University of Georgia
June 2015
Health
A clinical approach

Amber Clemmons, center, discusses patient cases with the bone marrow transplant inpatient team, which includes Dr. Jeremy Pantin, left, and Shawn Roberson, a nurse practitioner, at Georgia Regents University Medical Center in Augusta.

A clinical approach

Pharmacy clinical assistant professor finds enriching experience in stem cell specialty.

Amber Clemmons has a unique position in the College of Pharmacy as the college’s only clinical oncology pharmacist with an active practice site in inpatient stem cell transplantation. She has worked in that specialty at the Georgia Regents University Medical Center in Augusta since 2011 and has witnessed the rapid expansion of the field.

GRU opened the region’s first stem cell transplant program in 1997 to treat adult leukemias, lymphomas and other types of blood cancers. Its adult bone marrow transplant program is one of only three in the state of Georgia and is accredited by both the Foundation for the Accreditation of Cellular Therapy and the National Marrow Donor Program.

Clemmons works as a member of a multi-disciplinary medical team that includes transplant-trained physicians, physician assistants, nurse practitioners and inpatient nurses as well as numerous consulting specialists. As a clinical pharmacist, she reviews medications for appropriateness, including ensuring that each medication choice and prescribed dose are compatible with patient-specific factors such as age, kidney or liver function, financial abilities and other medications that may interact and cause harmful effects. Additionally, she educates physicians and other health care workers about medications, including any recently reported data or guideline updates and safety information.

Transplants, she noted, can be the infusion of either stem cells taken directly from the bone marrow or stem cells mobilized into the peripheral blood and then collected via apheresis, which is the process used at GRU. Stem cells give rise to the key components of blood: red cells that carry oxygen, white cells that are part of the body’s immune response and platelets that aid in clotting.

In the autologous transplant setting, the stem cells are collected from the patient and frozen to save them from being destroyed by the high doses of chemotherapy administered to kill the cancer cells. After high dose chemotherapy is complete, the stem cells are infused back into the patient, in a procedure similar to a blood transfusion, to regenerate normal blood cells. In the allogeneic transplant setting, volunteer donors undergo stem cell collection either before or at the same time as the patient receiving high dose chemotherapy with or without radiation. These donor cells are then infused into the patient after the administration of chemotherapy and initial immunosuppression medications. Engraftment of healthy hematopoietic stem cells takes several weeks.

Clemmons must anticipate and manage predictable side effects of the various medications and complications from the transplant process during each patient’s hospitalization.

“I truly enjoy forming relationships with my patients and their families.”

— Amber Clemmons

“Patients undergoing bone marrow transplants often require intense care over a prolonged period of time,” said Clemmons, a clinical assistant professor. “This allows me the opportunity to create relationships with patients and work closely with the medical team to optimize their pharmacotherapy plans, not only with respect to their transplant medications but also with regard to their (other diseases or conditions) and overall health.

“I truly enjoy forming relationships with my patients and their families. It is my hope to be an informational resource for patients and be a part of their support network as they go through the transplant process.”

Clemmons first meets with patients after they are admitted to the hospital and discusses all planned chemotherapy and other supportive medications. She sees six to eight patients daily during rounds with the multidisciplinary team, and they evaluate the patient for any ongoing or new medical issues. Then they discuss each medical problem, such as diabetes or hypertension, and work together to create a pharmacotherapy plan to optimize clinical outcomes.

She then communicates medication information to patients and caregivers. They develop a good understanding of why they are prescribed each medication and how to take the medication accurately, as well as what side effects to look for. She also provides supportive care, such as optimizing pain control, managing nausea and making nutrition recommendations.

Once the patient has completed therapy and is ready for discharge, Clemmons counsels the patient and their caregivers on the medications to be administered at home. The hospitalization process takes a minimum of two to three weeks.

Clemmons is also involved in clinical research and works with the other bone marrow transplant practitioners to update policies and procedures.

“In the past, our transplant and pharmacy group has evaluated and published on the potential differences in dosing and outcomes for obese patients with regard to specific chemotherapy and supportive care medications, the utility of novel dosing protocols, as well as the clinical outcomes and adverse events we have seen with specific treatment regimens in various patient populations,” Clemmons said.

— Sheila Roberson, College of Pharmacy