St. Luke’s performs Idaho’s first childhood stem cell transplant
Tatum Fontaine was only 3 months old when he was diagnosed with high-risk neuroblastoma, a type of cancer most commonly found in children under the age of 5.
Neuroblastoma develops in certain very early forms of nerve cells found in an embryo or fetus, according to St. Jude Children’s Research Hospital. About 800 cases are diagnosed in the United States each year.
Tatum was treated with chemotherapy but needed stronger doses that would destroy his marrow — the soft fatty substance found in bones and where blood cells are produced.
Nathan Meeker, a pediatric physician at Mountain States Tumor Institute at St. Luke’s, chose Tatum to be the first child to undergo a stem cell transplant in Idaho.
“Historically, we’ve had to do that at centers off-site, so they’ve had to go to Seattle or Portland or Salt Lake City to get this therapy, and they have to go away for extended periods of time for that,” Meeker said. “For several years now, we’ve been working towards getting a program here that would allow us to do that therapy.”
Parents Jet and Patti Fontaine, who live in Meridian, said they were thankful to have the transplant done at Mountain States Tumor Institute instead of Primary Children’s Hospital in Salt Lake City, which would have required one of them to move to Utah for several months. They said they weren’t worried by the fact St. Luke’s had not attempted a children’s transplant before.
“Because we had done all the previous treatment here, we were very comfortable with our doctors and nurses, and that made the decision easy,” said Jet, who works in the vehicle maintenance division for the Idaho Air National Guard. “He knows his doctors and nurses. He’s comfortable with them, and so are we.”
“The doctors and nurses here are incredible, so I didn’t want to go anywhere else,” said Patti, who is a pharmacy technician.
By having the treatment in Boise, the parents were able to take shifts. It also made it easier for their older children, Payton, 14, and Aubriana, 10, to have both parents at home.
Meeker, who has worked for the tumor institute for six years, previously spent five years at Intermountain Primary Children’s Hospital in Salt Lake City, where they have performed stem cell transplants on children for many years. Matthew Hansen, another Mountain States physician, had several years of experience with that type of transplant at Cincinnati Children’s Hospital.
Since 1993, the tumor institute has provided adult blood and marrow transplant services. Over the years, nearly 400 adult St. Luke’s patients have received autologous stem cell transplants, involving very high doses of chemotherapy along with the transplants.
The hospital hadn’t performed transplants on children in the past because there weren’t enough young patients with that need to make the establishment of a program worthwhile, Meeker said. With the population of the Treasure Valley between Ontario and Mountain Home now approaching 800,000 people, it can sustain the program. He expects three to seven children per year to receive similar transplants.
The St. Luke’s staff, which treats 50 to 75 new cases of childhood cancer per year, spent four years getting ready to perform the first child stem cell transplant. Tatum’s transplant took place in May, when the boy was 9 months old.
We’re extremely grateful that they chose us to be the first family to do it. There wasn’t really any point where we questioned the level of care he would receive because we were so comfortable with the doctors and nurses here.
Jet Fontaine, father of young transplant recipient Tatum Fontaine.
“It’s only the rare patient that requires this high-dose chemotherapy with stem cell rescue. There are only certain patients that have it as part of their regimen. It’s a pretty heavy regimen, as you can expect, and it has some life-threatening complications,” Meeker said.
Tatum spent 47 days in the Boise hospital while undergoing high-dose chemotherapy and the stem cell transplant, which involved thawing the cells after being removed from a freezer containing liquid nitrogen and then injecting the cells into a tube attached to Tatum’s body.
The procedure involved the removal of blood-forming stem cells from Tatum that were frozen and then injected back into the youngster’s bloodstream four months later. That allowed Tatum to be treated more aggressively with chemotherapy to destroy the cancer without the lasting harm to his bone marrow as the stem cells regenerate.
“By giving higher doses, we can improve the kill of the cancer and improve cure rates. After they get their own cells back, then it takes some amount of time for those stem cells to go back into the bone marrow and regenerate all of the bone marrow cells that will now reproduce all of the blood elements that are necessary for life,” Meeker said.
