Mandi Schwartz, 22, and her teammates on the Yale women’s hockey team had just celebrated a win over Brown University in December 2008 when Schwartz, who was feeling unusually fatigued, got the bad news: she had acute myeloid leukemia (AML). She returned home to undergo chemotherapy during a 130-day hospitalization. Her cancer was knocked into remission—only to come back in April 2010, three months after she had returned to Yale to finish her junior year.
Leukemia is cancer of the blood and bone marrow, the tissue inside bones where blood cells are produced. There are several forms of the malignancy, but the two most common are lymphocytic, affecting white blood cells called lymphocytes, and myeloid, affecting white blood cells called myelocytes.
Either form of leukemia can be either chronic or acute. Leukemia impedes the maturation of bone marrow cells; in the chronic form some maturation takes place but not to a normal extent, while in the acute form immature cells take over, reproducing and accumulating at a rate which crowds out normal cells. The body’s ability to fight off infection, control bleeding, and perform other critical functions becomes increasingly impaired.
The odds a person will be diagnosed with leukemia in a year are 1 in 7,752. More men are afflicted than women: the odds for a man are 1 in 5,882, compared to 1 in 10,100 for women. The incidence of leukemia is highest among whites and lowest among Asians and Pacific Islanders.
According to the Leukemia and Lymphoma Society, there are approximately 245,225 people in the US living with some form of leukemia, including those in remission. Chronic leukemia is more common than the acute form, and individual risk rises with age: the median patient age at diagnosis is 66 years. Both types of chronic leukemia are far more prevalent among adults than children, with chronic myeloid leukemia being the most common form of leukemia found in adults.
The most common form of the disease in children is acute lymphocytic leukemia. Although acute myeloid leukemia, Mandi’s type, is found in both adults and children, it most commonly occurs in people age 60 and older. It arises from damage to the DNA of developing bone marrow cells; risk factors include significant exposure to radiation, including previous cancer treatments. Other risk factors include exposure to toxic chemicals, smoking, other disorders of the blood, and some genetic disorders, including Down syndrome.
As a white female, Mandi’s odds of having AML are 1 in 19,230.
Overall, the incidence rate of leukemia is much higher among adults than among children, but from 2002 to 2006, leukemia accounted for 27% of all cancers diagnosed in children under the age of 20.
According to the Leukemia & Lymphoma Society, by 2005, the five-year survival rate for all people with leukemia had climbed to 54%; for Americans of European descent that’s up from 14% in the early 1960s. But survival still depends on factors like race, age, gender, and most importantly, type of leukemia.
Mandi’s best hope for survival now depends on a transplant of healthy stem cells, either from a perfectly matched bone marrow donor or a donation from approximately 200 cord blood donors. Cord blood is what remains in the umbilical cord after a newborn is separated from the mother; stems cells contained in cord blood are much less likely to be rejected by the recipient. A recent study published in Lancet Oncology, analyzing the data from 216 transplant centers around the world, found that adult leukemia patients who receive stem cell transplants from a cord blood bank do just as well those who receive a bone marrow transplant from a well-matched donor.
Now, like many cancer patients, Mandi Schwartz is not only battling her disease, but also fighting for time. Because of her ancestry, a perfect bone marrow match has been difficult to find, and the emphasis now is on assembling sufficient donated cord blood. The odds a female will die of ALM are 1 in 384.6.
Dr. Tedd Collins, a New Haven immunologist who is spearheading the drive to find a suitable donor for Mandi, at BecomeMandisHero.org, is tragically familiar with this race against time. He lost his own daughter, Natasha, to leukemia in August, 2009. She was a second year student at Yale Medical School, and before she died she asked her father to help look after Mandi.