Mandi Schwartz Update: Tests Indicate Birth of New Immune System

Mandi Schwartz. Image credit: Yale University

After spending six days in intensive care fighting her way through another life-threatening condition, Yale hockey player Mandi Schwartz got some much-needed positive news in her battle with cancer on Friday.

Tests have confirmed that, 23 days after her stem cell transplant, engraftment — i.e., the birth of her new immune system — has taken place. This marks a major positive step, but challenges still remain for the Yale women’s ice hockey center.

“The weeks since the transplant have been physically tough on Schwartz, and there have been several scary moments, but she continues to fight,” says her mother, Carol. “She remains focused on her goal of overcoming every challenge and getting her health back. We are all inspired by the support we have received from so many different people throughout this process.”

In 2008, Schwartz was diagnosed with acute myeloid leukemia, a type of cancer that starts inside the bone marrow and grows from cells that would normally turn into white blood cells, part of the immune system. Although she was declared to be in remission in 2009 following several rounds of chemotherapy, Schwartz was re-diagnosed in April 2010 and had to return home for more chemotherapy. At that point it became clear that in order to survive, she would need a stem cell transplant, which would essentially give her the new blood and immune system she needs to survive.

Since receiving the stem cell transplant on Sept. 22, the Yale student has been in the Seattle Cancer Care Alliance’s inpatient unit at the University of Washington Medical Center. Friday’s engraftment test results indicate that the transplanted stem cells have begun to grow in her bone marrow and manufacture new blood cells and immune cells, which puts her in a better position to fight off any potential infections. She also now has a new blood type.

The results come after a harrowing period for the student and her family that began shortly after the transplant took place. Her family — which, in addition to her mother, includes father Rick, brothers Jaden and Rylan, as well as his fiancé Kaylem Prefontaine — have all spent time with her in Seattle.

Prior to the transplant, in order to ensure that all of the existing cancerous cells in her body were eliminated and to suppress her immune system to prevent her from immediately rejecting the new donor cells, Schwartz received chemotherapy and radiation treatment. Among the immediate consequences of this treatment and the drugs required were fatigue, fevers, hallucinations, nausea and the condition known as mucositis (painful inflammation and ulceration of the mucous membranes lining the digestive tract).

The chemotherapy also took a toll on her liver, and she began suffering from veno-occlusive disease (VOD). In this condition, which is potentially fatal, veins in the liver become blocked, leading to an increase in weight, liver size and blood levels of bilirubin (a byproduct of the degradation of heme, part of the hemoglobin that is the principal component of red blood cells).

Schwartz retained approximately 35 extra pounds of body fluid due to VOD, and her breathing became labored. She was moved to the intensive care unit on Oct. 4. Her breathing and vitals showed improvement on Oct. 7, and she was released from intensive care two days later. By Oct. 13, she had dropped 30 of those extra pounds. The bilirubin count in her blood was down to 3.4, with the goal of getting it down to the 1.4 range. Doctors had to be careful to keep her from eliminating too much weight at once so as not to put too much of a strain on her kidneys; she did lose 10 pounds in one day.

Out of intensive care, the Yale student resumed her training regimen of riding on the exercise bike in her hospital room. She must stay in the hospital for further monitoring in the immediate future. As a transplant patient she is still at risk for graft-versus-host disease, which involves the transplanted immune cells attacking the body and can be fatal. Acute graft-versus-host disease can occur up to 100 days after the transplant, while chronic graft-versus-host can appear later.

After Schwartz is discharged from the hospital, she and her family will remain in Seattle for months of follow-up appointments. Complete recovery of her new immune system takes approximately a year, but could take longer if she develops any complications as a result of the transplant. She will be monitored regularly through blood tests to confirm that new blood cells are being produced.

Schwartz’s transplant on Sept. 22 utilized stem cells from two umbilical cord blood units donated anonymously to public cord blood banks. The procedure lasted 32 minutes and was similar to a transfusion. The stem cells were placed in her body through a vein so that they could find their way to her bone marrow to create new blood cells and immune cells.

Schwartz, a native of Wilcox, Saskatchewan, and her family continue to encourage all adults to sign up as bone marrow donors, and for expectant mothers to sign up as umbilical cord blood donors.

Here’s how you can help:

1. Send the Yale student a card or letter showing your support:

Mandi Schwartz
Box 308
Wilcox, SK S0G 5E0
Canada

2. Send donations (checks made out to “Yale University”, with “Mandi Schwartz” in the memo line) to:

Yale Athletics
ATTN: Wayne Dean
20 Tower Parkway
New Haven, CT 06520

3. Become an umbilical cord blood donor:

Click here to visit the U.S. National Marrow Donor Program’s page with information about umbilical cord blood donation.

4. Join the bone marrow donor registry:

Click here to visit the U.S. National Marrow Donor Program’s “Be The Match” website to learn how you can request a bone marrow donor testing kit or find a bone marrow donor testing drive near you.

Click here to visit the DKMS Americas bone marrow donor page.

Click here to visit the Canadian Blood Services page.

Click here for the U.S. National Marrow Donor Program’s list of International donor centers if you are not in the U.S. or Canada.

For more information about Mandi Schwartz and how you can help, visit https://www.yalebulldogs.com/mandi.

 — By Sam Rubin, Yale Sports Publicity

*Source: Yale University

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