. Instead, she took advantage of a BIDMC program that accommodates patients at the Longwood Inn across the street, thus avoiding long commutes.
Again, Ternullo had checkups at BIDMC every day for a month. She was finally discharged home with restrictions about activities, visitors and diet.
“Between my excellent and compassionate medical team and my wonderful caretakers at home, I was in very good hands,” says Ternullo. “And of course, my guardian angel, Dr. Luckner, who saved my life.”
As Ternullo slowly regained her energy at home, she dealt with Graft-Versus-Host Disease (GVHD), where the donor’s immune cells may attack the recipient’s body. Patients in Ternullo’s age group who have had allogeneic stem cell transplants are at greater risk for complications, including GVHD.
Ternullo’s GVHD is chronic but mild, with symptoms including tight skin and dry eyes and mouth. Fortunately, prednisone is helping treat this, and ironically, GVHD, a naturally occurring form of immunotherapy, is also mitigating chances of relapse.
Meeting Her Match
As Ternullo was able to gradually reduce her visits to BIDMC, she increased her correspondence with Luckner. It took more than a year to exchange personal notes because the transplant protocol calls for no contact during that period. In October 2016, Ternullo and her husband cruised the Rhine River and met Luckner in Cologne, Germany. “We spotted each other and ran into each other’s arms,” she recalls.
According to McMasters, “Mary has a great attitude, and she’s done very well as she approaches her five-year mark of being cancer-free. Allogeneic stem cell transplant is a curative, but very difficult treatment option for patients with acute leukemia and other hematologic malignancies. Thanks to recent advancements and use of reduced intensity conditioning, older patients [more than 60 years old] like Mary can now be offered this life-saving procedure.
“It’s a world-class program at BIDMC, which is renowned for its research and has a whole range of therapies,” says Ternullo, who is happy to be back to her gardening. “All I can say is, thank goodness for the advancements in medicine and the kindness of strangers.”
July 2017