When people are ordering their morning coffees in Grunt Cafe, it’s unlikely the realise the remarkable journey of its proprietor and owner Mark Fagan. The Foxrock man is now 44 and set up Grunt three years ago when he returned to Ireland following a successful stint working in hospitality in the Middle East with his wife Aiza.
But none of this would have been possible were it not for Mark’s elder brother Stephen.
For Mark was one of the first children in Ireland to receive a bone marrow transplant which save his life.
‘I was five when I was diagnosed in 1985 and I had a bone marrow transplant in May the following year,’ Mark says.
In what was no doubt a worrying time for his parents, Mark developed a cough that wouldn’t go away.
‘Because I was so young, I didn’t really know what was happening,’ he says. ‘I had a very bad cough and I was very sleepy – my dad took me to the GP a few times and nothing was really showing and then my parents took me the the National Hospital for an X-ray,’ he says. ‘Then they did a lumbar puncture and they confirmed I had leukaemia. Treatment started straight away and I went into remission. I couldn’t tell you anything really about the treatment because I was so young.’
St James’s Hospital on Monday marked the 40th anniversary of the first bone marrow transplant which took place in Ireland in 1984. This procedure marked the beginning of a pioneering treatment at the hospital, which now performs stem cell transplants in almost 200 patients in Ireland each year.
The first procedure in St James’s Hospital was performed by an expert team led by Professor Shaun McCann, emeritus Professor of Haematology at Trinity College Dublin and Head of Transplantation at St James’s Hospital. Since then, the National Adult Stem Cell Transplantation Service has expanded to include the first Irish centre for Adult CAR TCell Therapy.
These kinds of cellular therapy treatments are often life-saving for blood related cancers such as leukaemia, lymphoma and myeloma but also include some rare cases of bone marrow failure. The service is currently the third largest of its kind in Britain and Ireland, with patients referred from all over Ireland, including some patients from Northern Ireland, to St James’s Hospital.
Minister for Health, Stephen Donnelly, acknowledged the anniversary and congratulated the staff on their dedication.
‘Over the past 40 years, transplant expertise at St James’s Hospital has gone from strength to strength and the team has shown their dedication to the development of transplant services for those patients diagnosed with blood-related cancers in Ireland. I congratulate the hospital on this achievement and wish them continued success over the next 40 years.’
Due to a growing and ageing population, the number of blood cancer cases in Ireland and globally continues to rise. Stem cell transplants (sometimes referred to as bone marrow transplants) are used to treat and cure many types of blood-related cancers such as leukaemia, lymphoma or multiple myeloma as well as rare bone marrow failure conditions and solid-organ tumours. The purpose of the transplant is to cure the blood cancer or keep the haematological disease in remission for as long as possible.
In allogeneic stem cell transplantation, healthy stem cells are transplanted from one individual to another. Alternatively, in an autologous transplant the patient’s own stem cells are used. The first bone marrow transplant at St James’s Hospital in 1984 was an allogeneic transplant where donor stem cells were harvested from a sibling in order to treat a patient with leukaemia – which was what happened in Mark’s case though because he was so young, his memory of the time is hazy.
‘I probably remember getting a lot of fluids and needles put in me, I remember getting a lot of bloods taken and being sleepy all the time.
‘I remember being in the hospital in Harcourt Street; the old style lifts with the metal cages and the children in the room with me.
‘My brother Stephen was only nine and because he was so young as well, he remembers very little too – just a bit of pain and a bit of back pain.’
At the time when Mark was being treated, the bone marrow transplants were normally done in the Royal Marsden Hospital in England.
His father Brendan had a friend who was working in paediatric care in Boston so initially he wanted Mark to go there.
‘At the time it wasn’t normal to be giving kids bone marrow transplants in Ireland,’ he says of the system which had been initially done on adults.
