NC State vet school abruptly pauses rare treatment for dogs with cancer

Blaze, a 4-year-old English Shepherd, is “the best thing that ever happened to” Meredith and David Miller.

The young dog, described by the Millers as intelligent, loyal and sweet, has enjoyed for much of his life an active lifestyle of backpacking, hiking and trail running with the couple, who live near Baltimore, Maryland.

But Blaze’s life — and the Millers’ — changed late last year, after he was diagnosed with B cell lymphoma in November.

“We were kind of just, like, in shock, and working with the oncologist to figure out what the best course of treatment was for him,” Meredith Miller said of Blaze’s diagnosis in an interview with The News & Observer.

Lymphoma, which affects white blood cells and is most often found in lymph nodes, is one of the most common types of cancer among dogs. Though chemotherapy treatment is available for B cell lymphoma, it is not considered a cure for high-grade, aggressive forms of the disease, and dogs have a median survival time after that treatment of about 12 months.

But since 2016, and during a separate period from 2008 to 2011, Dr. Steven Suter, an associate professor of oncology at the N.C. State College of Veterinary Medicine, has offered another treatment for the disease at the college’s Veterinary Hospital — one that offers the possibility of a cure for sick dogs.

The treatment, in which dogs receive a stem cell transplant either from their own body or a blood-related donor, is only regularly offered at two places in the United States: a private practice in Bellingham, Washington, and at N.C. State. Suter has treated dozens of dogs with the protocol, which he has also researched and published academic papers on.

But in February, N.C. State abruptly paused the program.

The Millers, who estimate they have spent about $40,000 to this point on costs related to Blaze’s diagnosis and treatment, told The N&O that they felt blindsided by the decision.

“Having that rug ripped out from under us this far along in the process was really devastating, and it just felt like we had exhausted all avenues, basically, and this was our last hope, our last resort,” Meredith Miller said. “It’s not something we wanted to do, but we had to to save our dog, and now we couldn’t even do that.”

Meredith Miller told The N&O that since N.C. State paused the program, Veterinary Hospital administrators have said they still plan provide treatment to Blaze, but the couple worries the university may go back on its word — and they fear the treatment will no longer be an option for dogs who become sick in the future.

N.C. State College of Veterinary Medicine director of communications Mike Charbonneau told The News & Observer by email in February that the school did not “have anyone who can do an interview” on the pause in treatment, but provided this statement, which is also posted on the N.C. State Veterinary Hospital website:

“Very few veterinary facilities in the United States offer bone marrow transplants as a treatment for animals with cancer. At the NC State Veterinary Hospital, we are not accepting new bone marrow transplant patients at this time as we pause to proactively conduct an external review of the novel program.

“Bone marrow transplants can be difficult for already very sick animals, who then also have to spend a prolonged period of time away from their homes. Through this review, we want to carefully understand the risks versus rewards of this treatment. Providing animals with the best and most humane care possible will always be our priority.”

History of bone marrow transplant program at NC State

The first canine bone marrow transplant unit opened at N.C. State in 2008.

Suter, who has worked at N.C. State for about 18 years, performed the procedure on more than 70 dogs in a roughly two-and-a-half-year span, according to information published online by N.C. State in 2016. The cure rate for dogs with B cell lymphoma treated with a transplant using stem cells from their own body — known as an autologous transplant — during that time was 35%, Suter said in the 2016 article from N.C. State. His work in that unit was also featured in The New York Times in 2012.

The unit closed for just under five years before it reopened in 2016. At that time, Suter was able to offer allogeneic transplants, or transplants in which the sick dog receives stem cells from a blood-related donor dog. Research published by Suter last year shows that dogs with high-grade B cell lymphoma who received an allogeneic transplant had a cure rate of almost 90%.

When contacted by The News & Observer for additional information about the recent pause, Suter — who has previously spoken publicly about the procedure in other publications — would only confirm basic facts about the treatment, which are also posted online by N.C. State.

In either form of transplant — autologous or allogeneic — stem cells are taken from the donor source using an apheresis machine, which collects the healthy stem cells needed for the transplant and puts the other blood cells back into the body. Dogs are anesthetized during this process, which is considered painless and can take between four to five hours.

After the healthy stem cells are collected, the dog receiving the transplant undergoes full-body radiation to kill the cancer cells remaining in their body. The harvested stem cells and bone marrow are transplanted into the dog using an IV.

Dogs remain in the hospital for about two weeks following the procedure for monitoring and management of symptoms related to the treatment, which can include gastrointestinal illness.

Treatment is option of hope for young dogs

Lymphoma has generally been most common in middle- to older-aged dogs, roughly between the ages of 8 to 11 — but it can also affect young dogs, like the Millers’ 4-year-old Blaze or others as young as 2 or 3.

Chemotherapy — which can offer dogs with high-grade B cell lymphoma a survival time of about 12 months after treatment, according to information posted on the N.C. State Veterinary Hospital website — may be a valuable treatment for older dogs with lymphoma, who have lived a long life by the time they are diagnosed with the disease.

