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  • Unraveling a medical mystery

    Jenna Shaw and her daughter MadelineJenna Shaw with her daughter Madeline 

    Jenna Shaw, 29, of Blaine, Maine, had been feeling sick for many months after her daughter, Madeline, was born in 2009. She lost 70 pounds in seven months and was fatigued from sore throats and infections. After almost passing out at work in the summer of 2011, she called her doctor near her home in northern Maine. Her physician ordered blood work after Shaw told him that her gums bled when she brushed her teeth.

    The next day, her doctor called her at the hospital where she worked as an MRI technologist and asked her to leave immediately. Shaw's blood work showed that she was severely neutropenic [a condition of abnormally low white blood cells]; her immune system was ravaged.

    What followed was a labyrinthine medical mystery that ultimately landed Shaw in the care of Richard Stone, MD, director of the Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) Adult Leukemia Program, and Rana Yehia, MD, a medical oncology fellow.

    After Shaw underwent a bone marrow biopsy at a hospital near her home, she was life-flighted to Dana-Farber that night to start aggressive chemotherapy. The initial diagnosis: acute myeloid leukemia (AML).

    "I was told by oncologists in Maine that my prognosis was poor because of how fast the leukemia was progressing, and that I needed to be somewhere that they could save me,” she says. "They thought that I needed to be somewhere that medical professionals were capable of taking care of me, and most of all experienced. So, they called Dana-Farber."

    However, a second bone marrow biopsy performed at Dana-Farber revealed that her bone marrow and blood were now spontaneously clear of the leukemia. After an eight-day hospital stay and another clear biopsy, Shaw was discharged home.

    She traveled to Boston every two weeks; additional biopsies showed no sign of leukemia. "My doctors thought that maybe the leukemia went into an 'arrest' period from a bout of antibiotics," Shaw says, citing studies showing that this can happen, but that the leukemia usually returns. Two months later, cancer returned, this time as tumors on her legs and arms. A biopsy at her local cancer center, and confirmed at Dana-Farber, led to a diagnosis of leukemia cutis: Shaw had leukemia in her skin, but not in her blood or bone marrow anymore.

    "Dr. Stone worked carefully to determine the best treatment options for me," Shaw says. "He worked with me very closely and monitored me weekly to make sure that he was doing the right thing, taking care of a very rare type of leukemia — especially for how young I was [26] when I was diagnosed with leukemia cutis."

    Because of the need to eradicate the leukemia before it could spread further, Shaw was admitted to Brigham and Women's Hospital in October 2011 and underwent a 30-day stay, receiving three types of chemotherapy, rather than the standard two. After targeted radiation to the tumors on her legs, she received high dose chemotherapy and full body radiation, followed by a blood stem cell transplant from an unrelated donor in December 2011 under the care of Vincent Ho, MD, clinical director of the DF/BWCC Adult Stem Cell Transplantation Program, and Amy Joyce, MSN, ANP, nurse practitioner in the DF/BWCC Adult Stem Cell Transplantation Program.

    "My case [of spontaneous regression, and subsequent isolated relapse in the skin] was discussed at several conferences," Shaw says of her dual diagnosis of AML and leukemia cutis. "I was a mystery to many physicians from Maine to Boston."

    Today, thanks to her Dana-Farber care team, Shaw is in remission.

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