Released: 10/1/2020 11:51:20 AM
“She’s a bundle of joy, she’s a blessing. She’s just life.” That’s what Cariorl Mayfield of Niagara Falls, N.Y., says about his young daughter, Chasity, a year after she went through a complex series of therapies at the Roswell Park Oishei Children’s Cancer and Blood Disorders Program to treat the leukemia she was diagnosed with at only 5 weeks old.
Chasity, who will celebrate her 2nd birthday this month, shows no signs of cancer after successfully undergoing CAR T therapy — and is one of the youngest patients to receive this advanced cancer treatment. Few centers in the country are approved to offer CAR T, short for chimeric antigen receptor T-cell therapy, which involves removing a patient’s own immune cells through a process similar to a blood draw, bolstering them to make them more effective at recognizing and killing cancer cells, and infusing them back into the patient with the goal of providing long-term protection against cancer.
The specific form of CAR T that Chastity received was Kymriah, also known as tisagenlecleucel, a therapy approved by the U.S. FDA in 2017 for treatment of some advanced leukemias in both children and adults, and for which Roswell Park Comprehensive Cancer Center has been a certified treatment center since 2018.
Chasity’s battle with leukemia began in the fall of 2018, when her parents became concerned that the persistent vomiting, irritability and skin discoloration they saw in their newborn could be signs of something serious. After a few trips to the pediatrician, they took her to the Oishei Children’s Hospital emergency room, where childhood cancer expert Kara Kelly, MD, the on-call attending physician for the Roswell Park Oishei Children’s Cancer and Blood Disorders Program, would diagnose Chasity with an aggressive, treatment-resistant blood cancer, acute lymphocytic leukemia (ALL).
“When we got the news, it was just like, ‘How? How?’” recalls Chasity’s mom, Shawanda Prather. “I felt a pain in my stomach that I had never felt before.”
The family would endure several stressful months after they learned that Chasity had an especially aggressive form of ALL. Her Roswell Park Oishei treatment team determined that her leukemia was marked by a gene mutation that made it even less likely to respond to standard chemotherapies, and more likely to recur.
“This particular type of leukemia, when it presents in babies — particularly a baby as young as Chasity — the prognosis is terrible, with typically only about 20 to 30 percent being able to make it,” says Dr. Kelly, who leads the Roswell Park Oishei Children’s Cancer and Blood Disorders Program as Chair. “I knew we needed something different, something that the leukemia cells were not going to be resistant to. That's why more of an immune approach such as CAR T cells was very attractive, because they're not subject to the resistance that the leukemia cells are very good at adapting to.”
Chasity faced even greater odds as a Black infant with aggressive leukemia. A 2018 study in the journal Cancer reported that a Black child with ALL is 43 percent more likely to die than a white child with the same diagnosis.
Together, this family and this medical team are helping Chasity to beat those odds.
In the spring of 2019, Chasity’s blood stem cells were collected, re-engineered with the addition of Kymriah and infused back into her under the guidance of Dr. Kelly, pediatric oncology/cellular therapy specialist, Meghan Higman, MD, PhD, pediatric critical care specialist, Bree Kramer, DO and transfusion medicine expert, Joanne Becker, MD.
“This was kind of the equivalent of a Hail Mary approach,” recalls Dr. Kelly. “But we also knew it was her best chance for putting her cancer in remission, and she’d already proven that she was a strong baby, a real fighter.”
Tense nights, a few days’ stay in the Pediatric Intensive Care Unit at Oishei Children’s Hospital, additional treatments and a long road to recovery followed. But the treatment team quickly saw reason to be hopeful.
“One Friday night, I remember going to bed around 12 or 1 in the morning, and I just couldn’t sleep. So I quickly logged into the computer and looked up her labs, and she had turned the corner,” Dr. Kelly says. “You could see that the leukemia cells were dying, that they were being killed off by the CAR T cells. And by the end of the weekend, she was so much better. She had clearly responded to the therapy.”
The treatment team came to the conclusion that Chasity should have another very intensive therapy, stem cell transplant, also known as blood and marrow transplant, or BMT, to decrease the chances that her leukemia would return.
The team believes that Chasity, 7 months old at the time, may be the youngest patient to successfully complete CAR T therapy followed by BMT with long-term remission from cancer.
Now almost 2, walking, talking, and showing no evidence at all of the leukemia that once wracked her body, Chasity has two birthdays to celebrate: October 4, the anniversary of her birth, and July 24, the day she got a new immune system thanks to a haploidentical, or half-match, transplant of donor cells from her oldest sister, Vataeya, then 14.
“We just want to thank the whole team at Roswell Park and Oishei,” says Shawanda. “We knew our baby was in great hands with the nurses, the doctors, the counselors, all the support staff, and we felt very lucky to have this program a half-hour’s drive away. They gave us our baby back.”
“I look at her as our little miracle,” says Dr. Higman. “We had a baby who had high-risk disease, whose leukemia relapsed twice, whose ethnicity is itself a risk factor. By all of us chipping in and putting in what we could do and how we could help the family, this family walked through this process and are on the other end with a beautiful, healthy child and are doing well. And I think that's one of the best gifts we can give anybody.”