At the time of Daniel's treatment in 1989, no patient with such extensive tumor spread had survived. "Of course this is 17 years ago," Dr. Cheung adds. "Monoclonal antibody therapy was promising but uncertain. Instead of the conventional myeloablative chemotherapy with bone marrow transplant, we used antibodies to eradicate minimal residual disease, trying to avoid the long-term complications." Daniel was one of the first patients enrolled on this new treatment protocol.
Daniel had a more difficult road than other children, Dr. Cheung explains, because the disease was so extensive. "I still remember when he was septic with the blood infection that went to his lungs," he says. "He was on the ventilator in the ICU [intensive care unit] for nearly two weeks. I worried then." Adding to Dr. Cheung's concerns was the presence of active tumor, which lingered even after Daniel had completed a regimen of chemotherapy. Fortunately, Michael LaQuaglia, Pediatric Surgical Service Chief at Memorial Sloan-Kettering, was able to remove what remained of the tumor. Still, Dr. Cheung was worried.
Dr. Cheung points out that much has changed over the past two decades in the treatment of neuroblastoma. Today most patients with advanced neuroblastoma who come to Memorial Sloan-Kettering will receive monoclonal antibody treatment. "This treatment has evolved over the years to the point where now all of the treatment is given on an outpatient basis and is more tolerable," he explains. "We have improved the five-year disease-free survival rate to well beyond 40 percent."
When asked what it means to him to know that Daniel is doing so well, Dr. Cheung is quick to respond. "Everybody in the neuroblastoma team -- Dr. LaQuaglia, Dr. Kushner, Dr. Kramer, Dr. Modak, our nurses, and I -- is thrilled to know that Daniel is coping well, and that he is learning the art of healing in nursing school, which will allow him to give back to those less fortunate. In hindsight, we were only trying to do a good job. It means everything to us to know that our efforts were not in vain."
