Home » Fight the Good Fight: A young life under siege
Spring 2009 – Shine Magazine
By Kevin Harwerth – Texas Children’s Hospital
Taekwondo focuses on unifying mind, body and spirit—the three are interconnected and dependent upon each other. As Chaise Cheatham goes through the paces in his taekwondo class it is difficult to believe that not that long ago, this strong 9-year-old almost died from cancer.
Much like the practice of taekwondo, it took a unified approach to save his life. At Texas Children’s Hospital, research and patient care weave together to create targeted treatments that are changing the way children like Chaise fight—and beat—pediatric cancer.
Chaise was only 23 months old when his parents, Khouloud and Wayne, took him to the pediatrician for what they thought was a routine ear infection. When the normal coarse of antibiotics did not help him, they went back to the doctor. Further tests showed that his blood was “a little off.” His physician told the Cheathams to take Chaise directly to the emergency room at Texas Children’s Hospital. Less than an hour later they learned Chaise had leukemia.
Chaise was diagnosed with acute lymphocytic leukemia (ALL), the most common form in children. Fortunately Chaise was already at Texas Children’s, home to the largest pediatric cancer center in Texas and one of the largest in the United States. Texas Children’s Cancer Center has been ranked as the number one place for children to receive care in the state and number three in the nation.
For ALL, chemotherapy treatments are given in three phases with the total treatment spanning two to three years. Chaise finished his treatments and the disease appeared to be gone, but two weeks later his leukemia returned.
“Because his disease recurred so soon after his treatment was completed, Chaise’s best option was to undergo a bone marrow transplant (BMT),” said Alana Kennedy-Nasser, M.D., his bone marrow transplant physician in Texas Children’s 15-bed stem cell and bone marrow transplant unit—the largest in the Southwest.
Chaise received chemotherapy and radiation in preparation for the procedure.
“This drops the white blood cells in a patient to the point where it is impossible to fight infections,” said Kennedy-Nasser.
In order to protect Chaise from infection, he was kept in isolation—both at home and at the inpatient unit at Texas Children’s—for 60 days.
According to his mother, “This was a difficult time for Chaise because his contact with other children was limited; however, his daddy was really a big kid while he was at home, and the child-life experts with their arts and crafts really helped Chaise pass the time during stays at the hospital.”
Typically, the search for a matching bone marrow donor through the national registry would have been very difficult for Chaise since his mother is of Middle Eastern decent and his father Caucasian, explained Kennedy-Nasser.
“Amazingly, three matching donors were found,” she said. “The second person that was contacted was essentially a perfect match based on a bone marrow profile.”
Even more important, the donor was willing to donate extra blood for a clinical trial—generously agreeing to take this extra step would turn out to be life-saving for Chaise.
As part of his treatment, Chaise was placed on a clinical trial under the direction of Catherine Bollard, M.D. T cells—a group of white blood cells that play a central role in the immune system—are taken from the donor’s blood donation and then genetically altered to enhance their natural ability to seek out and kill cytomegalovirus (CMV), a common viral infection that can cause flu-like symptoms, and Epstein-Barr virus (EBV) which causes infectious mononucleosis.
Bollard explained, “Over 80 percent of adults in the United States are infected with CMV and/or EBV, but these infections are usually ‘silent,’ meaning they cause no signs or symptoms in an infected person.”
Chaise received a dose of the donor T cells shortly after the transplant, but he developed an EBV infection because one of his medications inadvertently suppressed his T cells. While the virus is normally “kept in check” by our immune system, this was life-threatening for Chaise because he did not have enough T cells to kill the cells infected with EBV. If left untreated Chaise could have developed lymphoma (cancer of the lymphatic system). Bollard and her team obtained FDA approval to give Chaise a second dose of T cells. After receiving this treatment, Chaise was able to fight off the EBV infection.
However, by this time, he also had problems with a CMV infection. CMV can cause life threatening pneumonia in patients after bone marrow transplant and is also caused by a lack of T cells. While medications to treat CMV infection are available, these drugs damage the kidneys and bone marrow. To avoid using this toxic treatment, Bollard went back to the FDA and requested permission to give Chaise a third course of the T-cell therapy. Again, this therapy was overwhelmingly successful, and his CMV infection cleared within a week.
The T-cell study is one of many efforts being tackled by the Center for Cell and Gene Therapy at Texas Children’s Hospital. Established in 1998 by Texas Children’s, in conjunction with Baylor College of Medicine and The Methodist Hospital, the center provides research, manufacturing and clinical support for cellular and genetic treatments. This comprehensive approach brings scientists and clinicians together to develop and apply new treatments for a wide variety of illnesses including cancer, HIV and cardiovascular disease.
According to Malcolm K. Brenner, M.D., Ph.D., director of the Center for Cell and Gene Therapy (CAGT) at Texas Children’s, “The center is one of the few, maybe the only center in the country, that has basic, translational and clinical research components for both cells and genes.”
Though the number of patients participating in the T-cell study has been small, Bollard said results have shown this treatment to be very safe and effective.
“A number of researchers are interested in Dr. Bollard’s work,” added Brenner. “There were a lot of people who did not believe this approach would work, but now that she has shown its efficacy, the focus is to make the process faster and simpler. The center and its collaborative environment will allow us to refine this approach so that it is available to more patients.”
Bollard believes this area of research is highly relevant for the treatment of cancer because over the last decade biological therapies, either alone or with other treatments, have started to have a positive impact on patients. As a testament to her research, Bollard has received numerous research awards to help support her efforts to harness the immune system in the fight against cancer.
Chaise received his bone marrow transplant in 2006 and is doing very well. According to his mother, “He is really on a roll.”
Chaise recently received his yellow belt in Taekwondo and is working toward his green belt. Much like the fighting skills he is learning through martial arts, Chaise received the strength and ability his body needed to fight his cancer and triumph—thanks to the life-saving therapy made possible by Bollard’s innovative research and the care of Kenndy-Nasser and her team at Texas Children’s.
“While the focus was on treating Chaise,” Khouloud said, it was done in a way that, “during our entire stay we never felt like we talked to a stranger. It was like these people were family.”