She soon learned she had a type of non-Hodgkin lymphoma called "diffuse large B cell lymphoma" or DLBCL. At the time of diagnosis, it was present in several areas of her body, including the lymph nodes in her chest, abdomen, and pelvis. Blood cancers are often found throughout the body at diagnosis and Peggy's case was no different. However, it was also in her stomach and the lining of her heart, her spinal fluid, as well as the leg where she had the pain that first brought her to the hospital.
Peggy's oncologist Suzanne Kirby, MD, PhD, a blood cancer specialist who practices at the Duke Blood Cancer Center at Duke University Hospital in Durham and at Duke Cancer Center Raleigh at Duke Raleigh Hospital, called Peggy's variant of the disease “very aggressive.” It would require intensive treatment.
According to the Leukemia & Lymphoma Society (LLS) and the American Cancer Society, approximately every three minutes one person in the U.S. is diagnosed with a blood cancer and approximately every nine minutes, someone dies. By the end of this year, in the U.S., new cases of leukemia, lymphoma and myeloma are expected to account for nearly 10% of the new cancer cases and 9.5% of cancer deaths. New lymphoma diagnoses will account for nearly half of new blood cancer cases.
Peggy never imagined she'd be at Duke as a cancer patient. Up to that point, she’d had an entirely different relationship with the University and Health System — both as an employee herself (a brief stint with Duke Human Resources) and as the wife, for the past 26 years, of Lovest Alexander, Jr., MHS, PA-C, the director of Diversity and Inclusion for the Duke Physician Assistant Program, and an associate professor of Family Medicine and Community Health with a 40-plus-year career history at Duke.
Even after viewing, with her husband and daughter, the PET scan image “all lit up” to show where the cancer was, Peggy refused to believe she had cancer. That she was training for a half marathon one day and two days later was facing down a diagnosis of lymphoma had come as a complete shock.
"Her shock was appropriate. Unfortunately, it is not shocking to those of us who treat this type of cancer; we have many patients with similar stories,” said Shelby Bettoney, PA-C, a physician assistant who works closely with Kirby at the Duke University Hospital Blood Cancer Center and has been treating Peggy since May.
Explained Peggy, “I’ve taken fairly good care of myself over the years. As a result, my sense of denial was very strong. I was afraid. It was almost a month before I could say, ‘I have cancer.’ That was the most frightening thing in the world. I said to myself ‘Lord, I don't want that dreaded disease. I don't, it's not me, I can't have cancer.’”
“Denial is a common part of the grief response to learning about a cancer diagnosis," noted Bettoney.
It took Peggy's family and a care-team effort, Bettoney said, to help her adjust to her new cancer reality.
“Peggy has had the benefit of the support of dedicated nurses who chose this profession; some have worked here for decades. Joey Misuraca is our RN manager and she is very committed to the experience of patients. She hires incredible nurses and fosters an environment of healing, safety, and teamwork,” said Bettoney. “The nurses help set the expectation for the patients' new "normal," answer questions, and suggest solutions for side effects or problems. The service also has a social worker, several case managers, an incredible recreation therapist, physical therapists and occupational therapists, and nutritionists who support our patients. I know she has enjoyed the care she received from Dr. Lou Diehl, one of our attendings who has a gentle way of helping folks adjust.”
Kirby had started Peggy on “R-EPOCH” — a regimen that included several chemotherapies (cyclophosphamide, vincristine, doxorubicin and etoposide), the steroid prednisone, and an immunotherapy (rituximab) delivered intravenously in the hospital over the course of five days, every 21 days. Rituximab (brand: Rituxan) is a monoclonal antibody, a man-made drug that works by targeting the CD20 marker that’s found on the surface of all B-cells (a type of white blood cell) to slow or stop cancer growth.
With lymphoma cells in her spinal fluid, treatment was a challenge. Most systemic cancer drugs can't get past the blood-brain barrier into the protected space that houses the body’s vital command center — the brain and spinal cord. To mitigate this, Peggy had an Ommaya reservoir (a quarter-sized, soft, plastic, dome-shaped device) surgically placed under her scalp and attached to a catheter directed into that protected space. This allowed the cancer drugs to be delivered straight into her central nervous system.
Three months out from treatment, Peggy’s scans revealed “an excellent response to treatment.”
“I thought I was going to die. I really did. I felt, ‘Kid, you aren't going to make it.’ But I did make it. I can now walk and my gait is stronger. My body is stronger. And you know this is a second chance for me… sometimes I almost cry at how blessed I am,” shared Peggy, speaking via Facetime from her Duke University Hospital room early last month.