But the story is different for younger dogs, including Blaze, for whom an additional year of life can still feel too short for their owners.

The Millers have spent tens of thousands of dollars pursuing the bone marrow treatment for Blaze since learning it was an option. That includes the cost of getting a diagnosis for Blaze, putting him on chemotherapy until he can receive the transplant and finding a donor match among his littermates. They have raised more than $13,000 through a GoFundMe online fundraiser.

The actual procedure will additionally cost the couple between $20,000 to $25,000 — a hefty price tag, but one pet insurance can cover in some amount, and one that is comparable to the cost of one to two protocols of chemotherapy.

And the Millers’ message is clear for people who may question their willingness to pay the high price.

“They don’t understand. He’s not a bicycle. He is a part of our family, and we treat him that way,” David Miller said. “If your kid was sick, you would do everything you could to save your kid. And that’s how we feel about Blaze.”

How the treatment is viewed by canine oncologists

N.C. State is one of the only places in the world that offers canine bone marrow transplant treatments. Another, in Bellingham, Washington, is a private practice — making N.C. State’s unit even more unique, as it is located in the university’s veterinary teaching hospital, with a goal of educating more veterinarians on the procedure.

“The bone marrow transplant program fulfills part of our mission to develop new treatments and techniques to fight the diseases we see every day,” Suter told N.C. State in an article announcing the reopening of the transplant unit in 2016.

The proximity of N.C. State to the Millers’ home in Maryland made the university a viable and manageable option for Blaze’s treatment, they said, citing concerns over the travel and transport a trek to Washington would require and the toll it would take on themselves and Blaze.

But the program being paused raised new concerns for the Millers, stretching beyond Blaze’s treatment.

“A concern we have is the only place in the entire world that teaches them how to do this is N.C. State,” David Miller said. “And so if no one knows how to do this procedure in the future, then the program’s closed until someone else at some other research university picks it up and starts over from scratch.”

Dr. Jeffrey Bryan, a veterinarian and professor of oncology at the University of Missouri, attempted to open a canine bone marrow transplant unit at Washington State University in 2008, but was ultimately unable to do so due to budget concerns, he told The N&O.

Since that time, though, Bryan has followed Suter’s work at N.C. State. Bryan said Suter, who has published research and data on the procedure, “has done a really fantastic job of advancing the science” and making information available for the wider oncology community.

Bryan said there may be some appetite or interest at other universities to offer the treatment, but “practically speaking, the record speaks for itself that other universities have not jumped into this and have not elected to make this a priority or a clinical offering.

“So, perhaps that shows the reticence of oncologists in general to take this on,” Bryan said.

That could be due to concerns around the cost of the procedure — which Bryan said lends itself to a “select subset” of clients, who can afford to do so, pursuing the treatment — and the level of skilled, intensive staffing required to perform the procedure and care for the dogs after.

Bryan said it was “unfortunate” the program at N.C. State had been put on pause, especially with dogs awaiting treatment.

In an email to The N&O, Charbonneau with N.C. State said there is no formal waitlist for the procedure, but there was a “small group” of potential clients “that had already started the bone marrow transplant process prior to” the pause being announced.

“I do not understand the circumstances. I have no inside knowledge of why this has happened,” Bryan said. “But it has been a unique resource. I have referred patients to it over my career. And I’m sad that it’s not available currently, and I hope it becomes available again.”

The N&O asked Charbonneau by email Tuesday if other treatment programs at the Veterinary Hospital had ever been paused in a similar manner to the canine bone marrow transplant unit. Charbonneau had not provided an answer as of Thursday morning.

Future of transplant program uncertain

Since N.C. State announced the program would be paused in mid-February, thousands have signed an online petition urging the university to resume the program.

When asked last month how long the program would be paused or if N.C. State anticipated resuming the program at any point, Charbonneau told The N&O by email that the review of the program “is ongoing, and no additional decisions about the program have been made at this time.”

Leaders at the college and the N.C. State Veterinary Hospital are “in the early stages of gathering information as part of the ongoing review of the novel BMT program, including speaking with employees and external specialists in the field,” Charbonneau said. “The results of our review will determine next steps.”

Regarding dogs who had begun the process to receive a transplant at the time the program was paused, Charbonneau said that “the hospital would continue to work with them through this process.” Charbonneau said hospital administrators reached out to these clients by phone in February.

In emails provided to The N&O by Meredith Miller, sent in mid-March, N.C. State Veterinary Hospital administrator Roy Hudson told Miller that the hospital plans “to see your dog’s process through to the end.” But Miller doesn’t see that as a guarantee and worries the plan may fall through, she said.

The Millers plan for Blaze to receive an allogeneic transplant, and have had several of his littermates tested to see if they are a match for donation. They originally planned for Blaze to be treated with the transplant this month, but the timing depends on when a match is found.

Looking beyond their own dog’s needs, the couple hopes the other dogs awaiting treatment are also able to be treated, and that the program can continue well into the future.

“We want these dogs to get treated that are on the waitlist,” Meredith Miller said, “and we want the program to be able to resume and at some point in the near future for other dogs to have this option.”