Chronic Myeloid Leukemia Survivor
- Diagnosed with chronic myeloid leukemia in 2008
- Treated with tyrosine kinase inhibitors and bone marrow transplant at SCCA
- Participated in a clinical study testing an investigational transplant protocol
- Helps raise money to support cancer research
Larissa Dhanani’s battle with leukemia began on a tennis court in Blaine, Washington—the home of the Peace Arch linking the U.S. and Canada. Larissa described herself as “a healthy, active, working mother of three sons. I watched what I ate, didn’t smoke, and ran marathons.”
So it surprised her in 2008 when several bruises she sustained during a tennis match had unusually hard centers and didn’t go away. A visit to Nathan Morrow, MD, her primary care doctor in Bellingham, resulted in a blood test that indicated a diagnosis of chronic myeloid leukemia (CML). “Then our life changed on a dime,” said Larissa. “My husband, Asiff, had left that morning on a business trip to South America. We reached him just in time during a layover in Florida; he caught a red eye and came home.”
Since 2001, many CML patients have benefited from imatinib (Gleevec), a tyrosine kinase inhibitor (TKI). It paved the way for the whole class of checkpoint inhibitors. TKIs block mutations from sending cancer-causing signals along the body’s molecular pathways. These drugs enable 80 percent of CML cases to remain treatable as a chronic condition. This means patients don’t progress to the acute phase that requires a bone marrow transplant.
Larissa’s initial treatment was with imatinib. Unfortunately, her disease became resistant to it after only a couple of months. Then, in March 2009, Larissa’s Bellingham oncologist, Patrick Nestor, MD, referred her to Vivian G. Oehler, MD, at Seattle Cancer Care Alliance (SCCA).
Dr. Oehler and her colleagues switched Larissa to a different TKI called dasatinib (Sprycel). They also took the precaution of tissue typing Larissa and her brothers—just in case Larissa might need a sibling to donate cells for a bone marrow transplant in the future. Said Dr. Oehler, “Patients on second-line therapy often don’t need to go to transplant if they respond positively to the drug. Unfortunately, Larissa progressed relatively quickly; that’s probably because dasatinib doesn’t treat the particular mutation that she developed.”
“You Came Here To Get Healed”
By December 2010 Larissa was in full blast crisis. This is the acute phase of CML; it involved more than 95 percent of Larissa’s white blood cells.
When she arrived at SCCA, Larissa recalled, “I was clutching my pillow and my little suitcase, and I was crying. The woman at registration said to me, ‘Honey, you didn’t come here to die, you came here to get healed.’ And I just started to get calmer and calmer.”
The preparation for a bone marrow transplant is demanding. Over a period of about three months, Larissa underwent two cycles of chemotherapy. Dr. Oehler and her colleagues also switched Larissa to a different TKI, nilotinib (Tasigna), which was specifically targeted to Larissa’s mutation. Just before the transplant, in April 2011, she received total body irradiation twice a day for four days to kill off her immune system so her body could accept the donor cells.
Larissa was lucky to have a strong family support system, which made a big difference as she prepared for the transplant. As it happens, Asiff has a cousin, also named Larissa, who is a breast cancer specialist at SCCA—Larissa Korde, MD, MPH. Dr. Korde invited Larissa to stay in her house, which is less than 20 minutes from SCCA.
Dr. Korde’s experience with the normal ebbs and flows of cancer treatment helped Larissa keep things in perspective. Larissa recalled, “ [Dr. Korde] was marvelous. When I’d get nervous, she would say, ‘Yeah, that happens.’ She was really good with keeping me Zen and filtering things for me. She’d make sure I just didn’t start doing Internet searches on my condition; she’d say, ‘No, no, no, you’ll see everything that could ever possibly happen or go wrong.’”
Participating in Clinical Trials
Dr. Korde also helped Larissa choose among the many clinical studies, or clinical trials, that were available to her. Most significantly, Larissa participated in an investigational protocol that used only specially selected stem cells for her transplant. Fortunately, Larissa’s brother Doug Colby, who donated his cells, was a perfect match. SCCA researchers were hoping to further improve patient outcomes by eliminating ineffective or “naïve” T-cells from the donated cells. Larissa said she was happy to participate because “research into developing cures, better treatments, and better drugs is so very important.”
Larissa’s transplant was a success. She did experience some typical side effects from the chemotherapy and the radiation therapy. But she was well enough to leave the hospital after three weeks—one week less than the average stay. “They don’t release you unless you can show them a schedule of 24/7 caregivers. I was extremely fortunate. I had a group, including my mom, sisters-in-law, and several girlfriends, coming down and staying over. And my middle son, Khalil, even took a quarter off from college; he came to Seattle and took the caregivers’ course so he could help me,” she said.
“Starting to Feel More Like Me”
Even so, the road to recovery was long and gradual. For about six months, Larissa lived close to SCCA, often visiting the clinic several times a day for blood work, X-rays, and transfusions of blood and platelets. “At first, I could hardly walk a block,” said Larissa, “just because my feet and ankles and legs would hurt all the way up to the knees. But everything gradually got better. One day you realize, ‘Oh, I’m walking a couple of blocks ….’ And then you’re walking eight blocks.”
By the end of the summer of 2011, Larissa was ready to go home. Living in the country presented some unusual problems. Specifically—dirt. To avoid infection, transplant patients require an especially clean environment. The Dhananis had to have their old carpet ripped out and have hardwood flooring put down. They also had to have their well water tested.
About a year after returning home, Larissa realized, “I’m finally starting to feel more like me.” She returned to work in September 2012 at the Family Service Center for the Blaine school district. And, as Dr. Oehler notes, “With every passing year, the chances of leukemia coming back are smaller.”
Healing and Helping Others
Today, Larissa makes it a priority to do what she can to support cancer research. She helps raise money for the Leukemia & Lymphoma Society. And in 2013 she was honored by Swim Across America, when 300 swimmers raised approximately $250,000 to support the cellular therapy lab that developed the protocol used in Larissa’s transplant. The event was, understandably, an emotional one: Larissa got a chance to meet some of the researchers who had helped her become a cancer survivor.
And meeting Larissa made a difference to both the researchers and the swimmers. As Larissa put it, “Afterwards people were coming up to me. Some just touched my shoulder; some asked if they could hug me; others thanked me for coming out. They just seemed so grateful to see what the money they had raised was going toward and how it changed my life.”