The high-dose chemotherapy was administered over a week, with the stem cells injected after the chemotherapy drugs left his body.
“They need to be there until their bone marrow regenerates, and we see white cells appear again in the blood. That typically takes two to three weeks,” Meeker said.
After going through the high-dose radiation, Tatum essentially was left without a functional immune system, Meeker said. He had to be kept for two to three weeks in a sterile room, where he was closely monitored, and received treatments of antibiotics and antifungal compounds.
Tatum suffered a complication, sinusoidal obstruction syndrome. Some of the small veins in Tatum’s liver were obstructed as a result of the chemotherapy. He had to be treated for that as he recovered from the chemo and the transplant.
“He was critically ill for a couple of weeks, and we had to treat him in an intensive care unit, and he received medication specifically for this condition, which is a fairly new therapy,” Meeker said. “Historically, this complication was almost always universally fatal. Fortunately, we were able to get him through that complication.”
The Fontaines said Tatum came through well.
“He’s a tough cookie,” Jet said.
While it’s frightening for anyone to undergo chemotherapy, which uses strong drugs to treat cancer, the risk to children isn’t any greater despite their younger age and smaller size, Meeker said.
“We actually find that these kids handle treatments very well. I think that’s perhaps one of the reasons why we get better cure rates in children is because they can handle quite intense therapy and do it quite well,” Meeker said. “They don’t have the other problems we all have as we get older.”
Improvements in therapies just in the past few years have pushed cure rates past two-thirds of young patients suffering from this form of cancer, Meeker said. Five years ago, it was below 50 percent, he said.
Tatum, whose cancer is in remission, will be monitored throughout his childhood.
“At this stage, he’s looking very good. He’s doing quite well and is fully recovered from his transplant and that complication. That was a scary time for us all,” Meeker said.
The Fontaines did not say how much the treatment has cost them. But they said they were grateful to a long list of friends, relatives and strangers who donated money to them through an auction and other fundraisers. A total of $7,270 was raised through a GoFundMe campaign.
“It says a lot about our community. There are so many giving people out there,” Jet Fontaine said. “It was surprising how many anonymous donations that we actually got.”
What is the danger from high-dose chemotherapy?
Doctors are limited in the amount of chemotherapy they can give a patient, based upon what is called a dose-limiting toxicity.
“In other words, at some point we’re going to start causing significant damage to that patient. So we’re limited by that threshold. Typically, with most chemotherapy engagements, that threshold is the bone marrow,” Dr. Nathan Meeker said.
“We’re going to start impacting the bone marrow to the point where we would destroy it and that would no longer be compatible with life,” he said. “If we were to do that, we would lose the bone marrow, and they would lose all their immunity and be subject to life-threatening infections.”
We’ve gone pink — and more
You might remember that for several years each October, we printed an entire day’s Idaho Statesman on pink paper in honor of National Breast Cancer Awareness Month and included stories in that day’s edition about breast cancer and Idahoans fighting the disease.
Over the years, many readers wrote asking us to focus on other types of cancers, too, and to highlight more area residents who have faced the personal struggles that the disease — in all of its forms — brings.
So we did something different this year. Each Sunday in October, we featured personal stories and more about screenings and treatment in the Explore section — covering several types of cancer. We also had stories about some of the Treasure Valley groups that are working to make a difference in the lives of cancer patients.
Our aim with these stories is to raise community awareness. The Idaho Statesman also will continue to support our community by donating at least $10,000 to local charities and research.
And we stuck with the pink paper this year on some of the pages. We hope it reminds you to get your screenings and to focus on your health — all year long.
▪ On pages 12D: Idahoan Kate Riley now understands so much more about both life and death through watching and supporting her mother live with breast cancer for about 16 years.
▪ On page 13D: Saint Alphonsus’ CLIMB program helps kids who have a family member going through cancer come to terms with what it all means. Plus, read reporter Erin Fenner’s first-person account of what she remembers about her own mother’s cancer struggle.
▪ On page 14D: Learn about Wishgranters, a Treasure Valley organization that helps make dreams come true for adults with terminal illnesses.