Julianna is back in action after treatment for blood cancer

Julianna and Joanne Vano

An experimental clinical protocol run by Mitchell M. Cairo, MD, department chief of the Pediatric Hematology, Oncology and Stem Cell Transplantation, has helped 13-year-old Julianna get back to all the activities she loves.

When Julianna Vano suddenly became listless and lethargic four years ago at age 9, her mother, Joann, immediately knew something was wrong.

“She was always very active, playing all kinds of sports, and then she just stopped moving,” Joann recalls. “She didn’t want to do anything. She basically stayed on the couch.”

Julianna’s doctor performed a battery of tests, searching for a diagnosis. When she started turning jaundiced, a sign that something might be critically wrong, Julianna’s pediatrician instructed them to head to the emergency room at Maria Fareri Hospital.

A diagnosis leads to enrollment in clinical study

At the hospital, Julianna was examined by a host of physicians, and underwent a number of tests, including an ultrasound, CT scan imaging and several biopsies. Jessica H. Hochberg, MD, of the Boston Children’s Health Physicians (BCHP) Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, oversaw her care and diagnosed Julianna with diffuse large b-cell non-Hodgkin’s lymphoma, an aggressive type of blood cancer where the white blood cells multiply uncontrollably. She also had a large mass on her pancreas. Julianna was treated at Maria Fareri for 32 days, and underwent her first round of chemotherapy during that period.

Julianna’s case presented BCHP’s pediatric oncology team with a unique opportunity to enroll her in an experimental clinical protocol run by Mitchell M. Cairo, MD, department chief of the Pediatric Hematology, Oncology and Stem Cell Transplantation, in coordination with other institutions. The goal of the study was to determine the efficacy of a drug that, while not new, showed promise in enabling physicians to eradicate malignancies while reducing the amount of chemotherapy administered, thus ameliorating the long-term side effects of the cancer-killing drug.

Monitoring cardiac side effects

The chemotherapy drug used to treat Julianna — and countless other cancer patients — was anthracycline. According to Hochberg, children and adolescents diagnosed with diffuse large b-cell non-Hodgkin’s lymphoma who receive chemotherapy drugs like anthracycline can run the risk of developing heart problems later in life. “The main thing we worry about are the cardiac side effects,” she says. “This class of drugs, anthracycline, are great drugs, but they can have long-term effects on the heart muscles and valves, and possibly lead to heart disease later in life.”

In Julianna’s case, she was administered anthracycline in conjunction with rituximab, a drug used to treat certain autoimmune diseases. “Results showed it did have benefits, and excellent outcomes,” Hochberg says. The clinical protocol monitored the effects of reducing the amount of anthracycline administered to the patient, while still proving an effective agent to quell the aggressiveness of the cancer.

“Julianna was one of the first patients on this kind of trial,” Hochberg says. The protocol proved extremely successful, she notes. “We’ll be finishing up the trial very soon, and we’ve seen tremendous results. Julianna really benefited from this treatment.”

Following her initial hospitalization, Julianna returned to Maria Fareri for follow-up chemotherapy treatments; she was admitted every 20 days or so and remained hospitalized during her chemotherapy regimen. Her last chemotherapy treatment was in August 2015; she has been doing well ever since.

Diving back in after successful treatment

Now 13, Julianna has dived headfirst back into the activities she loves, including soccer, lacrosse, basketball and dance and just started eighth grade at the Mildred E. Strang Middle School in Yorktown Heights. “She has no limitations,” her mother says.

Julianna is just one more success story for Hochberg and her colleagues at BCHP. “She is happy, there are no long-term side effects, and we’re past the point where we would be concerned about her relapsing,” says Hochberg. Julianna is now transitioning to the Childhood, Adolescent and Young Adult Wellness and Survivorship Program at Maria Fareri, which guides patients and their families through the final stages of treatment and monitors their progress.

Joanne Vano is effusive in her praise of her daughter’s care by the BCHP physicians and nursing staff at Maria Fareri. “It was such a positive experience,” she says. “I couldn’t imagine going anywhere else.”