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Bone Marrow Transplant for Ewing’s Sarcoma
Parents always hope that their children will develop healthy habits. In that respect, Cassidy Yeager is every parent’s dream. In her late teens, she could squat-press 350 pounds, bench-press 150, and was attending Saint Francis University on a track and field scholarship.
In spite of her healthy lifestyle, cancer still struck. It started with symptoms of a hip injury, not unexpected in a serious athlete. After several X-rays, the diagnosis was tendonitis. That summer, Cassidy turned 19.
During the next school year, the pain continued, and there were also signs of swelling. Cassidy wanted an answer to the nagging problem, and the X-rays weren’t providing it. “Still, I didn’t want them to tell me I couldn’t run,” she says. So she waited until the track season was over to see her doctor about her hip pain.
An MRI showed signs of what was then diagnosed as Ewing’s sarcoma, a cancer that starts in the bones. “By that time, it had metastasized to my lungs,” Cassidy says matter-of-factly. “It was scary, but to finally know what the problem was gave me a little bit of hope.”
In light of her age, Cassidy was referred to pediatric oncologist A. Kim Ritchey, MD, at Children’s Hospital of Pittsburgh of UPMC. Dr. Ritchey assembled his team, including a social worker, psychologist and child life specialist. In Children’s cancer treatment program, the whole team — not just the attending physician — regularly meets with the patient and family. Because teens, unlike the very young, understand the impact of cancer, and often have expectations and even plans for their own futures, the collaboration of medical and psychosocial professionals is critical. It ensures that teen patients feel supported throughout the dynamic range of issues they face.
At the point of her diagnosis, Cassidy’s good health proved to be her greatest advantage.
“Dr. Ritchey talked to me about their plans for my treatment,” says Cassidy. “He said, ‘We’re going to hit it as hard as we can.’” Cassidy recalls that her faith in the plan was rewarded: “After two chemo treatments, it was gone from my lungs.”
But it was one site down, and one to go. The malignancy remained in her hip. In Cassidy’s case, as with many bone cancers, surgery — and the necessary recovery and rehabilitation — were part of her treatment plan. To accommodate the ordeal, Cassidy took the next year off from college.
Surgeons performed a hemipelvectomy, removing the affected portions of her pelvic bone. The procedure was designed to preserve Cassidy’s use of her leg. Cassidy bounced back beautifully. She says, “That summer I had two jobs, and I did a lot of physical therapy.”
She also served as a volunteer for the American Cancer Society, a step she took just three months after her diagnosis, by working as a local committee member and chairing events to raise funds for programs and research. By the fall, she was back at college. She had changed her major to social work: “I still wanted to work with kids,” Cassidy says, “but I knew after what I had gone through that I wanted to help kids with cancer.”
Astonishingly, she also was back on the track team. In her field events, she was still strong, still hurling a javelin as far as ever. It was not until the spring, however, after several months of training, that Cassidy was able to compete in her first running event since her diagnosis.
It was an event for which she held the meet record. Another sprinter at the meet remembered losing to Cassidy during their high school days, and greeted Cassidy with, “Oh no, not you again!”
Cassidy laughs, “I didn’t go into the details, but I told her that I’d be lucky if I finished!” She did finish, but she was two full seconds slower than her meet record — an eternity to a competitive runner.
With her life back in gear, Cassidy completed her schoolwork and continued her part-time job and volunteer work. She also continued to have frequent checkups with the specialists at Children’s Cancer Program. Only when a patient has been cancer-free for five years is he or she considered a survivor.
So the regular visits were a necessity and, as it turns out, a lifesaver for Cassidy. “The cancer came back,” says Cassidy. A CT scan showed three spots on her lung: spots so small they could not even be biopsied. Cassidy was not surprised, and, if she was disappointed, the feeling barely registered with her. Two days after Christmas, she began a new chemotherapy regimen. Throughout the successful five-month treatment, she lived at home but still attended school and continued to work.
Cassidy’s team within Children’s cancer program discussed the positive outcome of her chemotherapy, but the recurrence itself raised enough concern that options were reviewed. Rakesh Goyal, MD, suggested bone marrow transplantation (BMT) as added insurance against any lingering cancer.
Because Cassidy’s cancer had never invaded her bone marrow, she could have an autologous transplant — that is, she would be her own marrow donor. Essentially, an autologous BMT greatly reduces the chance of rejection and need for harsh antirejection drugs. When the care team proposed the autologous BMT to Cassidy, her primary question was, “How did everyone else end up?” The team was able to answer her question quite thoroughly, thanks to a wealth of experience: Children’s performs roughly 30 BMTs every year.
When you’re a busy college student, there’s never a good time to be sick, and some times are even worse than others. Cassidy’s doctors wanted to schedule the BMT right away. Cassidy argued against it. “It was my senior year,” she says. Given that she had pressed on through multiple treatments, surgery and rehab, it was clear that this young woman could not be stopped. Graduation took priority.
Four days after graduation, however, her BMT began. Cassidy’s own cancer-free marrow cells were harvested prior to her receiving intensive chemotherapy and radiation. Such treatment ideally eliminates any remaining cancer, but usually also damages the function of the bone marrow — hence the need to “rescue” some healthy cells beforehand. Afterward, her marrow was restored — not by surgery but by infusing the healthy cells directly into Cassidy’s bloodstream. From there, they migrated back to the marrow.
For Cassidy, the process required her to spend 27 days as an inpatient on Children’s oncology unit. BMT patients need protection from germs and viruses while their marrow — essential to immune system function — is in a weakened state. Although Cassidy was technically in isolation much of the time, her mother was permitted to stay with her. The unit’s child life specialists also visited daily to offer in-room activities.
Showing wonderful spirit and creativity, Cassidy and her mother started a message service on the unit. They called it “Transplant Mail.” They wrote letters to the other isolated BMT patients, and encouraged them to write back. Five of the letter-writers became very close during their stay at Children’s. Together, they prepared for the common side-effects of the BMT process: mouth sores that can make it hard to eat and, despite the isolation and other precautions, serious infections.
Fortunately Cassidy had few such setbacks. Mouth sores did cause her to lose significant weight, but she never required intensive care. Although the chemotherapy sometimes nauseated her, “I got my weight back,” she says proudly.
Cassidy finished her protocol. When she was to be discharged, the staff discussed with her the likelihood of complications. They warned her that she would probably be back. Cassidy, however, took their predictions as a kind of challenge. She says, “When I left, I left.”
Now in her mid-20s, Cassidy Yeager is putting her hard-earned degree to use working full-time as a community income development specialist for the American Cancer Society. Cassidy has always been able to see the steps that would lead to her goal. For those with cancer, she sees the cure as the goal, and the next step is to ensure funding for research.
Cassidy plans to return to Saint Francis University for her master’s degree and, from there, to secure her dream job as a patient advocate or legislator with the power to make the next step happen. “We know a lot about cancer,” she says, “but we’re so far from where we need to be.”
September 17, 2012
September 17, 2012