Veteran Faces a Rare Form of Blood Cancer Called APL

Molly Maguire served in the Ohio Army National Guard and the Army Reserve as a Combat Engineer Officer (12B) and was medically retired after 22 years of service at the rank of Major (O-4). And it was on Veteran’s Day in 2022 when the symptoms of her rare cancer first began to appear: an unusually long nosebleed, followed by sickness the next day. By November 17, Molly was struggling to breathe.

A visit to the emergency department confirmed that she had pneumonia and a type of leukemia called acute promyeloctic leukemia (APL).

How APL Affects the Blood

APL develops in about 600-800 people each year in the United States, according to the National Organization for Rare Disorders.

“APL is a cancer of the white blood cells in the bone marrow. It results from an abnormal gene, called PML-RAR, which is formed when genes on chromosomes 15 and 17 switch places,” explains Abhijit Saste, MD, a hematologist/oncologist with ProMedica Physicians.

Dr. Saste continues, “The abnormal gene sends a signal to bone marrow cells (promyelocytes) that prevents them from maturing into healthy white blood cells. The bone marrow cells then release an irritative chemical, when they spill over into the blood. This impairs the blood clotting mechanisms, which then results in bleeding. The promyelocytes also crowd in your marrow, hindering the production of healthy cells in the blood.”

Molly’s Fight for Survival

For most people with APL, the outcome is very good. “There are very effective treatments available that can induce long-term remissions and it can be curative in a subset of patients,” explains Dr. Saste.

But Molly’s path to remission was rockier than most. With an existing lung condition, pneumonia and APL, she was admitted to ProMedica Toledo Hospital. She was put on a ventilator and began chemotherapy immediately to prevent bleeding complications.

“They gave me a 10% chance of survival at that time. It was very scary for a few days and I don’t remember anything,” says Molly. “But I was taken off the ventilator the Saturday after Thanksgiving. For the next 60 days, my lungs kept filling up with fluid.”

When Molly was released from the hospital months later, she had to learn to walk again.

Facing a Rare Blood Cancer

For Molly, 2023 has been a year filled with rounds of chemotherapy, physical therapy and learning what she can about APL.

As there are no genetic markers to her condition, Molly likely developed APL due to exposure during her military service prior to 2014. Although she’s done her fair amount of research about APL, it’s been difficult to have such a rare condition.

“I kept trying to find people and see if others were being treated with it. It took me a long time to find a support group and even then it was too emotional. Some support groups talk about everyone who has died. I needed a survivor to tell me what’s going on here,” says Molly.

For self-care, Molly has turned to friends, regular massages and the Wounded Warrior Project, which supports injured veterans through a range of programs and services.

A Collaborative Approach to Molly’s Treatment

Although APL is a rare type of cancer, it’s a well-studied disease. Dr. Saste and his team began Molly’s treatment with a detailed study of the evidence-based published guidelines for the management of APL. Her treatment was also personalized to her tumor biology.

“Treatment was a collaborative effort by our team of hematologists and oncologists, oncology pharmacists, oncology infusion nurses and oncology nurse practitioners,” explains Dr. Saste.

“We also sought the consultations of our specialist teams, comprising of critical care physicians, a cardio-oncologist, infectious disease physicians and nephrologists in co-managing her other medical parameters to safely deliver these strong treatment regimens,” he adds.

Facing the Lifelong Effects of Cancer

Thanks to Molly’s treatment, she has effectively cleared the cancer cells from her bone marrow and blood. But because she didn’t lose her hair during treatment, people may not even suspect that she has had cancer. It has sometimes felt like a hidden journey of painful chemo ports, uncomfortable chemo side effects and a lifelong commitment to monitoring her condition.

Molly wants to raise awareness of APL, risks for cancer and the lifelong journey that cancer survivors face.

“Molly will most importantly need regular blood work to monitor for the PML-RAR gene in her blood to ensure that she stays in remission,” says Dr. Saste. “Blood work and imaging modalities will also be undertaken at regular intervals to monitor her organ systems for their long-term health, given the stresses of her elaborate chemotherapy treatments thus far.”

“People need to understand that with diseases and cancers, there’s a long-term effect,” says Molly. “It impacts your mortality rate. Just because you have the ‘all clear’ after chemotherapy, doesn’t mean you’re completely in the clear.”

Still, there’s hope for those with APL and other blood cancers.

“The treatment landscape in the area of blood cancers is rapidly evolving,” says Dr. Saste. “The fact that APL is curable in a subset of patients is an unprecedented achievement in the field of hematologic malignancies.”