"So," Dr. Boulad notes, "she was in the five percent of patients with exceedingly high white counts, and that alone is a very high risk. For a patient with unusual white counts, it is important to go to an institution that specializes in the treatment of ALL. At Memorial, you have Peter G. Steinherz, one of the doctors who helped develop the treatment protocol for ALL in the U.S."
The typical treatment for ALL is divided into three phases: induction, consolidation, and maintenance. In the induction phase, doctors try to destroy as many cancer cells as quickly as possible. The consolidation phase seeks to destroy any remaining cancer cells. And once the number of leukemia cells has been reduced by the first two phases of treatment, the maintenance phase can begin. "Induction and consolidation are the toughest parts of the chemotherapy treatment," Dr. Boulad explains. Treatment for ALL patients typically lasts two years, but some high-risk patients are put into remission and then given a bone marrow transplant (BMT) to help assure that no stray cancer cells are left.
"Because it is such a difficult treatment," Dr. Boulad says, "other centers may have a tendency to wait for the patient to recover completely from one phase before going onto the next. And in these types of cancers, the intensity of treatment is important and will determine the treatment's success. We do so many high risk cases here at Memorial that we've become accustomed to dealing with the day-to-day complications. Where other centers might wait for complications to happen, we anticipate them and are proactive."
"In Faigie's situation," Dr. Boulad continues, "she had a complete remission after the first month of treatment, but because of her high white count, it was decided to go to transplant."
Yet Faigie's troubles were only just beginning. When the doctors did their routine pre-operative check, they discovered she had a large blood clot in her heart. As a result, before she could get the transplant, she first had to go through open-heart surgery.
After recovering from the surgery, Faigie finally got her transplant in September 1995. Fortunately, Faigie's younger brother qualified as a full-match donor, and there were no major complication from the BMT early on. However, she began to develop recurring infections and her white cell counts were somewhat low. In addition, she developed an infection of the chest bone, which was due to her prior open heart surgery. As a result, the doctors decided to give her what is called a supplemental bone marrow transplant known as a "marrow boost."
Besides a variety of relatively minor infections, Faigie was fine until December of 1996, when she was readmitted to the hospital with fever, a cough, and, most disturbing, noticeable changes in her mental processes, which turned out to be symptoms of viral encephalitis. "She came very close to going on a respirator," Dr. Boulad recalls, "but, thankfully, she avoided it." And after four weeks of antibiotics, she recovered and since then has had only minor problems.
When asked if there was anything about Faigie that helped her through the entire experience, Dr. Boulad nods his head.
"It's her will," he says. "Her will is extraordinary. She's a fighter and a very graceful individual. And she went through all of this with a smile."
"Despite everything she's gone through, she continued to be a very lovely human being. There are patients who, when they are admitted, everyone who comes into contact with them - doctors, nurses, technicians - comes back to you, their doctor, and says how wonderful a person they are. Faigie was one of them."
And when asked how it feels to help someone like Faigie, Dr. Boulad pulls out a photograph taken of him with Faigie at Faigie's wedding reception, big, beaming smiles playing across both their faces. "I felt like that all day long. I'd seen her go through her open-heart surgery, all her infections, her encephalitis, and to see her as beautiful as she was that day…It was one of the most rewarding days of my career," he says, smiling again.
