Remission Holds Fast After Five Relapses for Young Woman With Leukemia

Camille Goodale was living the quintessential college life. She was a sophomore at Colorado State University, making friends, and enjoying the freedom that college brings. Then, one day she started feeling tired, weak, and lightheaded. What she thought might be a virus turned out to be something much more serious: acute lymphocytic leukemia (ALL)—a blood cancer.

“I learned I had ALL in my sorority house. I was 19. I was supposed to be living the life of a dumb college kid. It totally put my life on pause,” Camille says.

The Washington state native took a leave of absence from school and started chemotherapy in Denver.

“I was essentially the perfect cancer patient in the sense that the first month of chemo worked, and my bone marrow biopsy showed I was negative,” Camille says.

The seven months of chemo that followed kept her in remission, and she stayed in remission for about another year.

“I had a high chance of remission, but for some reason the chemistry of my cancer cells and the genetic makeup of my leukemia made it tough to fully eradicate,” Camille says. “They were very sneaky and good at hiding!”

A routine test in December 2017 showed that her white blood cell count had skyrocketed, suggesting that her cancer had returned. She tried an immunotherapy drug called blinatumomab, which was unsuccessful.

Camille then transferred to Seattle for a different treatment—CAR T-cell therapy. In this treatment, doctors removed and engineered her own T cells (immune cells) to include a chimeric antigen receptor (CAR) that targets a protein on the surface of cancer cells. When the cells are put back into the body, they track and destroy cancer cells.

Camille’s first CAR T-cell therapy put her into remission, and she had a stem cell transplant for a shot at a lasting cure. The immunosuppressive medicine made her feel awful, but the transplant worked and she went into remission again. She grabbed the reins of her life and decided to go to Europe with her best friend. She wasn’t going to let cancer stop her from living.

“In remission, I want to live as much of my life as I can,” Camille says. “I’m resilient and I have a very strong will to live.”

Unfortunately, Camille’s cancer returned again, six months after her first stem cell transplant. She went through another round of CAR T-cell therapy in Seattle, which put her back in remission again.

Coming to Stanford Medicine Children’s Health for leukemia care

After travelling, she decided to move to California, where her mom had just bought a home in Santa Cruz. She transferred her care to Stanford Medicine Children’s Health.

“She was doing well. I saw her for post follow-up care and monitoring. Yet, after a while we suspected her leukemia was recurring,” says Kara Davis, DO, Camille’s pediatric hematologist-oncologist at Stanford.

It was Camille’s fifth relapse. The more someone relapses from leukemia, the tougher it is to treat and the chance of beating it nosedives. She needed something new and promising. And she needed it fast.

The first treatment Dr. Davis tried was a different type of CAR T-cell therapy, which didn’t fully eradicate Camille’s cancer.

“Camille had a partial response, but it didn’t clear her body of cancer,” Dr. Davis says. “We then discussed another treatment that targets the same protein on cancer cells but in a different way—a medicine called inotuzumab ozogomycin.”

Miraculously, Camille went into complete remission immediately. For a year, she got to leave the hospital and get back to enjoying life, with just weekly infusions. She even went back to school and finished her bachelor’s degree remotely. Yet the catch with inotuzumab is that it’s a temporary fix, not a permanent one. Over time, its toxicity can damage the liver. For any chance of cure, she needed another stem cell transplant.

“My mom looked at me and said, ‘I know you are tired, but you have to try one more time.’ She was my constant cheerleader through all of this,” Camille says.

Receiving a haploidentical stem cell transplant

Camille didn’t want another transplant. She knew how horrible it felt to be on the immunosuppressive drugs, and she didn’t want another hospital stay. “I said no, but after several months Dr. Davis asked me to just talk with the stem cell transplant team. I said I would to humor her.”

That was when Camille met Alice Bertaina, MD, PhD, the worldwide pioneer and foremost expert in a revolutionary strategy called alpha/beta T-cell depleted haploidentical stem cell transplantation. This method of transplant lets doctors use cells from a partially matched donor by selectively eliminating the immune system’s fighter cells (alpha/beta T cells) to reduce the risk of graft-versus-host disease. Dr. Bertaina engineered a unique alpha/beta T-cell depleted formula specifically for Camille.

“What makes the alpha/beta T-cell depleted approach so groundbreaking is that we don’t need a fully matched donor. We can use virtually any partially matched related or unrelated donor,” Dr. Bertaina says.

Camille needed a new immune system that could make antibodies against leukemia, and that’s just what stem cell transplants do. The big plus for Camille was that haploidentical stem cell transplants don’t require immunosuppressive drugs afterward. She said yes.

“When I met Dr. Bertaina, I loved her immediately. I was like, ‘Fine. I will do it. I’m in a good spot, so I might as well,’” Camille says.

Doing a second transplant for acute lymphocytic leukemia (ALL) is not very common, and with second transplants people have a lower chance of long-term success. It was a risk, but it was a risk that her care team was willing to take because it was Camille’s only chance at a cure. Camille’s older sister agreed to be the donor.

The stem cell transplant went as planned, and Camille remained in complete remission.

A final life-threatening illness

But while recovering from her stem cell transplant, Camille developed a severe, life-threatening case of hepatic encephalopathy (reversible advanced liver dysfunction). The liver damage she endured from a year of inotuzumab added up, and all hands were called on deck. The Critical Care team, the Pediatric Nephrology (kidney) team, and pathologists from both Stanford Children’s and Stanford Health Care joined forces to pull her from a coma and renal failure and save her life.

“A minute later could have been just too late for her,” Dr. Bertaina says. “Our ability to coordinate care so quickly and beautifully any moment of the day and night is what made the difference in her outcome.”

“Camille is a testament to never giving up, because her probability of surviving was so very low,” Dr. Davis says.

Still in remission after two-plus years

It’s been over two-and-a-half years since Camille’s second stem cell transplant. With each month that passes, her odds for long-term survival improve. Technically, ALL is considered cured when five years pass after stem cell transplant without a reoccurrence.

“Her prolonged remission is an excellent sign. Most relapses occur within a year or two. Her cancer could reoccur, but it’s statistically less likely. From our perspective, we feel very positive that Camille is heading toward a cure,” Dr. Bertaina says.

Camille credits Stanford Children’s for saving her life. “They just never gave up on me, even when things looked so bleak. It’s doctors like Bertaina and Davis who are progressing cancer research and treatment,” Camille says. “Not only are they extremely intelligent, they are very human, and that makes all the difference.”

In total, Camille underwent several rounds of chemotherapy, four CAR T-cell therapy treatments, and two stem cell transplants.

“I think what kept me going was I wasn’t ready to go. I have so much more to do on this planet,” she says.

Camille never thought she would turn 27 years old. She lives an active life in Colorado—hiking, rock climbing, and paddleboarding. In the future, she hopes to get married, buy a house, and start a coffee shop that doubles as an education center for childhood leukemia. Her happy place is on the back of a horse.

“Every day I get is a blessing, and I’m very thankful for it,” she says. “I was really determined to get back to horseback riding. Now, I lease a horse and get to ride three days a week.”

Dr. Bertaina loves the image of Camille on her horse, smiling and enjoying the sun. “When I think of her riding, all I feel is joy. Camille is alive and being who she wants to be. It’s the best gift we can receive, and a beautiful reminder to never stop finding more strategies to help people with ALL,” Dr. Bertaina says.

Learn more about stem cell transplantation for leukemia at Stanford Children’s >