Patients in the Spotlight: Delaney Doyle
High-Risk Cancer Marks Firsts for Newborn and Hospital
Delaney Doyle was just 15 days old when Kelly McMillin noticed her daughter’s abdomen was extremely swollen and distended. After having a normal pregnancy and delivery, Kelly, a nurse at Pain Treatment Medicine of the Finger Lakes, knew something wasn’t right. On Aug. 28, 2013, she and her husband Eric Doyle, residents of Clifton Springs, took Delaney to her pediatrician Odet Youssef, M.D., at Thompson Health’s Thompson Family Care. Little did they know, the next year would be full of overcoming medical obstacles, with multiple firsts for both the Doyle family and Delaney’s care team at UR Medicine’s Golisano Children’s Hospital.
After preliminary examinations, the Doyles were told to immediately bring their newborn girl to the Pediatric Emergency Department at Golisano Children’s Hospital. It was there that an ultrasound showed Delaney’s liver was extremely swollen and a large tumor was sitting on top of the adrenal gland on her left kidney.
“Being a nurse, I was going through a check list in my head as to what it could be,” said Kelly. “It was all very devastating, especially with her just being 2 weeks old.”
By just looking at the ultrasound results and seeing the structure of what had presented, Kelly and the medical team suspected it was neuroblastoma from the beginning. “We had a strong feeling the first night it was neuroblastoma,” said Kelly. “We would just have to wait for tissue confirmation and staging.”
Further work-up revealed that the disease had already metastasized into her liver and bone marrow. Delaney was admitted to the Pediatric Intensive Care Unit (PICU) for surgery the next evening. Chief of Pediatric Surgery Walter Pegoli, M.D., removed the tumor as well as Delaney’s left adrenal gland. The tumor was so large it posed multiple life-threatening complications.
“The tumor had caused Delaney’s surrounding organs to swell, especially her liver, and a large defect in her abdominal wall,” said Pegoli. “In the end, we had to create a temporary prosthetic mesh lining in place of her abdominal wall.”
Due to the complexity of the case and the degree of swelling, Pegoli didn’t want to immediately close Delaney’s abdomen. A little fighter, Delaney remained in the PICU, with an open abdomen, for five weeks. She was able to undergo her first round of chemotherapy in early October.
The Doyles received Delaney’s cancer classification Sept. 11, 2013. The results came back showing her tumor cells as an aggressive type of neuroblastoma that tends to be more resistant to chemotherapy.
“Usually children who present with neuroblastoma as young as Delaney have a stage known as 4S, a less aggressive form that often doesn’t even require therapy,” said Golisano Children’s Hospital oncologist Lauren Bruckner, M.D., Ph.D. “Delaney’s neuroblastoma was high-risk stage 4, making her case particularly rare, meaning she would need to undergo more intensive therapies.”
Bruckner consulted with medical experts, both nationally and locally, as to what would be the most effective and appropriate treatment for Delaney, especially given her young age and small size. They agreed to go ahead with a full dose treatment plan – without reducing the intensity – just as they would with an older child.
Delaney’s abdomen was finally closed the last week of September and the family headed back home in October, but their journey continued with five more rounds of chemotherapy.
Between her fourth and fifth rounds of treatment, Delaney was declared to be in remission and was admitted to the PICU again on Dec. 16 so specialists could collect her stem cells for transplant. At only 4 months old, Delaney was the youngest patient at Golisano Children’s Hospital to undergo a stem cell collection.
“We were worried about the technical side of things because of Delaney’s tiny blood vessels and the size of the tubing,” said Bruckner. “Delaney is such a trooper though and it ended up being a very successful collection.”
After a brief stay at home she was admitted again in February for a stem cell transplant, requiring her to remain in the hospital for six and a half weeks. The transplant made it possible for her to receive a high-dose form of chemotherapy, which could only be done because Delaney’s bone marrow was rescued by giving her the previously collected stem cells. Delaney’s treatment continued with 14 rounds of radiation.
With close to 200 days spent at the children’s hospital, Ronald McDonald House was a “home away from home” for the Doyles. Delaney’s parents spent time in both the House Within The Hospital and the House at Westmoreland, located right around the corner.
“Everyone that has played a role in Delaney’s journey, including her doctors, 4-3600 nurses, and more, are considered a part of our family,” said Kelly. “We have the utmost confidence in them as members of our team and we couldn’t get through this without them.”
This high level of confidence and trust was most recently shown in May when the Doyles agreed to allow Delaney to be the first patient at Golisano Children’s Hospital to undergo immunotherapy. When administering this therapy, an antibody, known as chimeric 14.18, was sent through Delaney’s body to train her immune system to seek out and fight the active neuroblastoma cells. After receiving the treatment once a month, Delaney completed her last immunotherapy session in September.
“The goal of the immunotherapy was to consolidate remission and make sure that Delaney continues to remain cancer free,” said Bruckner. “She continues to have no signs of active disease.”
Delaney will be tested for signs of cancer for the next several years and undergo another surgery with Pegoli to continue rebuilding her abdomen.
“She has certainly beat the odds,” said Pegoli.
Now 1 year old, Delaney is described by her mother as “the sassiest little girl with a great personality.” After spending most of her first year at Golisano Children’s Hospital it’s hard for the Doyles to imagine Delaney’s life being different. “It’s almost scary to be done,” said Kelly. “But, we are very much looking forward to having a new normal.”