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Every year in the U.S., about 50,000 people receive bone marrow transplants and about 500,000 complete a marathon. The math works out to less than 0.00008% of the U.S. population who have done both within the same two-year period, like Mary Becker, age 32, of Chesapeake.

“It’s incredibly unusual,” said Becker’s doctor, Gary Simmons, D.O., a hematologist-oncologist in the Cellular Immunotherapies and Transplant Program at VCU Massey Cancer Center, who ran the Richmond Marathon with her last month. “I’ve never run a marathon with a patient before, and I was very grateful to have the opportunity.”

Becker and Simmons ran the entire 26.2-mile race together, just two years after Simmons gave Becker a bone marrow transplant to treat severe anemia – meaning her body lacked enough healthy red blood cells to carry adequate oxygen to her tissues.

“I jokingly asked him to sign up and I didn’t think that he actually would,” Becker said.

In December 2016, Becker was attending law school at Tulane University. The 27-year-old had come home to Chesapeake for Christmas, when her whole family came down with a chest cold. She never really recovered.

Becker, a devoted CrossFit athlete, still went to the gym every day but found herself getting more and more winded during workouts. It got to the point where she would walk up the two flights of steps to her apartment and then sit down on the landing to catch her breath before unlocking the door.

In January of 2017, she went to the Tulane student health center, where she discovered that her red blood cell counts were extremely low, touching off a long journey to diagnosis and ultimately treatment.

Becker saw hematologists at Tulane Medical Center, Indiana University Health, Cleveland Clinic and the National Institutes of Health Clinical Center. None could figure out what was causing her anemia.

In order to function, Becker started getting blood transfusions every two weeks to borrow red blood cells from healthy donors. These transfusions take 6-12 hours each time, which is onerous for anyone, but especially for someone so young.

Also, the more transfusions a person gets, the higher the risk that they’ll start to reject the blood or that they’ll be more likely to reject a bone marrow transplant, which Becker increasingly suspected she needed.

After Becker graduated law school in 2018, she moved back in with her parents in Chesapeake and transferred her care to VCU Massey, where she began seeing Simmons.

“The first time I met Dr. Simmons, my dad was wearing a CrossFit shirt and Dr. Simmons said ‘oh I do CrossFit!’ We knew it was going to be a good match,” Becker said.

Simmons diagnosed her with pure red blood cell aplasia, which means her immune system was attacking her bone marrow, preventing the formation of red blood cells and depriving her body of oxygen.

After exhausting all other treatment options, Simmons recommended a bone marrow transplant, which Becker received in May 2019, 10 days shy of her 30th birthday.

As part of the procedure, Simmons cleared away Becker’s immune system with high doses of chemotherapy and immunotherapy and then infused her with donor stem cells – a special type of cell that can turn into any cell in the body – isolated from an unrelated donor’s bone marrow, to rebuild Becker’s immune system from scratch. What followed was a delicate tweaking of her immune system through immunosuppressant drugs to enable the donor stem cells to take hold.

“It’s like putting new grass seed on the lawn,” said Simmons, who is also an assistant professor of internal medicine at the VCU School of Medicine. “The goal is to grow that seed. Since you got rid of all the roots and weeds and rocks, you don’t have to worry about that. We just want to make sure a rainstorm doesn’t wash the seeds away.”

Even though the Becker and her donor are a “match” – meaning their cells are covered with the same proteins that the body uses to differentiate self from invader – there was still a chance that her body would reject the transplant or that the immunosuppressant drugs would prevent her body from fighting off infection. Overall, bone marrow transplant comes with about a 15% mortality rate, so it was a decision neither of them took lightly.

The time spent in the hospital during and after the transplant is another challenge. Recipients often have to leave their jobs, move to Richmond and spend months under careful surveillance as they’re slowly weaned off immunosuppressants.

Becker was daunted by the notion that she wouldn’t be able to work out while in the hospital, but Simmons, who knew her well by that point, reassured her that there was a treadmill on the transplant floor.

She continued to work out every day, making a full recovery without complications.

“It’s so much about mindset, I think, and just never doubting yourself and never thinking you can’t do it and always pushing yourself mentally and challenging yourself through sickness,” Becker said.

Becker’s donor, a stranger who lives in Germany, came through the Be the Match program. Only about 30% of people who need a bone marrow transplant can find a matched donor in their immediate family, so people like Becker rely on altruistic donors who contribute to this program and others like it.

“When you’re a match for someone, it’s likely you’re their only match,” Becker said. “There are so many people who are in need of bone marrow transplants who are waiting and waiting because they don’t have a match, so it’s important for people to get on the registry. Every person can be the one person that a transplant recipient is waiting for.”

Written by: Erin Hare