Kathryn Cartwright turned 21 on 21st January, a landmark birthday she couldn’t wait to celebrate with her family – and this birthday was all the more poignant as it is one she and her family never thought she would see.
At 16 Kathryn was diagnosed with Acute Myeloid Leukaemia (AML) and in the four and a half years since her diagnosis, Kathryn has stunned doctors with her ability to not only battle the leukaemia itself, but she has also made medical history.
She has undergone several cycles of chemotherapy, radiotherapy, two bone marrow transplants and a liver transplant and has to take a daily cocktail of drugs to help alleviate some of the associated problems.
Kathryn was diagnosed with AML in July 2007 after beginning to feel very tired and looking pale. The initial thought was that she may be anaemic – but when her GP carried out a blood test that showed she was severely anaemic, she was referred to Birmingham Children’s Hospital for further tests which revealed she had AML.
Kathryn started a cycle of chemotherapy but doctors at the hospital discovered that she had a particular high risk chromosomal abnormality. In simple terms, this meant that because of the missing chromosome in her leukaemia cells the chances of the chemotherapy curing the disease would be reduced greatly. The best chance of cure would have to come from a bone marrow transplant. Luckily her older sister Christine, 18, was a match and in December 2007 she had her transplant at BCH. This resulted in her leukaemia going into remission and Kathryn returned home with her parents, Judith and Alex.
Sadly, just four months later she discovered a lump on the side of her head which showed that the leukaemia had returned. Kathryn returned to hospital for further treatment and to discuss the options available to her. The only curative option available was to consider a second bone marrow transplant. It is rare to do a second bone marrow transplant though as the risks are higher and Kathryn and her family were warned that there was only a one in five chance of her surviving the second transplant.
“We couldn’t see that there was another option – to go ahead with the second transplant was risky, but it would still give me more of a chance than doing nothing. Without treatment, I would have died. I preferred a small chance than no chance at all.”
So doctors started Kathryn on a course of chemotherapy and radiotherapy to prepare her body for the transplant once they had found a match. A match was found from a young German male and in July, Kathryn received her second bone marrow transplant. The transplant started to work but she developed Graft Versus Host Disease, which badly affected her eyes and skin. She became incredibly photosensitive and had to spend a month in a dark room at home, only leaving to return to BCH’s Eye Department, where Consultant Ophthalmologist, Mr Manoj Parulekar, treated the painful condition.
Then during Halloween 2008, Kathryn had a high temperature, so was admitted to hospital. Two days later her eyeballs went yellow. Tests revealed that Kathryn had developed Graft Versus Host Disease in her liver and it had started to fail. By December, Kathryn was desperately ill in Birmingham Children’s Hospital in end-stage liver failure and wouldn’t be alive to see Christmas without a liver transplant. She went to the top of the supra urgent transplant list and on 21st December, the call came through that they had been waiting for saying that a liver was available. She underwent the eight hour operation and started her long road to recovery.
The liver was quickly accepted by Kathryn’s body and her leukaemia was also in remission which was great news for Kathryn and her family. But there were more surprises in store for them. Routine tests on her blood two weeks after the liver transplant showed that the second bone marrow transplant was being rejected and other stem cells were taking their place. Doctors at the hospital were baffled as the stem cells didn’t appear to belong to either of her bone marrow donors. Further tests revealed that the stem cells from her new liver had fully engrafted into her bone marrow, effectively replacing Kathryn’s own cells – an incredibly rare occurrence and, as far as doctors are aware, she is the first person in the UK this has happened to. There is only one other recorded case in Australia.
“It does feel a bit weird knowing that the stem cells of the liver donor have taken over my own stem cells and the cells of both my bone marrow transplant donors. I still live with the effects of GVHD, it affects my skin and lungs so I often get breathless and my skin is very delicate. Once a month I travel to Rotherham for photopheresis treatment – which helps my skin and lungs. But I often have to use a wheelchair as I get breathless easily and I take over 20 different tablets a day.”
Kathryn celebrated the birthday she never thought she would see with her family in London – dining at La Gavroche, visiting Hummingbird Bakery and staying overnight at a hotel.
Kathryn will need to have further liver surgery this year as her bile ducts need to be reconstructed by her transplant surgeon, Mr Mirza at the Queen Elizabeth Hospital.
Kathryn’s BMT consultant, Dr Mark Velangi, says:
“Kathryn is certainly the most unique patient I have seen at Birmingham Children’s Hospital. It is the first time we have seen the stem cells of a liver donor fully taking over a patient’s bone marrow. Kathryn sadly still has ongoing health problems associated with the GVHD but there is hope that in time and with the right treatment, Kathryn will overcome it. She is an incredibly brave and bright young lady who we are delighted to see celebrate her 21st birthday.”
“My last milestone birthday (my 18th) was spent in a cubicle on the High Dependency Unit of the Oncology and Haematology Ward at Birmingham Children’s Hospital. I wasn’t able to eat any of the cake or drink any of the champagne, because my gut was nowhere near healed enough to digest anything yet. This birthday was so different. Yes, I’m still not as healthy as I’d like to be, but I am here, and I’m alive, and I’m happier than I could have dreamed of being a few years ago. I’d like to thank my donors, all three of them, and my liver donor’s family especially; I haven’t got words to articulate how much that gift means to me. Also all the doctors, nurses and other staff who have spent the past four and half years taking care of me, medically and otherwise. Without their knowledge and understanding, I would most certainly be in a very different situation, and I appreciate them more than they will ever know. This birthday was spent surrounded by the people I love, and eating all the cake in sight!”