Days before his fourth birthday, Steven Magagna began complaining that his “arms hurt.” Thinking perhaps he was coming down with the flu, his mother Kathy was surprised when the pain became so severe that Steven could no longer move. After a visit to the emergency room at the University of Michigan, Steven was diagnosed with acute lymphoblastic leukemia.

Leukemia is the most common childhood cancer, accounting for about 25 percent of all cancer diagnoses made in children and adolescents. Leukemia is a cancer of the white blood cells wherein immature white blood cells are produced at such a high rate that they accumulate in the bloodstream, bone marrow, and lymph system. This elevated amount of abnormal cells interferes with the production and functioning of healthy white blood cells, which help the body fight off infection. Patients are left with little or no defense against infection. There are two main types of leukemia: acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML). The most common is ALL, which represents 75 to 80 percent of the cases treated at the U-M Comprehensive Cancer Center.

According to Raymond Hutchinson, M.D., Clinical Director of the Pediatric Blood and Marrow Transplant Clinic, leukemia patients commonly have symptoms such as bone pain, low-grade fever, or bruising on the skin. To make a diagnosis, bone marrow is tested for abnormal cells and genetic testing confirms whether the patient has leukemia and which type.

Collaboration Improves Treatment

Leukemia treatment is developed collaboratively by institutions like the University of Michigan C.S. Mott Children’s Hospital and the Cancer Center as a part of the Children’s Oncology Group (COG). The COG collects research data from its members and develops the treatment protocols that are used across the nation. As a founding member of the group, the University of Michigan has remained active in the effort to improve outcomes for children with cancer for over 40 years.

Steven bravely began treatment for ALL at the Cancer Center in May of 2000. Like most ALL patients, he was treated with several rounds of chemotherapy, which begin with a five- to seven-week series of drugs called induction. This is followed by a slightly more intense period of treatment called consolidation, which lasts about five weeks. The patient then repeats the induction and consolidation processes, only this time in shorter courses. Finally, these are followed by a maintenance period of therapy. Treatment can last from two to three years.

A Special Bond

Throughout the entire course of treatment, patients are accompanied by a nurse. Steven and pediatric nurse practitioner Mary Jo McNair formed an extremely special bond. She made visits easier for Steven by “making jokes about every shot and poke and singing songs about them with him.” Completing treatment in July 2003 was a bittersweet success for Steven as he knew he would not be seeing his friends at the Cancer Center as often.

Now 7-1/2 years old, Steven has spent about half of his life at the Cancer Center. He currently comes back once a month and will continue with periodic visits for four more years after that. If he remains in remission throughout this period, he will be considered cured, confirming the remarks of Hutchinson, who says, “I just think it is a pretty good success story. I think we’ve seen a lot of changes in terms of how kids do and certainly since the ‘60s when the results were terrible for both ALL and AML.”

Steven Magagna and his family consider their experience at Mott Hospital and the Cancer Center a joyful one. His mother Kathy reveals that Steven was “a quiet, scared child” when he first began treatment, but is now an exuberant 7-year-old who “finds something in everything and enjoys every moment in life.” She considers her son’s love of life “a gift that has grown in the Cancer Center.”