David Alston: Snatching the Silver Lining from the Cloud of a Cancer Recurrence

A 42-year-old Carrboro resident prepares for UNC Hospitals’ first triple-tandem stem cell transplant in an adult for the treatment of a testicular cancer recurrence, growing in wisdom and insight along the way.

Media contact: Tom Hughes, (919) 966-6047, tahughes@unch.unc.edu

Wednesday,  Feb. 15, 2012

Written by Elizabeth Swaringen for UNC Health Care

CHAPEL HILL, N.C. – Three infusions of your own stem cells – each infusion over a 21-day hospitalization – is daunting.  When it’s your best chance for beating a recurrence of testicular cancer, you look forward to it.     

“It doesn’t seem intimidating to me at all,” said David Alston, 42, of Carrboro.  “You don’t normally think of stem cell bone marrow transplants as treatment for testicular cancer, but it has been done in New York with success.  I’m pleased it’s available to me here at UNC Hospitals.”

This month David is having the first triple-tandem transplant done in an adult at UNC Hospitals.  The process involves harvesting and freezing his own stem cells, receiving high-dose chemotherapy to attack the cancer, then having the stem cells infused over three back-to-back hospitalizations.  

“He’s young and otherwise healthy, and we think this is the right thing for him,” said Paul M. Armistead, MD, PhD, assistant professor of medicine in the Division of Hematology/Oncology, a member of the UNC Lineberger Comprehensive Cancer Center and leader of David’s transplant team.  “This is his best chance for being cured.”

David, a Charlotte native, was diagnosed with aggressive testicular cancer in March 2011 after experiencing an “avalanche of symptoms.”

“I didn’t have a lump, but I had some weird back pain and loss of feeling in one leg,” David said. “By the time I had some scans, we found lymph node involvement in a lot of places. Essentially, the cancer had gone on vacation all over my body.”

Testicular cancer is one of the more curable cancers, often cured in the first round of chemotherapy, said Kim Rathmell, MD, PhD, associate professor of medicine, a member of UNC Lineberger Comprehensive Cancer Center and David’s  medical oncologist.  

Aggressive chemotherapy sent the cancer into remission, and by August David returned to his long-time job at Weaver Street Market in Chapel Hill’s Southern Village.

Routine blood test results in December surprised everyone:  the cancer was back.

“Because of the way David’s cancer came back, a more aggressive approach than chemotherapy alone was needed,” said Dr. Rathmell, adding how hard it was knowing David faced treatment again.  “I shop that store, and I had seen him back at work.”  

Matthew Milowsky, MD, who participated in the development of the triple-tandem transplant for testicular cancer at Memorial Sloan Kettering in New York City, joined UNC Lineberger Comprehensive Cancer Center last fall as co-director of UNC’s urologic oncology program.  Dr. Rathmell quickly recruited him to David’s team.  

“We have everything we need here at UNC to treat David,” Dr. Rathmell said.  “Had David come to us five years ago, when this recommended treatment was newer and we didn’t have local expertise, I would likely have referred him elsewhere.  Today, we are very comfortable doing this transplant here.  And it’s a total team approach.”

In January, David began receiving two types of chemotherapy to mobilize his stem cells in preparation for collection. This chemotherapy featured one less drug than what he endured after initial diagnosis and yielded fewer side effects.

“It was night and day difference,” David said, remembering the physical and mental side effects that sent him into the ICU last spring. “By comparison, what I’m doing in preparation for the transplant has been rather effortless.”

But the process is complicated and has many moving parts.

“David will have five chemotherapy infusions administered by two separate medical teams that have to work together through a lot of logistics about what happens when,” said Dr. Armistead.  “That David is organized and intelligent and sends a lot of questions to Dr. Rathmell and me via email, he’s helping himself stay on top of things.  Having a patient who is fully aware of what’s going on has kept us on our toes and helped us develop and coordinate a more fool-proof system.”

Still, as a single, stubbornly independent man, David needed help and support.  Luckily, his mother, Barbara Alston, a retired medical professional from Concord, is by his side.  

Both are staying at SECU Family House, the 40-bedroom hospital hospitality house minutes away from UNC Hospitals that provides comfortable, convenient and affordable housing for seriously ill adult patients and their family member caregivers.  
Barbara will stay at Family House during the nine weeks total that David is expected to be hospitalized. He will join her between transplants and for post-transplant monitoring.

“It’s a comfort being here at Family House,” Barbara said.  “If we need something, it’s taken care of, both here and at the hospital. I’m assured David’s getting the care he needs.  I’m helping him whenever and wherever I can.”

SECU Family House will play an even larger role in David’s recovery post-transplant, both Drs. Rathmell and Armistead agreed.
“This treatment is intense, and David will be more in the hospital than out,” Dr. Rathmell said.  “He will need a solid support system, and he has that with his mother.  It’s a fragile time, and she has his best interest at heart.”

“Post-transplant David will need to be monitored closely because his immune system will be very weak,” Dr. Armistead said.  “His mother’s medical background is a bonus. The Family House folks are used to immune-suppressed patients and can get them to the hospital quickly if needed.”

David has kept himself swimming in information to minimize the fear and mystery.  Barbara has been the great translator when his own efforts didn’t yield the level of detail he needed.

“The constant learning gives it all a degree of routine that took some of the scariness away,” David said.  “But you can’t be too independent or too brainy when you have cancer.

“Cancer blows you out of the water, but it leaves you with valuable insight,” he said. “How you deal with cancer is self-guided and you learn things about yourself and your personality that you never knew.  It’s the ultimate in snatching the silver lining from a cloud.”

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