- Diagnosed with follicular non-Hodgkin’s lymphoma in 2002 at age 50
- Treated with standard R-CHOP chemotherapy at local hospital
- Diagnosed with large B-cell lymphoma in 2006
- Treated in a clinical trial with I-131 followed by a bone marrow transplant
In February 2002, Lisa Verner ended “the worst job of [her] life,” an urban-planning/real estate–development consulting job that had gone bad. She immediately went to Hawaii for a vacation and started taking care of herself—walking, eating better, and just living more healthfully. When she returned home, feeling relieved of all her stress, Lisa wondered why she was having night sweats and felt tired all of the time. So she went to her doctor for a physical on May 28, her 50th birthday.
“My doctor poked around at my stomach and said, ‘That shouldn’t be hard,’” Lisa recalls. Lisa went for a computed tomography (CT) scan and eventually a bone marrow biopsy. She learned she had stage IV follicular non-Hodgkin’s lymphoma. The cancer was in her bone marrow. Her oncologist told her she had an 85 percent chance of recovery with chemotherapy.
“I cried,” Lisa said, recalling the day she got her diagnosis. “It was a shock. It was scary. My brother was there that day for my birthday. We called my parents together. Then I was just in shock for a while.”
Taking on her cancer as if it were one of her consulting projects, Lisa went through eight cycles of the standard R-CHOP chemotherapy, a combination of rituximab (Rituxan), cyclophosphamide (Clafen, Cytoxan, Neosar), doxorubicin hydrochloride (Adriamycin), vincristine sulfate (Vincasar), and prednisone, at the medical center where her doctor practiced. By December 2002, Lisa’s lymphoma was in remission. “And I went on my merry way for a few years,” Lisa said.
No longer actively worrying about her cancer on a daily basis, Lisa enjoyed her life working as a consultant and being active. Out cross-country skiing one day in February 2006, however, she fell and hurt her knee. She went to an orthopedic doctor, who did a magnetic resonance imaging (MRI) scan of her knee. The MRI showed areas of concern. A knee biopsy confirmed that lymphoma had returned, but this time in a more aggressive form, large B-cell lymphoma.
Treatment for Large B-Cell Lymphoma
In September 2006, Lisa began the chemotherapy regimen called R-ICE: rituximab, ifosfamide (Cyfos, Ifex, Ifosfamidum), carboplatin (Paraplatin), and etoposide (Toposar, VePesid). And she began to think about options to get herself through this latest diagnosis.
“My team reactivated,” Lisa said, referring to her brother, Paul, and two friends, Ann and Kathy, who’d helped her through her first cancer treatment. They went with her to all of her doctors’ appointments then and would this time as well.
“Kathy’s mind works in spreadsheets,” Lisa said. “She put all of my options on the wall with the possible outcomes. And it boiled down to a bone marrow transplant making the most sense.”
Lisa’s oncologist told her about Seattle Cancer Care Alliance (SCCA), where Lisa learned that an autologous transplant (using her own stem cells) would give her the best chance of living another five years. Lisa cried again—and decided to go forward.
Step 1: Treatment on I-131 Clinical Trial
After deciding to have a transplant, Lisa had three additional rounds of R-ICE chemotherapy. During these treatments she also got shots of granulocyte-colony stimulating factor (G-CSF), a growth factor that stimulates the bone marrow to make more stem cells. Next, her stem cells were harvested from her bloodstream (using a process called apheresis) so they could be transplanted back into her body later. “They harvested twice as many stem cells as they needed,” Lisa said. “It was easy. And they froze them.”
Then Lisa went on to have external-beam radiation therapy to her knee and her left arm, where she had begun feeling pain.
Lisa had also decided to participate in a clinical study run by SCCA’s Ajay Gopal, MD, associate professor of medical oncology at the University of Washington (UW) School of Medicine, using iodine-131 (I-131), a form of radioactive iodine, as part of her transplant process. The goal of I-131 treatment is to give radiation therapy internally, through the bloodstream, so it can travel throughout the body killing cancer cells. By January 2007, she was ready to begin the preparations “to see if I could tolerate it [the radioactivity],” she said. “I had heart and breathing evaluations. It was all very interesting.”
Step 2: Going Radioactive—Nine Days in Isolation
On Feb. 7, 2007, Lisa was admitted to UW Medical Center (UWMC) to begin I-131 treatment. Paul, Ann, Kathy, and another friend, Denise, who flew out from Washington, DC, were by her side, but they wouldn’t be able to stay with her the whole time. Because patients give off potentially dangerous amounts of radiation after receiving I-131, Lisa would need to be isolated in the hospital for nine days.
“I checked into an isolation room. Everything was covered in plastic,” Lisa said. “Anne had taken me on a shopping trip to Value Village to get clothes to wear that I could leave there when my treatment was done, since they would be radioactive, too.”
Lisa received her infusion of I-131, and her friends came every day to talk to her through the protective door of her room. But Lisa didn’t mind the isolation that much. A self-professed introvert, she had lots to read and enjoyed looking out the window at the view.
Step 3: Bone Marrow Transplantation
After making it through her isolation, Lisa was moved to the other side of the UWMC building. “This room felt like a dorm room, with friends and staff coming and going. My friends made posters and decorated the walls,” Lisa said.
Lisa then had two more days of chemotherapy to kill off any remaining immune system and cancer cells that may have managed to live through her other treatment. Then she had her transplant.
“It was kind of anticlimactic,” she confessed. “The little bag of stem cells took just a few minutes to infuse. My parents and friends came to visit me. I was in the hospital for another 16 days after that.” When she was finally released, Lisa’s friends and family took care of her as her immune system began its slow recovery. There was, and is, no longer any sign of disease in her body.
After her transplant Lisa worked with an SCCA nutritionist, physical therapists, and the transplant long-term follow-up team to regain her health and prepare for her future. Since 2007, she has had regular check-ups with Dr. Gopal and her local oncologist, who looks at her knee and elbow, places where her cancer may recur. Flow cytometry tests have shown that a very small percentage of her cells are missing chromosome 7, which may be a precursor to leukemia. But monitoring occurs annually, and Lisa is optimistic.
“The way SCCA operates is the way that medicine should be practiced: on time with precise-to-blunt communication,” Lisa said.
There is an emotional element to having cancer once and then twice and then having a bone marrow transplant. “You forge ahead and get through it, and only then, after it’s all done, can you let it all get to you,” Lisa said. “I’m more understanding about what other people are going through now.”
With cancer hopefully behind her for good, Lisa looks forward to the normal parts of life that are a little less dramatic, like taking walks, working with her consulting clients, and taking more relaxing vacations to sunny, warm beaches.