When Ann Carroll was diagnosed with cancer at age 28, her dream to get married and have a baby felt out of reach. Now, seven years later and cancer-free, she is living that dream with her husband and their 7-month-old son, Teddy.
“I didn’t think I would get this far,” says Carroll, of Boston, Massachusetts. “My whole journey started when I walked into my doctor’s office because I wasn’t feeling well.”
As a graduate student in 2019 studying clinical psychology at Northwestern University, Carroll started experiencing lightheadedness and tunnel vision. When she noticed a blind spot in her vision, she went to her doctor. Bloodwork and a physical exam showed that she had a retinal hemorrhage.
Her symptoms led to a diagnosis of acute lymphoblastic leukemia (ALL) – a fast-growing cancer of the blood and bone marrow in which immature white blood cells multiply rapidly, leaving little room for healthy cells. ALL is commonly thought of as a pediatric cancer, but the diagnosis can also affect adolescents and young adults, who face cancer during a time of great transition in their lives.
A time of great transition
At the time of her diagnosis, Carroll’s grandmother had recently died of uterine cancer. “I found out about my diagnosis on the day of my grandmother’s funeral, and I was planning my wedding,” recalls Carroll. “There’s never a good time to be diagnosed with cancer.”
Adolescence and young adulthood are full of life transitions, and adding a cancer diagnosis can make that time more challenging, notes Daniel DeAngelo, MD, PhD, chief of the Division of Leukemia at Dana-Farber Cancer Institute.
“In early adulthood, people are often starting careers, attending college, dating or getting married, and parenting,” says DeAngelo. “They are learning how to be on their own – often for the first time. A cancer diagnosis can seriously affect this period of change.”
Young adults with cancer also often face very different challenges than patients who are diagnosed earlier in childhood or as older adults – from adjusting to a cancer diagnosis and coping with uncertainty to feelings of isolation and changes in body image and physical appearance.
“Adolescents and young adults have unique needs,” adds DeAngelo. “They can benefit from a committed multidisciplinary care team that includes physicians, nurses, social workers, and other health professionals.”
In addition to a dedicated care team, Dana-Farber also connects young adult patients with the Young Adult Program, which provides emotional support services, opportunities to meet other young adult patients, and hosts virtual and in-person educational programming.
Incredible strides in care
After two years of treatment at the University of Chicago, Carroll moved to Boston and received follow-up care at Dana-Farber. At the time, she was enrolled in a phase 3 clinical trial for B-cell ALL that used a pediatric-inspired chemotherapy regimen with the addition of the antibody-drug conjugate inotuzumab.
Since the trial was led nationally by DeAngelo, Carroll was able to continue her follow-up care at Dana-Farber. This clinical trial builds on previous clinical trials that established pediatric-inspired ALL treatment as the standard for adolescents and young adults with ALL, to further improve outcomes.
In children, ALL is associated with a 90% long-term survival rate with chemotherapy, compared with about 40% in adults ages 18-50. Following decades of research and clinical trials, and the addition of immunotherapy, long-term survival for adolescents and young adults with ALL is now 80%.
Inspired by the overall long-term survival rate of pediatric patient responses to treatment, Dana-Farber implemented an approach that involves fewer bone marrow-suppressing drugs and applying more chemotherapeutic drugs for adolescent and young adult patients.
“In pediatric cases, patients are still growing, and treatments affect them differently,” explains DeAngelo. “In adults, treatment involves more chemotherapy, which can be very taxing on the body. With this pediatric-inspired approach, we’ve seen steady, but impressive incremental improvement in long-term survival and resilience.”
A brighter future
Carroll continued her follow-up care at Dana-Farber with DeAngelo and Marlise Luskin, MD, MSCE, a physician in Dana-Farber’s Adult Leukemia Program.
“I felt overwhelmed by all the life changes I was going through, but I also felt really lucky,” Carroll says. “My care team treated me like a whole person — they didn’t just treat my cancer. I always hoped to be a mother, and I was not sure how treatment would affect my fertility. My team took my concerns seriously. Now, we have Teddy, and he feels like a dream come true.”
In Carroll’s follow-up plan, Luskin emphasized taking a holistic approach to patient care, and was referred to multiple long-term survivorship specialists, including fertility and cardiology.
“It is the best part of the job to not just successfully treat a patient’s cancer, but to accomplish our mission of helping a patient achieve their goals in life – personally and professionally,” says Luskin.
Over decades of innovation in cancer treatment, Luskin and DeAngelo have seen rewarding moments when their patients get married, have children, and continue building their lives and careers.
“I’m on this journey with all my patients,” says DeAngelo. “I see them get married, have those kids they hoped for, and be the best selves they can be once they complete treatment. It’s incredibly rewarding.”
Written by: Maddi Langweil
Medically Reviewed by: Daniel DeAngelo, MD, PhD