After ‘Hail Mary,’ Leukemia Patient is in Remission With Help of Donor – Dana-Farber Cancer Institute

Family is the most important part of Michelle Nagels life. When she was diagnosed with acute myeloid leukemia (AML) in May 2007, her mind instantly went to her children; all she wanted was to see them grow up and have children of their own.

When she learned of her condition, Nagel and her family were allover the map; she was living in Germany, her husband was in Ireland, her sonwas on his high schools field trip to Paris, her daughter was going to collegein New York City, and her parents and siblings were in the United States.

Little did she know, when she wasin Ireland, she was in closest proximity to the stem cell donor who wouldeventually save her life.

Though she had been feeling sick for a few months, Nagelsdiagnosis came as a surprise.

There were peculiar things happening in and with my body that Ihad not experienced before, and I had no explanation for, she recalls. ButIm not one to run quickly to a doctor for every little thing.

This was until a bug bite on her ankle turned into a bad infectionthat spread through her foot and wasnt healing. Nagel went to the doctor inGermany, who stabilized her condition enough that she could travel to Irelandto visit her husband for their 24th wedding anniversary. When shegot there, however, things got worse.

I woke up with a terrible fever and I was quite literally whiteas a ghost, she remembers. Even my lips were white, and I had an unexplainedbump on the side of my face.

After reviewing her symptoms and running blood tests, a doctor inGalway called Nagel and told her to go to the emergency room, where two doctorswould be waiting for her.

When I asked what was wrong, she simply told me I was anemic. Iknew well enough that one is not sent to the emergency room for anemia, Nagel says.

She spent the night in the hospital, where the next morning, shelearned she had acute myeloid leukemia. The doctors further explained to Nagelthat the only possible cure for her disease was a bone marrow transplant. Herinitial reaction was to tell her family.

My first thought was to organize my life. I didnt panic oroverreact. I took charge and planned; I did what needed to be done for myfamily, says Nagel.

She remembers being glad that she had the diagnosis, rather than anyone she loved. She then told herself she would take it one day at a time.

Nagel began her treatment in Ireland, where she was placed on achemotherapy regimen. When this treatment failed, her doctors switched gearsand put Nagel on a second and then ultimately a third line of a chemotherapy inan effort to achieve remission. However, she wasnt able to stay out of thehospital for very long: due to multiple infections, she had to continue herstay for a few months.

Once she got back home to Germany, Nagel and her husband startedto piece together a plan. She still needed a stem cell transplant, and afterbeing encouraged by her mother to come to Boston for treatment, she decided tocontinue her care at Dana-Farber/Brigham and Womens Cancer Center (DF/BWCC).

By November 2007, six months after her initial diagnosis, Nagelwas in Boston. Shortly after her arrival, she began experiencing the symptomsof a condition known as rigor, which results in a sudden feeling of being cold,shivering, and a rise in temperature. The symptoms landed her back in thehospital, where doctors discovered her AML had returned.

This dealt a major blow to Nagels treatment timeline, as the relapse meant she could not to receive a stem cell transplant. But her team had a plan: Nagel was placed under the of care of Martha Wadleigh, MD, clinical director of adult leukemia at DF/BWCC. For cases of relapsed AML, patients like Nagel are treated with chemotherapy to get into remission first, and then they undergo a transplant.

Nagel was a few months into chemotherapy when she experienced what she calls a bump in the road: she fell, hit her head, suffered a brain injury, and was in a medically induced coma for five weeks. After coming out of the coma, she spent another five weeks rehabbing to build up the strength to walk again.

I would go to the chapel in my wheelchair to pray to live longenough to be a grandmother, she recalls.

She wondered about being able to recover enough to continuetreatment. But after four months of recuperation and a slight adjustment in herchemotherapy, it appeared Nagel would be able to undergo the transplant.

In order to receive the transplant, Nagel would need a donor. Sheconsulted with her medical team, who searched donor registries worldwide forpossible matches. They got back good news.

It turns out I was blessed with multiple possible matches. I feltnumb, she reflects. I was happy and relieved to know I had many potentialdonor possibilities, but all I focused on was moving forward day to day.

Nagel still had another major hurdle to overcome. Although she had improved, she had not achieved complete remission after chemotherapy. Despite having some evidence of minimal disease, she started getting ready for transplant under the watch of John Koreth, MBBS, senior physician at the DF/BWCC Adult Stem Cell Transplant Program.

She had a treacherous course even getting to us for transplant. Dr. Wadleigh did an outstanding job in her preparation, Koreth says. The transplant was a Hail Mary. For someone with active disease, there is a low percentage this will work.

In July 2008, Nagel underwent an allogenic reduced intensity (or mini) transplant. This is a modified form of the procedure that uses lower doses of chemotherapy and no radiation therapy; its suggested for patients who cant tolerate the harsh side effects of a full-intensity treatment.

The transplant was a success, and initially, Nagels AML was inremission. However, six months after the transplant, the cancer returned. Tocounter the cancer, Koreth tapered Nagel off of the immune suppressant she wastaking; it was being used to overpower her old immune system so that her newone could take hold.

The results were remarkable. Nagel achieved remission and continues to be in remission to this day. Now, more than a decade removed from her procedure, shes seen her son graduate high school and college, as well as watched her daughter graduate college, get married, and have a child Nagels first grandchild. Months later, she met the man who she credits with saving her life.

All Nagel knew about her donor at the time of her transplant wasthat he was a 57-year-old man from Great Britain. It wasnt until two yearsafter her transplant that she and her donor agreed to learn each others fullidentities. The Dana-Farber Donor Services team got to work.

When her 60th birthday came around, Nagels familysurprised her with a trip to England to meet her donor, Graham Hawthorne, andhis family.

It was an emotional meeting. Id wanted to give Graham a big hug for his generosity an understatement but I hadnt anticipated that it would be as meaningful or as emotional for him and his family, she explained about their first meeting. They met at a restaurant, where Nagel was introduced to Hawthornes wife, daughter, and 10-year-old granddaughter.

With every milestone I thank God and the blessing of a man whosecells saved me and have kept me alive to see each blessed event, said Nagel ofher experience. This was an answer to my prayers.

Hawthorne joined the registry 40 years ago, little did he know hewould be saving the life of a stranger across the globe.

If Graham had not been selfless enough to donate to a stranger, we would not have known the fulfillment and love this act can bring, Hawthornes wife said of the experience. We have become friends with a family thousands of miles away, who we would otherwise never have met, and both families are very thankful for it.

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After 'Hail Mary,' Leukemia Patient is in Remission With Help of Donor - Dana-Farber Cancer Institute

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