Center News Magazine: New Clinic Enhances Adult Bone Marrow Transplant Service

Monday, December 1, 2008
(Left to right) Adult BMT Service Interim Chief James Young, clinical researcher Juliet Barker, and allogeneic BMT outpatient service Clinical Director Ann Jakubowski (Left to right) Adult BMT Service Interim Chief James Young, clinical researcher Juliet Barker, and allogeneic BMT outpatient service Clinical Director Ann Jakubowski

Opened in the spring of 2008, a new outpatient clinic within Memorial Hospital is enabling Memorial Sloan Kettering’s adult allogeneic bone marrow transplant (BMT) service to enhance comfort and convenience for a rapidly growing patient population.

With this new facility, we are able to care for more transplant patients in a calming environment, improving their well-being while greatly reducing wait times,” said James W. Young, Interim Chief of the Adult BMT Service. “The outpatient clinic provides, in a single location, the follow-up treatments that patients need after they have received their transplants.

Memorial Sloan Kettering Cancer Center has been a leader in bone marrow transplantation as a treatment for cancer since Center physicians performed the first successful transplant from an unrelated donor in 1973. Such transplants, from one person to another, are called allogeneic. This type of transplant uses cells obtained from a donor — either a family member or someone unrelated — whose tissue type closely matches that of the recipient. Today, the Adult BMT Service more commonly performs allogeneic transplants using blood stem cells rather than marrow. The service also does allogeneic transplants using stem cells from umbilical cord blood. (Autologous transplantation, in which a patient’s own cells are used, is also performed at Memorial Sloan Kettering but by another service.)

Demand for transplants has surged at Memorial Sloan Kettering in recent years because, Dr. Young explained, the treatment benefits people with a variety of cancerous and noncancerous diseases. There also are more varied ways of performing transplants, as the field has expanded to treat diseases common in older patients. Finally, more people are eligible for allogeneic transplants from unrelated donors due to improvements in matching tissue types. As a result, the number of adult patients receiving allogeneic transplants at Memorial Sloan Kettering jumped from 58 in 2004 to nearly 120 projected for 2008.

Allogeneic stem cell transplantation patients typically remain in the hospital for several weeks following the transplant. After they are discharged, they require extensive, specialized care that may include blood transfusions, intravenous drugs, and respiratory treatments. Before the new outpatient clinic opened, patients received these treatments in the Adult Day Hospital, sharing the space with patients being seen for other types of cancer. As the number of transplant patients increased, the logistics of accommodating all their treatment needs became a challenge.

The clinic's waiting room is for the exclusive use of transplantation outpatients. The clinic’s waiting room is for the exclusive use of transplantation outpatients.

Allogeneic stem cell transplantation patients typically remain in the hospital for several weeks following the transplant. After they are discharged, they require extensive, specialized care that may include blood transfusions, intravenous drugs, and respiratory treatments. Before the new outpatient clinic opened, patients received these treatments in the Adult Day Hospital, sharing the space with patients being seen for other types of cancer. As the number of transplant patients increased, the logistics of accommodating all their treatment needs became a challenge.

Memorial Sloan Kettering recognized that a dedicated outpatient space would increase efficiency and patient comfort. The new clinic includes five examination rooms, a consultation room, and four private bays equipped with recliners and flat-screen televisions for use during intravenous procedures. There also is an isolation room with a stretcher if a patient needs to lie down or be treated in private. A full-time nurse practitioner and a social worker are in the clinic to attend to patients’ needs and concerns.

A top priority in designing the clinic’s layout was to maximize the flow of patients to ensure they could get what they need quickly,” said Dayna Orange, Administrator of Ambulatory Care at Memorial Hospital. “We went through multiple architectural plans before deciding the optimal location of each room. Now a patient can see his or her doctor in the exam room and afterward walk only a couple of steps to receive specialized treatment.

Consolidating therapies into one space also allows patients to leave the hospital sooner. “A transplant patient might need a specific treatment, such as a platelet transfusion, every two days,” said Ann A. Jakubowski, Clinical Director of the outpatient service for allogeneic BMT. “If they are well enough to be discharged, it’s unfair to hold them in the hospital while they wait for their next transfusion.

Private bays enhance comfort during intravenous procedures. Private bays enhance comfort during intravenous procedures.

Juliet N. Barker, a clinical researcher who has spearheaded Memorial Sloan Kettering efforts in umbilical cord blood transplantation, said cord blood transplant patients in particular need to come in frequently after their transplants for transfusions and measurement of drug levels in the blood. “After discharge, they usually are still weak and exhausted,” she said. “They can’t be spending lots of time sitting in waiting rooms. With this new clinic, they can turn up, be treated quickly, and go home.

Transplant patients remain vulnerable to infection for many months following a transplant, as their immune systems slowly recover and start to function normally. The new clinic enables them to be relatively isolated from other patients after their transplants. The need for as clean an environment as possible dictated some of the facility’s design decisions.

We were very careful in our choice of finishes, as well as in the cabinets installed in both the clinic’s patient areas and its storage spaces, to ensure they could be easily cleaned and would not harbor bacteria,” said Anthony Hagan, Senior Projects Manager of Construction in the Department of Facilities, Construction, and Design.

Another advantage of the new clinic is that if a patient needs to be hospitalized, he or she can come to the clinic and be admitted directly from there rather than going through the Urgent Care Center (Memorial Sloan Kettering’s emergency room). Discharged patients also can come to the clinic for unscheduled appointments or treatments.

We have more flexibility for unplanned visits that don’t need to be seen in Urgent Care,” Dr. Young observed. “If a patient calls and says, ‘I have a rash,’ and you can’t assess it over the phone, we now have a place where they can be seen. The nurse practitioner can evaluate the patient and then contact the physician regarding treatment. We’ve already used the new clinic for these situations quite a bit.