"It's nice to come here to get help in managing my GVHD. Sure, it would be really nice if I didn't have it, but I have gotten used to the idea that every day it is likely to be itchy somewhere in my body," she said of the telltale symptoms of her immune system's ongoing tug of war with her transplanted cells.
GVHD remains one of the most intractable complications of transplantation, and at Fred Hutch, a major focus of research. In recent years, researchers have made major strides to prevent GVHD and to help reduce or alleviate symptoms in patients such as Keren.
Keren is a two-time transplant survivor. Her battle against cancer, she said, tempered her stamina and professional ambitions, but she hasn't allowed complications such as GVHD to stand in the way of a life well lived.
She was diagnosed with chronic myeloid leukemia in 1993, when she was seeking a master's degree in health policy.
Unfortunately, her unrelated donor's bone marrow failed to engraft and after two months in a hospital without an immune system, she had to undergo a second transplant, this time receiving stem cells from the same donor, in late 1994.
"It was a difficult time, but what I found so helpful was talking to patients. I learned not to have any set expectations and to be prepared for what is possible," she said.
Several years ago, she decided to write a survivor's guide to bone marrow transplantation to help patients like her. It remains available at the National Bone Marrow Transplant Link website at nbmtlink.org. Most recently, she published a survivorship guide for coping with late effects of transplantation.
Because of her deep interest in health care issues, she chose a career in the cancer field, which has allowed her to remain close to people who have been stricken by the disease. For the past 15 years, she has facilitated a support group for young adults with cancer.
"Navigating the health care world is extremely difficult and much more so for people who are dealing with a life-threatening disease. I love to help," she said.
Keren and her partner, Joshua, have two beautiful children: Talia, a vivacious 9-year-old, and Ben, who just turned 7. Of course, running after them takes a lot of energy, a task that's a little harder for a transplant patient.
"A lot of us think we're going to come out of transplant and return to our previous levels of health and stamina. But that's not the case," she said. "There are a lot of changes that happen, and adjusting to these changes is very difficult.
"Having a better idea of what to expect makes it easier to handle the changes, which is why we need to tell the stories of different survivors, those who emerge vigorous and healthy as well as those who have lingering long-term chronic health issues.
"This way, patients can go into the transplant with a more complete picture of the possibilities and are better prepared to deal with what is to come," she said.
"What did this experience with cancer do for me? It made me know on a deep, visceral level that I am mortal and that things may change in a flash," Keren said. "So, since those precarious days in the transplant unit, I have committed myself to doing something nice for myself each day. I wanted to have a moment of light, a moment of goodness."