A Case History of a Rheumatologist With Relapsed Leukemia and Triple-Negative Breast Cancer

Breast cancer is a result of a cell in the breast mutating and multiplying rapidly. There are over 275,000 occurrences of breast cancer in the U.S. each year. However, new treatments have increased the five-year survival rate to ninety percent.

Dr. Julie Hildebrand offered this account to the MD Anderson Cancer Center. Dr. Hildebrand found herself as a cancer patient not one but four times before her fiftieth birthday. She chose to transfer from her local hospital to MD Anderson because rather than providing a cure, her first stem cell transplant was only effective for several months.

In 2019, Dr. Hildebrand decided to have her second round of treatment at MD Anderson because it is the leading cancer hospital in the nation and conducts the greatest number of clinical trials in the U.S.

At her first consultation at MD Anderson in September 2019, she suspected that she was relapsing and then her lab results confirmed that her disease had returned. Dr. Hildebrand explains that being a doctor does not alter the overwhelming feeling of fear that occurs when a patient receives a cancer diagnosis.

The verdict was that her chemotherapy-induced acute myeloid leukemia and triple-negative breast cancer had returned in spite of her initial stem cell transplant.

Guillermo Montalban-Bravo, M.D. was assigned to her case. Upon meeting with Dr. Hildebrand and her husband he immediately outlined a treatment. He put her at ease by sharing his background and his experience with other patients who had relapsed under similar circumstances. Dr. Bravo felt confident that if he administered the same therapy in Dr. Hildebrand’s case it would be successful. He told Dr. Hildebrand to expect the treatment to be difficult; but a cure was possible.

A Difficult Decision

Dr. Hildebrand was encouraged knowing that Dr. Montalban-Bravo had a decisive plan. But she thought about her children at home in Wisconsin. She would have to stay in Houston and begin treatment immediately. Her husband went back home to care for the children and her mother flew to Houston to stay with her. The procedure and recovery took nine months. But Dr. Hildebrand explained that it was her only option, because if she returned to Wisconsin, treatment might fail for the second time, and that would be fatal.

Chemotherapy is Not One Size Fits All

The treatment began with a few rounds of chemotherapy prescribed by Dr. Montalban-Bravo. The chemotherapy was not initially effective. But after participating in two clinical trials an effective chemotherapy regime was found.

The treatment was followed by the second stem cell transplant on September 25, 2019. Dr. Betul Oran conducted the transplant. The cells used in this transplant were donated by Dr. Hildebrand’s teenage daughter. Nevertheless, she developed graft-versus-host disease (GVHD), where the donated stem cells see the body as foreign and go on the attack.

To remedy the GVHD, Dr. Hildebrand was required to participate in a third clinical trial as the drug she needed, itacitinib, had not yet received FDA approval. Fortunately, the drug was effective against the GVHD.

Dr. Hildebrand marveled that second stem cell transplant had kept her in remission for eleven months, although she acknowledges having various side effects such as nausea and weight loss. But it was during the eleventh month that she felt a lump under almost identical circumstances as the first cancer. It was close to the spot where the original cancer developed.

The statistics were in her favor. Leukemia only occurs in about 2% of breast cancer patients who had undergone treatment with the same chemotherapy used in Dr. Hildebrand’s case. This should have allayed her fears. Yet it did not as she already had breast cancer and leukemia and was concerned that history would repeat itself.

Dr. Oran and her local oncologists agreed on a plan going forward. Although MD Anderson monitors her on a regular basis, she receives her breast cancer treatments through her local oncologists. Dr. Hildebrand is extremely grateful for being close to home during the pandemic.

The Right Decision

It has been twenty-one months since the second stem cell transplant. One more treatment for breast cancer was needed. However, Dr. Hildebrand has been in remission ever since day one of Dr. Bravo’s stem cell transplant showing no evidence of breast cancer or leukemia. She is now back at work and able to enjoy time with her family.

Rose Duesterwald

Rose Duesterwald

Rose became acquainted with Patient Worthy after her husband was diagnosed with Acute Myeloid Leukemia (AML) six years ago. During this period of partial remission, Rose researched investigational drugs to be prepared in the event of a relapse. Her husband died February 12, 2021 with a rare and unexplained occurrence of liver cancer possibly unrelated to AML.

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