A stem cell transplant with a twist. 'They are connected in so many ways'

It's been years since they met, but Nicki Kremer and Richard Davis remember every detail.

Kremer, a college student at the time, and her family were waiting at Tampa International Airport for Davis to arrive from Kentucky. Her hair was still short from the chemotherapy.

They knew Davis went by a nickname, "Bubby." Then he appeared, wearing cowboy boots and holding his daughter.

"Nicki and Bubby looked at each other for the first time, and they just knew," recalls Madelyn Balitz, Kremer's mother. "We stood there in the airport crying. They walked out hand-in-hand. They are connected in so many ways."

It's been 14 years since Kremer spent months inside the Moffitt Cancer Center in Tampa, unsure if she'd ever find a bone marrow donor who could save her life.

Now 38, she's in remission, thanks to the stranger from Kentucky who donated stem cells for a transplant. And in just a few months "Bubby" will give her something else.

He'll officiate at her wedding.

• • •

Kremer was 24 and a student at Ringling College in Sarasota when she was diagnosed with acute lymphoblastic leukemia, a cancer of the blood and bone marrow that affects white blood cells, and is mostly diagnosed in young children.

"At 24, I was considered old for someone with this type of cancer," she said.

She had no history of cancer in her family and was an active person who ran cross-country and track in high school.

What started out as general lethargy quickly became dire. Kremer battled kidney and liver failure and dropped to just 72 pounds. After her diagnosis in August 2005, doctors said she needed a bone marrow transplant to survive.

"One of the biggest barriers to survival is finding a suitable donor," said Dr. Asmita Mishra, an oncologist in Moffitt's blood and marrow transplant and cellular immunotherapy program. "Historically, we tap into family members, like siblings or secondary relatives like parents or children. It's when patients don't have family members, or ones who are healthy enough, where the registry comes in."

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About 20,000 people in the U.S. need a bone marrow transplant every year, according to the Gift of Life Marrow Registry, a national listing of donors that comes into play in the 70 percent of cases where a match can't be found in a patient's family.

After six months, physicians alerted Kremer that they'd found a match. A donor from the registry linked to her blood and marrow type. But Kremer wouldn't know who her donor was for a year — even though her blood type would change to become his, and his cells would breathe new life into her frail body.

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"He'll never take credit for what he did," Kremer said. "But he's certainly done a lot."

• • •

Davis worked at a Pepsi manufacturing center in rural eastern Kentucky. He had an aunt who needed a blood transfusion once, so he decided to donate blood.

"I became a regular donor and did it a couple of times a year," he said.

One day, nurses at a blood bank asked him about becoming a bone marrow donor. Davis didn't hesitate to sign up.

"Then a couple of years passed by and I was matched with someone," he said.

He didn't know a whole lot about the process going in, but said it turned out to be "much more intense" than he expected.

"A lot of times it doesn't work and people don't survive," said Davis, now 44. "They wanted me to keep that in mind."

While more than 130,000 people are diagnosed with a blood or bone marrow cancer every year in the U.S., the number of bone marrow donors has not kept up.

On average, one person in a thousand who sign up to donate their marrow go forward with the routine screenings and are paired with a person in need, said Jay Feinberg, CEO of the Gift Of Life Marrow Registry.

That's largely due to fears that the process is painful, with severe side effects, he said.

But Feinberg and others say that's by and large a misconception that doesn't account for medical advances.

"About 80 percent of the time, donors don't even donate bone marrow," he said. They're donating stem cells, which are much easier to collect.

While bone marrow transplants are still fairly common in cases that involve cancer in children — and require extraction from the hip under anesthesia — stem cell transplants are more similar to donating blood.

"We've become extremely savvy in collecting stem cells from the blood and vein," said Mishra, the Moffitt oncologist. "That part of the process has tremendously improved. The vast majority of transplants I do come from stem cells in the blood, not bone marrow."

And that's the way the transplant worked between Davis and Kremer.

The donor is connected to two tubes — one collecting blood, and the other returning it to the body. During the cycle, stem cells are extracted from the blood and the rest goes back to the patient, Mishra said.

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There are some side effects. People often experience lethargy and flu-like symptoms afterward, Mishra said. Donors also must receive regular stem cell growth injections for nearly a week leading up to the procedure.

Davis remembers the process lasting eight hours. He and his wife drove two hours to Lexington for it. When he left the hospital, he collapsed.

"I remember being so tired, I slept for a day and a half," he said. "My wife kept checking on me to make sure I was still breathing. In the days after, I felt like I had a bad case of the flu. But this is nothing compared to what Nicki went through."

• • •

Kremer's road to recovery was a long one. In preparation for the transplant, she underwent radiation and chemotherapy, leaving her immune system stunted but prepared to accept the donor stem cells.

After going back to school, she had cataract surgery due to side effects from the steroids she was given during treatment. She also suffered from breathing issues, and lost her ability to have children.

But that didn't stop her from meeting and falling in love with her now fiance, Corey Iacofano.

Over the years, Davis became part of Kremer's family. They kept in touch by phone and online, and visited when Davis traveled to Florida with his family. He eventually took a job with the Kentucky Blood Center, encouraging more people to be donors like him. And he became a preacher, with his own Baptist church.

"I had joked with her for years about being single," Davis said of Kremer. "But then I started noticing the Facebook posts and the way she talked about this new fella. They were spending a lot of time together and I knew it was coming."

When Kremer asked him to officiate her wedding, Davis said he burst into tears.

"I'm humbled above measure," he said. "It's amazing to be part of the full circle of her life."

When asked if he'd ever donate again, he didn't hesitate: "Absolutely," Davis said.

"I thought I was helping her. But it's the opposite. She's blessed me. She's been there for me. I hope to take the fear and hesitation away from people so they can see what comes of this. All it takes is one person to save a life."

Contact Justine Griffin at jgriffin@tampabay.com or (727) 893-8467. Follow @SunBizGriffin.

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The gift of life

So you want to be a bone marrow donor? The first steps are easy and painless.

1. Find a registry, like Be The Match or the Gift of Life Marrow Registry and sign up.

2. Request or receive a swab kit. They usually come in the mail. Follow the instructions to swab the inside of your mouth. Package the sample correctly and put it in the mail.

3. Most people go years without getting matched. But if you signed up and did the swab, your information is stored in the registry.

4. If you match with a patient in need, you will go through several exams, including blood screenings, to make sure you're healthy enough and have no other conditions that would disqualify you from donating stem cells or bone marrow.