New Immune System, New Life for California Teen Overcoming Leukemia

Aggressive leukemia stopped in its tracks by innovative cancer treatments at Stanford Medicine Children’s Health

From the minute you meet Emily and Susana, it’s obvious that they have an extraordinary mother-daughter bond. Their connection is so palpable that it’s like talking to one person—they sit close, find each other’s gaze constantly, and finish each other’s sentences. Now, they even share the same immune system.

“About 99.9% of me is in Emily,” says Susana.

Emily recently underwent a stem cell transplant for her high-risk leukemia. Susana was her stem cell donor, thanks to an innovative approach at Stanford Medicine Children’s Health that allows a relative, such as a parent, to be a donor even when they’re not a full match.

“We’ve been super-close since she was in my belly. It has always been me and Emily. I’m her mom, but we’re still best friends, and this whole process of cancer has made us even closer,” Susana adds.

A five-year fight with cancer

Emily literally grew up with cancer. She went from a timid 9-year-old when diagnosed to a composed 14-year-old today. Susana vividly remembers how shocked she was when the doctors told her that Emily had acute lymphocytic leukemia (ALL)—the most common childhood leukemia.

Leukemia is a cancer of the blood that develops in the bone marrow, the place where white blood cells—the immune cells that help fight infection—form. With leukemia, the bone marrow makes abnormal white blood cells that crowd out functioning, normal cells. Acute lymphocytic leukemia comes on quickly and can get worse if not treated right away.

“It was so scary. She is my only child, and given how close we are, I was a mess. I wasn’t sure how or if we would get through it,” Susana says.

Acute lymphocytic leukemia often makes children feel weak, tired, and short of breath. They can experience fevers, night sweats, swollen lymph nodes, easy bruising, and more frequent infections.

One of the first doctors the family met on their cancer journey was Lianna Marks, MD, a pediatric hematologist-oncologist with the Bass Center for Childhood Cancer and Blood Diseases. Today, the mother and daughter from Los Banos, California, consider Dr. Marks family.

“Emily holds a special place in my heart because she was my first patient at Stanford Children’s,” says Dr. Marks. “She’s very strong. She faced her fears, and she let people support her.”

Chemotherapy, the first of a trio of treatments

Emily went through cancer treatment three times during the past five years. Dr. Marks started Emily on chemotherapy right after she was diagnosed with leukemia in October 2018. Chemotherapy is a group of medicines that kill cancer cells by making it hard for them to grow or reproduce. It’s often the first treatment for acute lymphocytic leukemia. Emily spent the next two years receiving chemotherapy.

“Emily’s leukemia was aggressive,” Dr. Marks says. “We have a lot of experience treating very aggressive and relapsed leukemia, partly because we harness research to provide the latest clinical trials and partly because of our expertise and many years of experience.”

In February 2021, Emily’s medical team deemed her cancer-free. She got to “ring the bell”—a ceremony where the care team lines the hallway and cheers as a child rings a large bell to celebrate going home. For almost a year, Emily returned to normal life. But then a routine follow-up test revealed new cancer cells.

Emily’s aggressive, high-risk leukemia comes back

“Dr. Marks looked at Emily’s lab work and then looked at me, concerned. My heart dropped, and I knew right then what that meant,” Susana says.

Most of the time, leukemia can be tamed by chemotherapy alone, but in 10% to 15% of cases of childhood leukemia, extra treatment is required. That’s when it’s considered high-risk. Emily was a part of this small group of children.

“Our hope with standard chemotherapy is that the child’s leukemia cells are wimpy and they’ll go away and stay away with chemotherapy alone, but not Emily’s. Hers were stubborn,” says David Shyr, MD, a pediatric stem cell transplantation specialist at Stanford Medicine Children’s Health.

Once again, Emily returned to Stanford Children’s for more treatment in January 2022. “Having to tell Emily and Susana that the leukemia was back broke my heart—it was so difficult after all she had been through. But we were there for her every step of the way,” Dr. Marks says.

Putting in place a multispecialty cancer care plan

Several experts joined forces to determine the very best treatment plan for Emily. The plan was to tamp down the cancer with chemotherapy and then provide cutting-edge chimeric antigen receptor (CAR) T-cell therapy.

CAR T-cell therapy engineers a child’s T cells (immune cells) to include a chimeric antigen receptor (CAR) to help the immune system see and kill cancer cells. This promising approach has been shown to reduce cancer cells in 80% of children with ALL.

Once again, Emily was the exception. The CAR T cells did not last in her body. Her leukemia was knocked down but still there. In November 2022, the team decided to take the next step—a stem cell transplant.

Using innovation to allow mom to be her stem cell donor

“Emily’s cancer was barely poking its head up, and we knew a stem cell transplant could offer her a high chance of cure,” Dr. Shyr says.

Stanford Children’s routinely uses a revolutionary strategy called alpha/beta T-cell depleted haploidentical stem cell transplantation, pioneered by Stanford’s Alice Bertaina, MD, PhD.

“Stanford Children’s was one of the first hospitals in the Bay Area to offer this innovative type of stem cell transplant, and we’re a leader in providing it to children with complex health needs,” Dr. Shyr says.