‘My dad remembers it all,’ Mark says. ‘He hates Halloween because that is when I was sick and February is when I was diagnosed really and my transplant was on my brother’s birthday which is May 10.’
His dad then met Professor Shaun McCann at the hospital and asked him if he would carry out the bone marrow transplant on Irish soil meaning that neither of his sons would have to travel.
‘Stephen was a 90 per cent match and my dad just wanted Professor McCann to do the transplant in Ireland,’ Mark says.
‘Adults were a bit different but leukaemia in kids wasn’t as common. I remember my grandad went with another gentleman and the two of them came together and bought TVs for the wards for the children and there were new curtains and so on to make it more for children.
‘I just remember machines, hospital rooms, blood, needles. And after the transplant I couldn’t really contact my family as I had to stay clear of anyone in case of infection.
‘The nurse who looked after me in my recovery was a family friend who nursed me back to health when I was very sick in isolation. It was her and me and I have a fond memory of her in the hospital.’
These days Mark is extremely close with his brother Stephen.
‘I suppose these things bring you closer in life and I think the fact that he was able to save my life means I am indebted to him for doing that. And obviously we would do it for each other again.’
Mairsile Hourihane, who received a bone marrow transplant at St James’s Hospital in 1989, was also at the celebration.
‘My diagnosis of CML nearly 40 years ago was the beginning of an uncertain and scary time in my life,’ she says.
‘After my diagnosis in St Vincent’s Hospital, I was under the care of excellent haematologists with a support team at St James’s Hospital, who ultimately saved my life. Even though the service was in its infancy when I received my bone marrow transplant, I always knew that I was lucky to be in the best place with the best team looking after me, and I am delighted to be here to celebrate all that the team continues to achieve.’
The work of the Stem Cell Transplantation Service is supported by many departments and organisations within St James’s Hospital/
Trinity St James’s Cancer Institute and beyond. In particular, links with clinical teams within the hospital including the intensive care unit, close liaison with the Irish Unrelated Donor Registry and the Irish Blood Transfusion Service are crucial to find compatible donors for those who do not have a suitably matched family donor and to ensure that complications for patients are kept at a minimum.
Since its inception, the transplant unit has been supported by the Bone Marrow for Leukaemia Trust, a charitable organisation, which has provided equipment, contributed to funding for staff and the development of accommodation for patients post their stem cell transplant.
‘Since 1984, we have provided stem cell and bone marrow transplants to over 3,750 patients, improving rates of survival for patients with blood cancer and giving them fresh hope,’ says Dr Catherine Flynn, Consultant Haematologist and Associate Clinical Professor at the Trinity St James’s Cancer Institute.
‘Looking after our increasing number of transplant survivors is a privilege but also presents a growing challenge. Our service would not be able to run without our dedicated nursing staff and colleagues throughout the hospital. We work very closely with bodies such as the Irish Blood Transfusion Service and are very grateful to the many stem cell donors from all over the world. We are hopeful that we can continue to grow our service through adequate support and resources.’
On Monday, acknowledging this milestone in cancer care in Ireland, Professor Mary Day, St James’s Hospital Chief Executive Officer said: ‘St James’s Hospital has a long history of stem cell and bone marrow transplant and this anniversary would not have been reached without the clinical expertise that we have accumulated and developed. The ground breaking work of our expert clinicians, such as Professor McCann, has allowed us to cement our place as a world leader in cancer care and led us to the establishment of the Trinity St James’s Cancer Institute, the first OECIaccredited cancer institute in Ireland.’
And for Mark, this achievement means more than words can say.
‘My health is fine, I am doing well thank god,’ he says. ‘I worked in hotels for many years in Dublin in hospitality, I moved to the Middle East for many years. I was working in hotels in Ritz Carlton there then I came back about three years ago and I opened up my own cafe Grunt in Foxrock.
‘The transplant isn’t really something I talk about so it was great to meet up with different people and hear their stories and also see the nurses and doctors who looked after me so well.
