After ‘Hail Mary,’ Leukemia Patient is in Remission — With Help of Donor

Family is the most important part of Michelle Nagel’s life. When she was diagnosed with acute myeloid leukemia (AML) in May 2007, her mind instantly went to her children; all she wanted was to see them grow up and have children of their own.  

When she learned of her condition, Nagel and her family were all over the map; she was living in Germany, her husband was in Ireland, her son was on his high school’s field trip to Paris, her daughter was going to college in New York City, and her parents and siblings were in the United States.

Little did she know, when she was in Ireland, she was in closest proximity to the stem cell donor who would eventually save her life.

Nagel’s diagnosis

Though she had been feeling sick for a few months, Nagel’s diagnosis came as a surprise.

“There were peculiar things happening in and with my body that I had not experienced before, and I had no explanation for,” she recalls.  “But I’m not one to run quickly to a doctor for every little thing.”

This was until a bug bite on her ankle turned into a bad infection that spread through her foot and wasn’t healing. Nagel went to the doctor in Germany, who stabilized her condition enough that she could travel to Ireland to visit her husband for their 24^th wedding anniversary. When she got there, however, things got worse.

“I woke up with a terrible fever and I was quite literally white as a ghost,” she remembers. “Even my lips were white, and I had an unexplained bump on the side of my face.”

After reviewing her symptoms and running blood tests, a doctor in Galway called Nagel and told her to go to the emergency room, where two doctors would be waiting for her.

“When I asked what was wrong, she simply told me I was anemic. I knew well enough that one is not sent to the emergency room for anemia,” Nagel says.

She spent the night in the hospital, where the next morning, she learned she had acute myeloid leukemia. The doctors further explained to Nagel that the only possible cure for her disease was a bone marrow transplant. Her initial reaction was to tell her family.

“My first thought was to organize my life. I didn’t panic or overreact. I took charge and planned; I did what needed to be done for my family,” says Nagel.

She remembers being glad that she had the diagnosis, rather than anyone she loved. She then told herself she would take it one day at a time.

The beginning of treatment

Nagel began her treatment in Ireland, where she was placed on a chemotherapy regimen. When this treatment failed, her doctors switched gears and put Nagel on a second and then ultimately a third line of a chemotherapy in an effort to achieve remission. However, she wasn’t able to stay out of the hospital for very long: due to multiple infections, she had to continue her stay for a few months.

Once she got back home to Germany, Nagel and her husband started to piece together a plan. She still needed a stem cell transplant, and after being encouraged by her mother to come to Boston for treatment, she decided to continue her care at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC).

By November 2007, six months after her initial diagnosis, Nagel was in Boston. Shortly after her arrival, she began experiencing the symptoms of a condition known as rigor, which results in a sudden feeling of being cold, shivering, and a rise in temperature. The symptoms landed her back in the hospital, where doctors discovered her AML had returned.

This dealt a major blow to Nagel’s treatment timeline, as the relapse meant she could not to receive a stem cell transplant. But her team had a plan: Nagel was placed under the of care of Martha Wadleigh, MD, clinical director of adult leukemia at DF/BWCC. For cases of relapsed AML, patients like Nagel are treated with chemotherapy to get into remission first, and then they undergo a transplant.

Nagel was a few months into chemotherapy when she experienced what she calls a “bump in the road”: she fell, hit her head, suffered a brain injury, and was in a medically induced coma for five weeks. After coming out of the coma, she spent another five weeks rehabbing to build up the strength to walk again.

“I would go to the chapel in my wheelchair to pray to live long enough to be a grandmother,” she recalls.

She wondered about being able to recover enough to continue treatment. But after four months of recuperation and a slight adjustment in her chemotherapy, it appeared Nagel would be able to undergo the transplant.

A ‘Hail Mary’

In order to receive the transplant, Nagel would need a donor. She consulted with her medical team, who searched donor registries worldwide for possible matches. They got back good news.

“It turns out I was blessed with multiple possible matches. I felt numb,” she reflects. “I was happy and relieved to know I had many potential donor possibilities, but all I focused on was moving forward day to day.”

Nagel still had another major hurdle to overcome. Although she had improved, she had not achieved complete remission after chemotherapy. Despite having some evidence of minimal disease, she started getting ready for transplant under the watch of John Koreth, MBBS, senior physician at the DF/BWCC Adult Stem Cell Transplant Program.

“She had a treacherous course even getting to us for transplant. Dr. Wadleigh did an outstanding job in her preparation,” Koreth says. “The transplant was a Hail Mary. For someone with active disease, there is a low percentage this will work.”

In July 2008, Nagel underwent an allogenic reduced intensity (or “mini”) transplant. This is a modified form of the procedure that uses lower doses of chemotherapy and no radiation therapy; it’s suggested for patients who can’t tolerate the harsh side effects of a full-intensity treatment.

The transplant was a success, and initially, Nagel’s AML was in remission. However, six months after the transplant, the cancer returned. To counter the cancer, Koreth tapered Nagel off of the immune suppressant she was taking; it was being used to overpower her old immune system so that her new one could take hold.

The results were remarkable. Nagel achieved remission and continues to be in remission to this day. Now, more than a decade removed from her procedure, she’s seen her son graduate high school and college, as well as watched her daughter graduate college, get married, and have a child — Nagel’s first grandchild. Months later, she met the man who she credits with saving her life.

A second family

All Nagel knew about her donor at the time of her transplant was that he was a 57-year-old man from Great Britain. It wasn’t until two years after her transplant that she and her donor agreed to learn each other’s full identities. The Dana-Farber Donor Services team got to work.

When her 60^th birthday came around, Nagel’s family surprised her with a trip to England to meet her donor, Graham Hawthorne, and his family.

“It was an emotional meeting. I’d wanted to give Graham a big hug for his generosity — an understatement — but I hadn’t anticipated that it would be as meaningful or as emotional for him and his family,” she explained about their first meeting. They met at a restaurant, where Nagel was introduced to Hawthorne’s wife, daughter, and 10-year-old granddaughter.

“With every milestone I thank God and the blessing of a man whose cells saved me and have kept me alive to see each blessed event,” said Nagel of her experience. “This was an answer to my prayers.”

Hawthorne joined the registry 40 years ago, little did he know he would be saving the life of a stranger across the globe.

“If Graham had not been selfless enough to donate to a stranger, we would not have known the fulfillment and love this act can bring,” Hawthorne’s wife said of the experience. “We have become friends with a family thousands of miles away, who we would otherwise never have met, and both families are very thankful for it.”