At age 8, Maddison “Maddie” Nuñez vividly remembers the impact of hearing medical news at age 4 that would severely disrupt her young life. In 2018, she was diagnosed with acute lymphoid leukemia (ALL) – a type of blood and bone marrow cancer. At age 4, she was treated at Baptist Health Miami Cancer Institute.
“I felt confused, worried and excited to see what the journey would bring me,” said Maddie, who has been in remission and disease-free for a year and a half.
It all started with Maddie having what appeared to be a virus. “She came home from kindergarten 4 and she was sick. She had a slight fever,” her mother, Melissa Nuñez, explained. “I had taken her to the doctor, and they checked her for strep, mono (mononucleosis) and the flu. All came back negative.
(Watch the video: Listen to Maddie, her mother Melissa, and Doured Daghistani, MD, medical director of pediatric oncology at the Miami Cancer Institute. Video by Alcyene Almeida Rodrigues.)
A week later, Maddie continued to have to see her GP to have her blood checked. They noticed her white blood cell count was high and recommended they go see Doured Daghistani, MD, medical director of pediatric oncology at the Miami Cancer Institute.
“She came here, I examined her. I repeated his blood count. I felt like there was something wrong,” Dr Daghistani said. Maddie was admitted to hospital for a procedure called bone marrow aspiration which takes a sample of the liquid part of your bone marrow. “And the second or third day confirmed that diagnosis of acute lymphocytic leukemia.”
“As a mother your heart stops and I wish I could trade places with my daughter because it’s the unknown isn’t it?” said an emotional Melissa Nuñez. “We give you the best prognosis. The doctor said she had a 95% chance of living and good things would come. But that would be a huge battle.
Maddie remembers being scared of the cancer journey, and in particular not liking losing her hair. “I had hair, straight hair, and it started falling out. My dad finally had to shave it off. So, I hated it!”
ALL has different subtypes, Dr. Daghistani said. The best subtype is children who present between the ages of 2 and 9 and have a low white blood cell count. “And these are the children whose family we tell when we see them, that there is more than a 90% chance of survival and recovery. And it’s Maddison’s luck, ”he reassures.
“It’s extremely welcoming when you come to the Miami Cancer Institute, especially in the pediatric field,” said Melissa Nuñez. She remembers visiting the Institute for the first time and having the whole team come to greet them. “The social workers, the nurses, the child life specialist, the nurse practitioner and Dr Daghistani…everyone has worked so well together to try to make it as smooth as possible, so that Maddison doesn’t not feel different, even though she knows she was going through different things. They all made sure she was happy.
Chemotherapy has different phases, says Dr. Daghistani. “The first phase we call induction is the first month. The second phase we call consolidation, between 6 and 9 months, and the simpler part, about a year and a half, we call maintenance. This is the process that Maddison went through.
Maddie has been off chemotherapy for a year and a half. According to Dr. Daghistani, this period is called remission, when there are no signs of the disease in the body.
“Usually, we wait five years after the end of chemo before saying that there will not be a 100% relapse”, explains the oncologist.
“Maddie is a very nice girl; she’s a really mature girl and she’s very smart,” reiterates Dr. Daghistani. “I’m very happy to tell you that Maddie is now disease free and doing incredibly well.”
“I’m in remission and feel much better now that I have hair,” Maddie said gratefully and happily.
His mother shares the same positivity. “The feeling of overjoyed knowing that she no longer has cancer in her body – that’s probably one of the greatest gifts you can imagine and pray for. We are so grateful, very humbled to have been able to experience that here at the Miami Cancer Institute, and we will be forever grateful to you for curing Maddison.
And Melissa Nuñez gives this advice: “You have to keep the hope, keep the faith. Life is a gift and keep being positive.
About Acute Lymphocytic Leukemia (ALL)
Acute lymphoid leukemia is a very rare cancer, according to Dr. Daghistani. “It’s a country of 330 million people and every year there are maybe only 5,000 children who get this diagnosis. So it’s not common, but it happens.
The disease has no unique symptoms. The most common presenting sign is fever. “Every child goes to daycare and comes back with a fever. So you’re not going to think of acute leukemia when you have a fever,” explains the specialist. “Now if the fever persists for five days and 10 days, and if you have other symptoms like Maddie had – bruising, pain”, then you should see a doctor.
The treatment for ALL is chemotherapy. “When I started my training in 1983… at that time we used a specific type of chemotherapy, and the majority still use it to this day. The prognosis or chance of recovery for children with ALL was about 60-70%. We are now over 90%,” said Dr Daghistani.
The Miami Cancer Institute is uniquely equipped to treat pediatric cancers. “We are part of a national group,” adds Dr. Daghistani. “We bring the most recent protocol. We are even doing phase one trials. These are drugs that have never been tried in pediatrics anywhere, and we are proud to be able to offer them to our children here in the community.