Transplanting the Gift of Health
This article was originally published in Spokane Coeur d' Alene Living.
by Paige Turner
Dr. Hakan Kaya never forgets the birthday of a patient that he met several years ago. The day is so easy to remember not just because it also happens to be his birthday, but because it was on their birthday that this patient was diagnosed with Leukemia. Sitting in his office, feeling her world fall apart and fearful of the future, the meaning of the diagnosis began to sink in. Leukemia. Cancer. A disease that could kill her. What was she to do? Luckily she was in the hands of Dr. Kaya, a physician with a special expertise in treating leukemias and helping people say “I used to have Leukemia,” rather than “I have Leukemia?”
After graduating from medical school in Turkey, Kaya left his homeland for Wake Forest University in North Carolina where he did a three-year fellowship in hematology, oncology and transplantation. When he came to Spokane and started practicing at Cancer Care Northwest, he became the only fellowship trained transplant physician in the region.
A cancer of the bone marrow cells, Leukemia can strike anyone at any age. Bone marrow is essential because it creates three types of cells: white blood cells to fight infection, platelet cells to help your blood clot, and red blood cells to bring oxygen to the body and give you energy. The cancer impacts these three types of cells.
“I need to educate my patients,” says Kaya, who realizes that most people do not know much about Leukemia. Here is a basic lesson.
There are two types of Leukemia; acute and chronic.
Acute leukemia is the most lethal of all cancers as it can kill you within weeks. You can quickly develop infections (lack of white blood cells), bleed a lot (lack of platelets) and feel fatigued (lack of red blood cells). This form is often diagnosed because a patient sees a doctor due to feeling extremely fatigued, having high fevers, infections, bruises and bleeds more often than normal. Luckily this form is somewhat rare.
The more common form of Leukemia is chronic, which is a slow growing cancer. This type of cancer is usually discovered during a routine medical exam. For instance, you could go in for a regular appointment, and during routine blood work, they notice your white blood cell count is high. You may not be feeling any symptoms when diagnosed.
Under the umbrella of acute Leukemia, there are two types: ALL (acute lymphocytic leukemia) and AML (acute myelocytic leukemia). ALL is usually a disease of childhood. “Nowadays we have great success treating childhood leukemia,” says Kaya. “In fact we can cure it.”
Often cancers can be treated, but not cured. That is one thing that makes Leukemia unique. “There is a pretty good chance you can be cured from Leukemia,” says Kaya. Although he is well aware of the success rates, he is also understanding of the fear that grips his patients upon diagnosis. “You have to apply emotional support. I sit here and I hold their hands,” he says. “How can you not hug someone if they have tears in their eyes?”
If a patient is found to have symptoms of Leukemia (high white blood cell count, fever, sickness, etc.) they are often sent to Kaya for a confirmation. This is done through a procedure known as a bone marrow biopsy. Taking only five to ten minutes, a thick needle is inserted into the hip bone and draws out marrow, which is then sent to a pathologist to be read.
For anyone who is facing the prospect of a diagnosis of Leukemia, they are often on edge, and the added stress of a biopsy can leave them feeling frightened and nervous. Kaya recognizes this and works to make his patients feel comfortable throughout the procedure, using humor and an emotional connection to make them feel better. “We talk them through the whole thing,” he says of the procedure. He has even been known to joke with his patients, lightening the mood by saying he has never done this before but he has seen it on TV! Patients respond to the joke and feel more relaxed, which makes the procedure easier to complete. “I joke all the time, joking is important!” says Kaya, a doctor who likes to prescribe high doses of laughter for his patients.
If the biopsy comes back with a diagnosis of Leukemia, patients and their doctors need to plan an approach to treatment quickly, because Leukemia is a fast acting cancer. On the flip side, though, it is also highly treatable with an aggressive treatment plan. A stem cell transplant like the one Kaya performs, called an autologouos transplant, is one of the options for certain patients. This is what it looks like:
Patients will be hospitalized immediately upon diagnosis and put through intense amounts of chemotherapy in order to kill the cancer and put them into remission. They must stay in the hospital throughout the entire time (usually 4 weeks), because their immune systems will be so weakened that they are susceptible to any germs they come into contact with. Once the cancer has been put into remission, with all of the cancer cells killed off, they are discharged from the hospital. For transplant candidates, harvesting stem cells would be the next step. Much like a dialysis machine that filters blood, harvesting stem cells is done by drawing the blood out of the body, where upon stem cells are filtered out of the blood, and are then frozen.
The bone marrow is then all killed off, and the reserved stem cells are reintroduced to the body, where they take hold and reproduce healthy bone marrow. Because they were harvested after all of the cancer had been killed off the bone marrow that rebuilds is healthy and Leukemia-free.
(It should be noted that the stem cells that Kaya works with are very different from the often controversial field of stem cell research where stem cells are harvested from umbilical cords and etc.)
Patients usually face a two-to-three week stay in the hospital post-transplant in order to ensure their immune system has time to rebuild and that they allow their body time to heal and strengthen itself. In this world of instant gratification, people want results quickly. Despite the seeming ease of this procedure, especially compared against other options, it is essential for both patients and their family to remember this is still a hardship for your body and requires patience as you rest, regain strength and build up your health.
The mortality rate for this procedure is very low, usually less than 3 percent, while the mortality rate for other options including allogeneic transplants is between 20 and 30 percent. The procedure here autologouos transplant is not right for everyone or every situation, so it is up to a doctor to help you figure out what your case needs, based on risk factors, health and etc.
“The only reason I am able to do stem cell transplants in Spokane is because of physicians from other specialties in the Spokane medical community,” says Kaya. “I have full support of the medical community.” That support means that Kaya knows he can team with specialists who help him provide the best care. The fact that Spokane has so many wonderful doctors is what makes his work possible and is something that Kaya was thrilled to discover when he moved here. “When I moved here I thought Spokane was a small town,” he says of his impression 6 years ago. “It is the Mayo Clinic of the Northwest,” he now says, comparing the skills, services and specialists in our medical community to that of one of the highest regarded medical meccas in our country. “The most important thing I tell them [patients], I guarantee the therapy you will get here is the same you’d get at Mayo or Harvard. I think we give better care here than anywhere else.”
Leukemia is a very rare disease he says; especially acute Leukemia. “I see only 10 acute leukemia cases a year,” says Kaya. With every patient he treats, he offers hope. “They really need to know with new advances in the medical field, everything is treatable, and many times curable. We have excellent treatments now. There is a lot of hope for the future.” He looks to how far we have come over the years with medical care as part of this hope. “Fifty years from now people will laugh at us,” he says, dreaming of a future where it seems funny that we succumbed to the things we did. “It’s all going to make a difference. This is a field you can make a dramatic difference in people’s lives. I can’t imagine something better.”
On his most recent birthday, Dr. Kaya’s birthday-sharing patient brought him a cake, to celebrate not only their birthdays, but also her three years of being cancer free thanks to the innovative care she received here in Spokane. That may be the best gift either of them has ever received.