Doctors Unlock Cancer Patient's Medical Mystery
Jim CunninghamWhen Jim Cunningham was 22, he wrote off a nagging backache and constant fatigue to being stressed from his job in direct sales. So Jim was shocked when a CT scan in late 2003 revealed that he had advanced Hodgkin’s lymphoma, a type of cancer that starts in the lymph nodes. Jim’s cancer was so far along that it had spread to his liver, spleen, and bone marrow.
For some types of Hodgkin’s lymphoma, cure rates can be as high as 70 to 80 percent. Chemotherapy is often a central part of treatment. In 2004, Jim began chemotherapy but developed a severe skin lesion on his leg. At one point, the condition became so severe that doctors considered amputating Jim’s leg. That’s when Jim’s doctors recommended the University of Chicago Medical Center, where cancer specialists see hundreds of patients with lymphoma each year.
Doctors as Detectives
While Jim’s skin problem baffled his local doctors, it was cancer experts at the University of Chicago Medical Center who were able to solve the medical mystery that threatened Jim’s body. There, doctors discovered that Jim’s skin reaction was caused by a very rare reaction to pegfilgrastim, a medicine given during chemotherapy to help protect white blood cell counts. Only one other case like Jim’s had been documented in North America. Once doctors identified the problem, they cleaned out the lesions and treated the allergic reaction with a corticosteroid, which was able to dramatically change the course of Jim’s treatment in just 48 hours. With his skin under control, doctors could return to combating Jim’s cancer.
After completing six cycles of chemotherapy, Jim spent several months in remission. But in spring 2005, Jim received the news he feared most--that the cancer had returned. He told his doctors at the University of Chicago that he wanted to undergo a more aggressive treatment approach. So in the fall, doctors started him on chemotherapy once again and prepared him for an autologous bone marrow transplant. In this procedure, doctors harvested Jim’s own stem cells. Research shows that such transplants can cure about 40 percent of patients with relapsed aggressive lymphomas.
"Doctors described the bone marrow transplant as a way to reboot my immune system," Jim says. Typically, doctors use the drug filgrastim in combination with apheresis to harvest cells. This involves filtering out the circulating blood stem cells using a special machine. But because Jim could not tolerate the drug used to stimulate white cell production, they had to harvest the cells using a more invasive method. Doctors inserted two large needles into Jim’s pelvic bone to retrieve the stem cells. Then Jim received 12 chemotherapy treatments in six days, followed by the reintroduction of two-and-a-half million of his own stem cells back into his body.
"Stem cell transplants are very important in the treatment of patients with hematologic malignancies, such as lymphoma, leukemia and myeloma," says Koen Van Besien, MD, who heads the lymphoma and stem cell transplant programs at the University of Chicago Medical Center. "They also can provide a cure for patients with sickle cell disease or thalassemia.
The University of Chicago stem cell transplant program has a large number of ongoing studies in transplant. "In some studies, we investigate new drugs or vaccines to improve cure rates after transplantation. Other studies relate to donor transplantation," Dr. Van Besien continues. "We have found that for many patients of minority descent, we cannot find good unrelated donors. We have pioneered a very interesting study where we combine an adult donor with a cord blood transplant." University of Chicago physicians have performed two such transplants and plan to complete more in the coming months.
A Caring Team of Specialists
Jim credits Dr. Van Besien for his amazing recovery. "I owe him my life, and I’ve referred a few patients to him already," Jim says. "The doctors at the University of Chicago were just fantastic--they were brilliant, down-to-earth, and attentive to my questions. Also the nurses--I call them ‘angels with Crocs’ [colorful clogs that many nurses wear] because they are so compassionate."
Jim also credits the support of his family and vast network of friends to help him get through the tough times. During some weeks when he was in the hospital, he might have as many as 40 visitors.
A Shoulder to Lean on
Today, Jim, who is now 26 and lives in suburban Oak Lawn, has been cancer-free for a year and a half. In addition, he is happy to spend his time focusing on fluctuations in interest rates rather than on changes in his health status. He has returned to school full time to pursue a business degree and hopes to own a real estate company in the future.
Since he’s recovered, he’s gone to Capital Hill to ask Illinois senators to back funding for lymphoma research. In addition, Jim is actively involved in his local Rotary and many organizations that offer support for cancer patients.
"I try to tell other patients to think positive," Jim says. "I believe that was a big part of my recovery. I’m living proof that you can survive cancer."
