The gift of family: Evolving the use of an innovative pain management technique for bone marrow donation

In recognition of Childhood Cancer Awareness Month this September, the inspiring story of Ava, a young leukemia patient, stands out. Ava's life was forever changed when her sister Allyssa selflessly donated bone marrow, offering her a second chance. Their journey underscores the power of family and the hope that comes with medical advances in the fight against childhood cancer.

It was January of 2023 when the Wease family heard news they never expected: Their daughter, Ava, was diagnosed with leukemia. It all started when small spots started appearing on Ava’s feet and ankles. The family initially dismissed these as bug bites after a family walk in the mountains, but when the spots continued to spread and Ava’s energy decreased, they became more concerned. 

 

Despite an urgent care visit for treatment, Ava's symptoms persisted. “The spots kept increasing, and I knew she needed to be seen as soon as possible, so we took her to the emergency room through a hospital system in Georgia. My motherly instincts kicked in in the waiting room – I started feeling the back of her neck and noticed her lymph nodes were swollen, and her stomach was protruding,” said Charlina Wease, Ava’s mother. 

With a white blood cell count over 300,000, Ava was diagnosed with B-cell leukemia, which is the most common type of acute lymphoblastic leukemia and considered very curable. Ava immediately started chemotherapy and spent two weeks in the hospital, including some time in the intensive care unit (ICU).

“She came very close to remission, but we discovered she had a mutation, which threw a curveball and required a bone marrow transplant. Luckily, the doctors referred us to MUSC, and while we had no family in South Carolina, we knew we wanted to see Dr. Hudspeth,” said Max Wease, Ava’s father.

During this difficult time, Ava’s sister, Allyssa, was identified as a half. or haplo-identical, match. “For the parents, it’s exciting that her sibling can be used as a match, but it’s also a difficult day because they now have two kids who are patients,” said Michelle Hudspeth, M.D., director of the Division Pediatric Hematology/Oncology and director of the Pediatric Blood and Marrow Transplant program.

"The fact that we can successfully do a half matched transplant speak to the advances in the field. MUSC helped design and participate in the pivotal pediatric trial with haplo-identical donors from 2015-2017 that made Ava’s transplant possible."

Allyssa’s role as a bone marrow donor became crucial in Ava’s fight against leukemia. Though the procedure was challenging, the innovative use of a regional anesthesia technique called a quadratus lumborum (QL) block, performed by Nicole McCoy, M.D., assistant professor in the Department of Anesthesia and Perioperative Medicine, made Alyssa’s pain and recovery much more manageable. 

“This technique is really a game-changer for patients undergoing bone marrow donation,” said McCoy. “Historically, this nerve block has been utilized for pain control in lower abdominal procedures. This is the first time we're seeing it used for pain control of the posterior hips, and the result of decreased opioid administration has been astounding. In our most recent study, the number of patients who received any opioids decreased from 84% to 23%.”

McCoy said that's an important trend as providers look to create ways to provide adequate pain control, reduce side effects from opioid medications and decrease fears related to opioid administration and potential misuse. 

“The pain relief from the QL block often lasted 36 to 48 hours, so the acute pain from the procedure was managed well even after patients left the hospital. And almost no patients needed to take opioid pain relievers during their recovery, which is a huge win.”

 

“This was a great example of partnership and collaboration. Dr. McCoy took an existing technique and thought outside the box to apply it for this situation, and it has totally changed how quickly donors like Allyssa can get back to themselves again,” added Hudspeth. In fact, Allyssa said she was happy she healed quickly because she got to come home and play outside again.

McCoy explained that this collaboration reflects MUSC’s family-centered care model. “I have a passion for alleviating pain in bone marrow donors specifically. Knowing the parents have to take care of both patients, our goal was to hand the children back to their parents comfortable and safe so the family can focus on celebrating the successful transplant.”

Now, one year later, the family and care team at MUSC are thrilled to know that the bone marrow donation was a success, and Ava shows no signs of leukemia. Allyssa is back to cheerleading, and Ava is starting her sophomore year of high school, playing the viola in orchestra and practicing to make the volleyball team. 

Ava said she was inspired by her MUSC care team to become a pediatric hematology/oncology nurse when she grows up. “This whole journey made me realize I can do it because of my experience as a patient,” she said.

 

Reflecting on their journey, Ava’s mother shared her family's heartfelt gratitude and hopes for helping others in similar situations. “This was really tough as a family, but it made us stronger going through this together. There are a lot of other families experiencing this – if we can help other families and spread the word about the great things happening throughout MUSC, we want to do that,” said Charlina. “Of course, we also want to give thanks to the doctors, nurses and everyone behind the scenes. We have been so blessed to have such a great group of doctors supporting us.”

The Wease family’s story is a testament to the power of innovative medical care and the strength of a supportive family. “Working side by side with Dr. McCoy and the families and really being able to cure someone is what it’s all about – it’s what we do this for,” said Hudspeth.