Leukemia patient prepares for Friday transplant using dad's donated cells

By Courtney Finafrock, Riley Children’s Health videographer, cfinafrock@iuhealth.org

Call it a mother's intuition; Madison Williams knew something was not right when her son, Krue, who was around six months old at the time, was experiencing frequent unexplained rashes and fevers. Because the symptoms would show up after normal business hours, Madison took her son to their local urgent care.

"They told us every time that it was cellulitis," Williams explained.

But Williams continued to feel concerned, so she made an appointment with Krue's pediatrician. She requested lab work.

"After about two-ish weeks of labs, because they kept redrawing because they're like something's just off with his labs, we can't figure it out, they did give us a referral up here to Riley," Williams explained. "We were told it was going to be within a week, and then within 45 minutes I got a phone call back saying you need to get him to the emergency room now!"

Krue's family packed up and headed north to Riley Hospital for Children.

"That was the weekend before he turned one," Madison said. "We spent his first birthday in the hospital getting his diagnosis. We weren't entirely sure what type of leukemia it was, but we knew it was leukemia of some sort."

A month later, Krue was diagnosed with juvenile myelomonocytic leukemia (JMML). The toddler began chemotherapy as he awaited a stem cell transplant.

"We all had to be tested first to see if any of us would be a match and [Kamryn] was the only one that was a 100% match," Williams said.

Kamryn is Krue's older sister, who was five at the time of his initial transplant.

"We used Kamryn as the donor initially because she was a full match, to decrease the toxicity, specifically for graft-versus-host disease," Dr. April Rahrig, Krue's pediatric stem cell transplant physician, explained. "Graft-versus-host disease is a condition where the donor's T cells recognize the patient, or the host, as foreign and they start attacking the tissues."

Even at a young age, Williams said her daughter wanted to help her little brother.

"The best way we could explain that to her was Krue had bad cells and she had good cells and Krue needed her good cells," Williams explained. "So that's what she knew is she was giving her good cells to Krue to try to make him better."

Krue received his stem cell transplant in December, but only 87 days passed before he relapsed.

"Really the only cure for relapsed JMML is another transplant," Dr. Rahrig said. "We are doing a different type of transplant this time around and he's going to be getting a transplant from his dad."

Krue's dad, Dale, is only a 50% match. So, in order to prepare for the toddler's second transplant happening on Friday, Dale must undergo special injections.

"Leading up to the cell collection from dad, dad will need to get an injection that will help move his stem cells from his bones into his blood so that we're able to collect those," Dr. Rahrig explained. "Then those cells will go through a machine, and the bad T cells will be removed, those alpha beta T cells will be removed, and what's left is the stem cells and the good T cells that will grow and help those cells engraft."

Krue's family is holding on to hope that the second transplant will wipe the cancer out for good.

"It's super meaningful that we're able to use a second family member to try to save Krue's life," Williams said.