BY AMBER SMITH
Chris Atwood of Moravia has quite a few medical issues for a man of 59, but they don’t rattle him.
“I think that fixating and worrying about your health is bad for your health,” he says.
Atwood is a plumber and pipefitter and an avid bicyclist who underwent a kidney transplant in 2001. Twelve years later, he was diagnosed with lymphoma, a cancer caused by the anti-rejection drugs he had to take for his new kidney.
The development of post-transplant lymphoproliferative disease, or PTLD, is a well-known potential complication. Atwood’s response to the diagnosis was not typical.
“Great,” he said to the doctors and nurses who assembled to break the news. But it wasn’t a sarcastic great. Atwood was grateful. “Now I know what the problem is. Let’s fix it.”
Perhaps the outlook Atwood has comes from growing up on a farm with five siblings, not a lot of money, and parents who were older.
His father, who would be 106 if he were alive today, grew up walking a plow behind horses. His mother did laundry with a washboard and clothesline. They canned most of the food they would eat during the winter. From young ages, the kids had chores.
Atwood had a newspaper route that he delivered by bicycle, pedaling 11 miles per day. He joined ROTC to help pay for college at Syracuse University. He majored in geography until the money ran out.
Atwood was born with a kidney problem, which was discovered during college. It was a valve problem that caused reflux. Bladder contents would backwash into the kidney, putting him at risk for infection.
It wasn’t a problem until February 1998. He recalls catching a cold, which he couldn’t shake. He ended up in the hospital undergoing blood tests. That’s when he learned he would eventually need a kidney transplant.
For three years, he followed doctor’s orders to eat no protein, no potassium and no phosphorus. The diet was difficult to follow, plus he was always tired.
Atwood continued working as a plumber/pipefitter, though. He said nothing about his condition at work. “I didn’t want any special treatment,” he says, “and I didn’t want to get fired.”
On Valentine’s Day 2001, he got a phone call at 2:30 a.m.
A kidney was available for transplant. He left for Upstate University Hospital. His wife joined him after she got the kids off to school. Atwood recalls that he was sore for a few days after the surgery, completed by Dilip Kittur, MD. Then one morning, he woke up feeling so much better.
“That’s when I realized how sick I was before: how well I felt afterwards.”
Atwood never had to undergo dialysis for his kidney disease. He still appreciated the irony of his first assignment after he returned to work with his new kidney: plumbing and pipefitting for a dialysis center on James Street in Syracuse.
The bike riding
Since his days with a newspaper route, Atwood had been a bike rider. He’d take time to ride to Buffalo on occasion, or up to the Adirondacks. He took a break from riding when he became ill with kidney disease.
Then, four years after his transplant, “I got this card from the Leukemia and Lymphoma Society’s Team in Training, out of the blue.” It was an invitation to raise money by training for and completing a 100-mile bike ride at Lake Tahoe.
Atwood decided to do it. He had a bike he was riding to try to get back in shape. Having a goal would help.
He did the Team in Training races for two years in a row. Then he competed in the National Kidney Foundation’s Transplant Olympic games, held in Kentucky. He did not do well, but in 2008, when the games were held in Pittsburgh, Atwood says he was better prepared. He won two gold medals.
Today he rides between 2,000 and 3,000 miles per year.
He rode the Erie Canal from Buffalo to Albany. He has circumnavigated every Finger Lake. In 2017 he completed a quest to ride across every county in New York state.
Atwood has lived with his donor kidney for almost 17 years, describing himself as “fit as a fiddle.”
Toward the end of summer 2013, he was plagued by coughing fits. He underwent some imaging scans and blood work, and a mass was discovered by accident. His kidney doctor, John Leggat, MD, told him it was cancer. He set up an appointment with Teresa Gentile, MD, PhD, who oversaw Atwood’s cancer care.
“She was a godsend,” Atwood says. For a while, he was quite sick. He underwent six cycles of chemotherapy three weeks apart, and then maintenance treatments after that. He lost his hair, but he had no negative side effects from the medicine.
His treatment concluded in March 2014. He still sees Gentile regularly. “I’m 100 percent in remission,” he says, “and I’m back to normal, living perfectly well.” That includes riding his bike.
Cancer can be a complication
People undergo organ transplants to extend their life expectancy and improve their quality of life. Kidney transplants, for instance, free many people who require kidney dialysis.
But taking medicine to suppress the immune system and protect the new organ raises a person’s risk of infections and the development of cancer. Transplant doctors tell patients about this risk before they have surgery.
The risk of developing a type of skin cancer called squamous cell carcinoma increases a hundredfold for transplant recipients, according to the Skin Cancer Foundation. This is likely because of the suppression of the immune system, coupled with an interaction between the medication and the sun’s ultraviolet radiation.
The cancer Chris Atwood developed is a lymphoma called PTLD, for post-transplant lymphoproliferative disorder.
“It’s related to the Epstein-Barr virus,” explains John Leggat, MD, Atwood’s kidney doctor. That’s the virus that causes mononucleosis. “Most people are exposed to the virus at some point. It tends to live in you, in lymphocytes (a type of white blood cell), and when you’re immunosuppressed it can cause those cells to proliferate abnormally.”
Leggat says doctors don’t screen for PTLD, but they regularly see transplant recipients for medical appointments. “When someone starts having odd symptoms, we will chase that down, because PTLD is always in the back of our minds.”
The prognosis for someone with PTLD used to be poor. Since the Food and Drug Administration approved rituximab in 2006, Leggat says treatment is generally successful.
Rituximab is a man-made antibody that triggers cell death by binding to a particular protein found on the surface of cells that are part of the immune system.
During treatment for the lymphoma, patients stop taking their immunosuppressant medication because rituximab suppresses the immune system. And after treatment, the dosage of a patient’s immune-suppressing medication is lower than usual.
Legato says, “Once a person survives this cancer, they don’t need so much immunosuppression.”
This article appears in the winter 2018 issue of Cancer Care magazine.