This unique transplant lets doctors use cells from a partially matched donor and selectively eliminate the immune system’s fighter cells (alpha/beta T cells) to reduce the risk of graft-versus-host disease (GvHD). It’s groundbreaking because it expands options for children who don’t have a fully matched donor, like Emily. Another bonus is that patients don’t need immunosuppressive medication afterward, which can have unpleasant side effects.

“When I heard I could be Emily’s donor, I was surprised but happy at the same time,” Susana says. “I did my part by going into it with intention and feeling emotionally and physically good because I knew my energy was going into her body.”

A life-changing stem cell transplant

As they did throughout Emily’s cancer journey, mother and daughter faced the challenge together. It was one more hurdle to getting Emily well. During the stem cell transplant in March 2023, doctors removed healthy bone marrow from Susana and, much like they would in a blood transfusion, placed the cells in Emily where they traveled to her bone marrow to engraft (embed) and make new, healthy cells.

To set the stage for healing, Susana and Emily turned her room into a place of relaxation with a diffuser of lavender oil, soothing music, and an area where they meditated and relaxed with tuning forks and singing bowls. Even the staff appreciated the sense of calm in the room.

“They are both very spiritual, and they wanted to go into the transplant with a positive mindset. It worked, because Emily had one of the smoothest transplants and recoveries I’ve seen,” says Akilah Burford, LSW, the family’s oncology social worker.

During recovery, Emily experienced very few problems—just mild GvHD on her skin and mouth sores, which are almost always standard.

“I got to leave two weeks early because I was doing so well. I was told that usually you have a feeding tube for months, but I only needed one for two weeks,” Emily says.

The care team was thrilled with her success. Finally, those stubborn leukemia cells were gone.

“What’s really wonderful is that today I don’t have to worry about patients like Emily. In the past, watching a child relapse three times would have been an ‘Oh no!’ moment,” Dr. Shyr says. “Yet today, we have several treatment options, and we’re researching others that get us closer to the chance of a cure. To think that all these treatments are now considered the norm is simply amazing.”

Dr. Shyr describes Emily and Susana as two peas in a pod—not just mother and daughter but sisters and best friends.

“Part of the reason Emily is doing so well is her mom. Susana really knows and trusts Emily. You don’t always see that,” Dr. Shyr says. “I never doubted that they could endure the treatment.”

While Emily is not out of the woods yet, she is starting to see cancer in the rearview mirror. With acute lymphocytic leukemia (ALL), doctors look to time in remission to determine if it is cured.

“If a child stays in remission for two years after a stem cell transplant, their family can have a sense of relief that the risk of the disease returning is fairly low. In most patients, if ALL is going to reoccur, it usually does so within the first year,” Dr. Shyr says.

Extra help to ease concerns and brighten days

Besides what Susana calls “the best of the best” medical care, she and Emily were extremely grateful for all the little extra efforts their care team made to help them cope during their long cancer journey. Burford, their social worker, tapped into several pediatric cancer foundations for special grants to help the family with rent, meals, gas, and food but also to make life fun.

She arranged for Susana to stay near the hospital in the Stanford Ronald McDonald House during and after Emily’s cancer treatments. She also enlisted psychology, music therapy, art therapy, and Child Life and Creative Arts to make their stay as pleasant as possible.

Over the years, Burford coordinated Home and Hospital Instruction, which allowed Emily to participate in school remotely while receiving support from a school instructor at the hospital. It paid off. This past May, Emily was able to walk in her eighth-grade graduation ceremony. She graduated with honors and received the prestigious principal award for excelling despite the challenges of cancer.

Burford also set up Mario Kart tourneys—a favorite of Emily’s—between the family and her care team.

“She’s an incredible player, and I joked that she needed a medication to make her sleepy so others could win. She beat me all the time,” Dr. Marks says.

Taking advantage of her fresh start

Emily is nearing the six-month mark since her transplant, and she is showing zero signs of leukemia. She’s feeling better and starting to get back to things she enjoyed before cancer, which include art and drawing anime—a true talent. She also loves making music with her ukulele and piano.

“Her immune system is still recovering after her transplant, but hopefully she won’t have to live differently than any other kid on the block,” Dr. Shyr says.

To Emily, the stem cell transplant was a rebirth, in more ways than one.

“I feel like I was reborn. It was a big deal,” says Emily. “In a way, I feel like a different person.”

She and her mother grew together through medical and emotional challenges. They welcomed the care team as their new family and opened themselves up to support from family and friends. This fall, Emily will attend school in person for the first time since fourth grade—and she’s starting high school.

“This is a fresh start for her, not just medically but emotionally. She has a new immune system, she’s grown from a girl to a teenager, and she’s starting a new school,” Burford says. “Her identity is no longer her cancer.”

Susana is incredibly proud of Emily and extremely grateful to Stanford Medicine Children’s Health. She’s inspired by how Emily handled her cancer experience—the way she stayed real and spoke her truth. As for Stanford Children’s, she says she’d recommend the hospital a million times over for childhood cancer care. “I can’t even express my gratitude for what Stanford has done for us. They literally saved Emily’s life,” Susana says.