August 16, 2022 by John Fernandez
Stem Cell Transplant Saves Young Mother With Leukemia
Like most Saturday mornings for Daymara Cano, June 5, 2020, began with plans of having breakfast with her husband and their two young children and then getting on with the weekend’s busy activities. But when she collapsed just trying to get out of bed, she knew something was seriously wrong.
“I had been a little tired, but I thought maybe it’s because the kids are home, doing home schooling, and I was working at home because of COVID-19,” she said. Ms. Cano, who was 35 at the time, even considered she’d contracted the virus because she had felt a small lump in her neck, a slightly enlarged lymph node. “But I was perfectly fine until that morning.”
An Unexpected Diagnosis
Her husband, Ronald, rushed her to the Baptist Hospital Emergency Center. After a variety of tests, Ms. Cano got news she never expected. She had acute myeloid leukemia (AML), a type of blood cancer. There would be no attending her son Adrian’s baseball tournament in Orlando in July, no painting with her daughter, Victoria. Instead, Ms. Cano was immediately admitted to the hospital to begin treatment for her life-threatening disease.
(Watch video: Hear from patient Daymara Cano and medical oncologist Yuliya Linhares, M.D., chief of Lymphoma Services at Miami Cancer Institute. Video by George Carvalho.)
Some 20,000 cases of AML are diagnosed in the U.S. each year, according to the American Cancer Society. While the majority of patients are older adults, it can occur in anyone. Symptoms often mimic other illnesses and can include fever, fatigue, bone pain and unusual bleeding.
“This is a disease that requires very intense treatment,” said medical oncologist Yuliya Linhares, M.D., chief of Lymphoma Services at Miami Cancer Institute, a part of Baptist Health. “The treatment really takes the human body to the height of what it can handle and requires a prolonged hospital stay.”
AML can be aggressive, and within hours of arriving at the E.R., Ms. Cano felt quite ill. Doctors quickly began the chemotherapy regimen designed to put her into remission. Over the next two months of her hospitalization, her team of experts, which also included medical oncologists Lyle Feinstein, M.D., and Talia Zahra, M.D., as well as Guenther Koehne, M.D., Ph.D., deputy director and chief of Blood & Marrow Transplant and Hematologic Oncology at the Institute, guided her care.
“It’s hard,” Ms. Cano said. “I had a bad reaction to chemo. And you don’t get to see the sky. You don’t get to feel the outside. But the doctors and nurses and everyone went above and beyond in every aspect.”
Stem Cell Transplant Required
Fortunately, the chemo did its job and put Ms. Cano into remission. “But we knew disease would return without stem cell transplantation,” Dr. Linhares said. Stem cell transplants are used to treat a variety of blood cancers as well as other blood diseases such as aplastic anemia and severe combined immune deficiency.
The search for a donor began. Ms. Cano’s siblings were not a match, meaning she would need an allogeneic transplant, one from an unrelated donor. A close match was found. “Not a perfect match. Usually, if it’s not a perfect match the risk of rejection and graft versus host disease is much higher. In the past, we were unable to do such a transplant,” Dr. Linhares explained.
What made Ms. Cano’s allogeneic stem cell transplant a possibility was the groundbreaking work of Dr. Koehne, who developed a technique to manipulate donor cells prior to transplant to diminish the often harmful, and sometimes deadly, graft versus host disease complication. Last March, Miami Cancer Institute hit a milestone, performing its 100th transplant since beginning its program just a year and a half before.
On Sept. 18, 2020, Ms. Cano had her transplant. “When we infuse the stem cells, they are sitting there like little babies in the bone marrow. They take time to grow,” Dr. Linhares said. “I often compare it to farming. We are weeding out the bad cells and then putting in the new seeds. The tender, new plants, we have to nurture them.”
To destroy the deadly cancer cells, the patient’s immune systems is wiped out, and then the infused healthy cells can grow. During this time, patients are at high risk for infection. Once deemed healthy enough, they must be repeat all the vaccinations they had as an infant and young child.
Not cleared to start her re-vaccination process quite yet, Ms. Cano contracted COVID-19 this past August. “I was very worried,” Dr. Linhares said. “This is why everyone needs to be vaccinated.” In addition to protecting yourself, you are protecting cancer patients and others with poor immune systems. Fortunately, quick antibody treatment prevented Ms. Cano from becoming very ill with COVID-19.
She Rings The Bell
More than a year after her AML diagnosis, Ms. Cano experienced another day she will never forget. On Oct. 5, 2021, she rang the bell at Miami Cancer Institute, signifying the end of her treatment. Surrounded by her children and other family members, friends, doctors and many others from her healthcare team, the moment was very emotional, she said. “It’s like a new beginning. I was given that chance. Miami Cancer Institute is a blessing in my life. In the end, there is hope.”
Quick to call Dr. Linhares her savior, Ms. Cano said the doctor’s kindness and openness gave her confidence. A mother herself, Dr. Linhares attended the ceremony. “Just seeing her kids with her was so heartwarming and honestly made me cry,” she said. “I always treat all my patients as part of my family. I tell my patients we are partners.”
Ms. Cano’s long-term prognosis is excellent, and today she is enjoying watching her son, 11, play baseball again. Next on her agenda is taking a karate class with her daughter, 8. “For almost a year and a half, I was out of their lives. I enjoy the simplest things now. I appreciate my mom and my grandmother even more. They were my rock. And my husband, he’s my best friend. That man did everything for me.”