When nine-year-old Cashlin came to Atrium Health Levine Children’s Hospital, the young boy was already well acquainted with the inside of a children’s hospital. When he was just two, Cashlin had a heart transplant. His transplant was a success, but as he grew up, Cashlin developed concerning symptoms: painful abdominal swelling, fever and unexplained weight loss. His mom, Yameika, was concerned that the problems were related to his heart. She brought Cashlin to see Gonzalo Wallis, MD, a cardiologist at Levine Children’s.
Given the child’s symptoms and medical history, Wallis suspected posttransplant lymphoproliferative disease (PTLD), a cancer that affects people following an organ or bone marrow transplant. Wallis consulted with Javier Oesterheld, MD, an oncologist at Levine Children’s. Together, they diagnosed Cashlin with PTLD.
To allow a body to accept a transplanted organ, the patient must take immunosuppressant medications. This weakening of the immune system, however, can lead to infections that make immune cells behave unusually, to divide too quickly and to accumulate in the lymph nodes. Early on, this infection can occur without symptoms. If it progresses, these cells can become cancerous, resulting in PTLD. While a PTLD diagnosis usually happens close to the time of a transplant, sometimes – as in Cashlin’s case – it occurs years later.
PTLD is a rare disease, and most people who receive transplants will not develop it. The close working relationship between Wallis and Oesterheld, which connected the renowned cardiology and oncology departments at Levine Children’s, was the key to Cashlin’s diagnosis, as well to his innovative treatment.
Groundbreaking Pediatric Cancer Care
Yameika was understandably nervous about Cashlin undergoing new treatments. She worried how cancer drugs may affect the strength of his heart. Wallis and Oesterheld talked her through the dangers of PTLD and what the care team would need to do to help Cashlin become healthy again.
“The experience I had with Dr. Wallis and Dr. O. was more like an experience with family,” Yameika said. “They let me know the concerns and side effects and everything, and they made it easy for me to understand. I told them, ‘OK, I trust you. Let’s do it.”
Cashlin’s treatment began with medicine and chemotherapy, which, in most cases, are enough to treat PTLD. Cashlin’s body did not respond well to them, however. He went into kidney failure and required dialysis, and Donald Weaver, MD, a pediatric nephrologist at Levine Children’s, joined his care team. Soon, Cashlin’s condition worsened. Cashlin’s skin began to slough off and he developed hallucinations. Cashlin’s care team grew even bigger: with wound care specialists, neurologists and pathologists.
“This is world-class medical care, not in one specialty or two, but in every specialty your child might need,” Wallis said. “Cashlin went through the worst of it – from diagnosis to complications – but he received all the care he needed in one place.”
Doctors recognized that Cashlin, unresponsive to conventional therapies, required a new treatment. The child became the first patient at Levine Children’s to receive brentuximab, a cancer treatment that had just been approved. That new drug empowered Cashlin’s body to fight the cancerous cells.
“The doctors told me that there was a patient somewhere else who had a case similar to Cashlin’s, and that the new medicine had helped him,” Yameika said. “Once he started using that new medicine, it worked perfectly. Cashlin never had any complications. I was feeling shocked and praise-the-Lord at the same time!
At each step, Oesterheld and the oncology nurses made sure that Cashlin understood his treatment – what was happening, why it was happening, and what would happen next. Even as he became a ground-breaking cancer patient at Levine Children’s, he never felt alone.
“Cashlin was very comfortable with Dr. O. and the nurses,” Yameika says. “Cashlin was able to ask questions and they’d answer him with whatever he needed to know. He’d ask what everything was, why he was taking it, and then they’d explain everything to him until he said, ‘OK.’”
Through it all, though, Wallis and Weaver continued to check in on Cashlin to make sure that brentuximab wouldn’t adversely affect his heart or kidney function.
“The entire team was amazing,” Yameika said. “They made sure that they did whatever they had to do so that we could beat this cancer.”
Cashlin, now a 14-year-old ninth grader, remains cancer-free. He has a new team these days: his baseball team. No one who watches him round the bases would guess that this child had a heart transplant and beat a rare cancer. He’s got big plans—college, a business degree, a career in Major League Baseball, and then owning his own restaurant.
“I just tell him, ‘Sky’s the limit,” said Yameika, who calls her son a miracle. “You know you can do it!”
