A New Battle

Cancer relapse is one of the worst things a patient can experience. It's hard to imagine the psychological impact Dalal experienced the moment she learned that after two and a half years of unbearable pain and a triumphant victory, all it took were five words to shatter everything. Shortly after this shock, my father was immediately called and informed by my oldest brother Yazeed who was also in Philadelphia. My father's first action was to call Dalal and calm her down.

"I immediately called her in the hospital to talk to her and alleviate her emotional pain. Her loud screams and cries tore my heart apart, especially that I was so far away and could not hold her close to me. I urged her to stop crying and promised her I would be by her side within hours, immediately taking the first flight headed to the United States. I assured her by the words of the quran that every disease has a cure and that this would be a fleeting phase that will go by quickly."

That phone call gradually calmed her down. Within a few hours, she was taken back to the same room she was in two years ago. The new battle was just about to start. The next morning, another oncologist who was a part of her team of doctors came in after he learned that the cancer had relapsed. He expressed his sadness and encouraged Dalal to stay patient and strong, telling her that everything she endured thus far will pay off. He took a look at the CT scan that was performed a month ago after my mother explained that it showed no sign of the tumor. To our surprise, he assured that the tumor was actually visible in the CT scan, but it was mistaken for the Thymus gland (produces T-cells) that is located in the neck. At that moment, it was realized that the cancer was already growing back as soon as we landed in the United States, if not even before that. This made us wonder why the oncologist chose to have the PET scan done a month after the CT scan. If there was the slightest suspicion that the cancer could have relapsed, then perhaps she should not have waited a month to perform the PET scan. Now that the cancer was back, all priorities were shifted towards it. The tympanoplasty, which was the main reason we came to the Philadelphia that summer, was immediately cancelled.

My father held true to his promise and was at the doorstep of Dalal's room the next morning. The reunion was filled with happiness, but it was also filled with sorrow now that the disease came back. The doctors decided to perform a biopsy of the tumor to see whether or not it was a different kind of cancer. They also did a biopsy of the CSF to ensure that it had no cancerous cells. The results showed that the tumor was identical to the previous one, and the CSF did not contain any cancerous cells. On August 19, 2008, another VAD device was implanted in her arm. The second line of chemo treatment was also being discussed. The doctors explained to my parents that when it comes to patients who have a relapsed cancer, one of the only hopes of a cure is a bone marrow transplant surgery. The bone marrow produces red and white blood cells along with platelets (tiny blood cells that form clots to stop bleeding and heal wounds). Therefore, it is vital for patients with cancers that affect the blood cells (such as Lymphoma) to have a healthy bone marrow, otherwise there may not be a cure for them.

There were certain requirements before the transplant could be performed. The tumor had to shrink to a certain size and a perfectly matched donor had to be found. I vividly remember the day when me and my three brothers were taken to a small room to have our blood tested, hoping that one of us were a perfect match for Dalal. That was the first time in my life that I voluntarily took an injection. I had a horrific fear of needle injections as a child, but if it was for my one and only sister, then I would overcome that fear no matter what it took. Five days later, the results came back and my oldest brother Yazeed was a perfect match. Although deep inside I wished that I would have been a match for her, we were all very happy that we did not need to expand the search beyond family members.

The relapsed cancer was more powerful than the previous one, so the second line of treatment had to be more powerful than the first. The new therapy was extremely strenuous. The side effects were back more severely and Dalal's hair fell much faster than it previously did. She was given a two-week break before they began the second stage of the new therapy. During the break, the doctors performed a scan to check for progress. The tumor had shrunk down from 13cm to 5cm. We were very happy with these results and had high hopes that it was only a matter of time before the bone marrow transplant was done. On the last night of the two-week break (September 11, 2008), Dalal felt a slight swelling in her throat. Fear and anxiety engulfed my parents' hearts so they immediately rushed her to the hospital. The scan they took that night was depressing; the tumor was resisting and grew back to 8cm. With this unexpected result, it was concluded that the second line of treatment was ineffective as the cancer was able to beat the powerful drugs. My parents were aware that the ineffectiveness of multiple therapies and the need to switch to a new line of treatment indicated a diminishing in the hopes of a cure. The doctors decided to make the third line of treatment very similar to the NHL-BFM 90 protocol that worked previously. The tables below show the second and third lines of treatment drugs that were in Dalal's official treatment plan.