About a month after Alex Hammer turned 4, he started getting constant fevers and ear infections. When he started sounding like he had marbles in his mouth when talking and was having trouble breathing, his mother, Krista, took him to see an ear, nose and throat (ENT) doctor.

Alex—who lives in Washington Township, New Jersey—was diagnosed with mononucleosis (mono) and was put on steroids. He improved right away, but about a week after the steroid course ended, all of his symptoms returned.

The ENT doctor suggested Krista see Alex’s pediatrician. It was the day before Thanksgiving in 2016 when they went to the pediatrician visit. After an exam and a consultation with another doctor in the office, Alex’s pediatrician told them to go home, saying he was going to do some checking and would call later.

When he called 30 minutes later, after consulting with a specialist, he told Krista to quickly get Alex to the emergency room at Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center. A medical team was waiting for them there because the pediatrician suspected Alex had cancer.

A Holiday Like No Other

Over the course of six hours, Alex had a number of tests, including x-rays and blood work. When a medical team of 10 people walked into Alex’s room, Krista knew the news couldn’t be good. Alex had lymphoblastic lymphoma (LBL), a type of pediatric non-Hodgkin’s cancer, in his neck and chest. Each year there are about 800 new cases of non-Hodgkin's lymphoma diagnosed in children under the age of 19 years. Eighty percent of patients remain disease free at the end of therapy. This is a highly curable type of pediatric form of cancer, says hematologist/oncologist Stacey Rifkin-Zenenberg, D.O.

Because this type of cancer involves rapidly dividing cells, immediate treatment is recommended. Alex’s medical team wanted to get his treatment started that same night, but his family asked to wait until after Thanksgiving. “It was hard to believe this was all happening,” Krista says. “My husband said, ‘Let us go home. Let us see our family. Let us wrap our brains around this.’”

The day after the holiday, Alex was in surgery to insert his port (a small, metal doughnut-shaped device) into a vein to facilitate blood draws and chemotherapy treatment. His parents were also asked if they would allow him to be enrolled in a clinical trial to test whether a targeted drug administered in addition to standard chemotherapy drugs would enhance the effectiveness of treatment.

Whether Alex would get the drug being tested was decided in a randomized way, by flipping a (computerized) coin, but his parents agreed to let him participate in the trial. It’s still too early to know the results of that trial, says Burton Appel, M.D., Alex’s primary oncologist and associate director of the Children’s Cancer Institute at the Children’s Hospital. However, we know that many of the successes of pediatric cancer treatment in the past 50 years were determined by randomized trials like Alex’s.

The Winding Road to Recovery

Alex’s treatment lasted more than two years, and during that time, he experienced the typical complications of chemotherapy, says Dr. Appel, such as fevers, pneumonia and low blood counts. Some of those complications landed him in the hospital.

Alex was not thrilled with having to go through it, his mom says, and it was a challenge to get him to do things that needed to be done in the hospital. “He’s very stubborn. He knows what he wants and won’t do anything he doesn’t want to,” she says. 

The medical team understood. “You could tell he just wanted to feel better so he could go back to being active,” Dr. Appel says. “I think the most difficult thing for him were the times he had to spend in the hospital. He just wanted to be at home, which is of course very normal for a child.”

The good news was his cancer responded well to his treatment. He completed chemotherapy in March 2019. “Most relapses would occur within the first one to two years after completing chemotherapy,” Dr. Appel says. “So the fact that he's over that two-year mark is very encouraging.”

Superhero Powers

When Alex finished his treatment, the surgeon who put in his port, Keith Kuenzler, M.D., removed it in a second procedure, cleaned it up and gave it to Alex’s mom. “Patients and parents are always proud to take it home on the day of its removal,” he says. “Especially compared with the day I have to put the port in, it’s such a wonderful moment. I never get tired of it.”

Krista Hammer wasn’t sure what to do with the piece of metal at first but brought it home regardless. “I brought it home and remember staring at it. I held it in the palm of my hand. It was literally the size of a dime. I was like, ‘This is what kept him alive,’” she says.

Then inspiration struck. Throughout Alex’s treatment, his family referred to him as “Iron Man,” after the superhero Alex admired. In the center of Iron Man’s chest is a circular device that keeps him alive and gives him superpowers—sort of like Alex’s port.

A family friend put Krista in touch with an artist who altered an Iron Man figurine by inserting Alex’s port into its chest. “It sits in Alex’s room, and it’s just the coolest thing,” Krista says.

Now that Alex is more than two years post-treatment, he will be referred to Hackensack Meridian Children’s Health’s Cure and Beyond program, Dr. Appel says. Cure and Beyond is a lifelong support program for childhood cancer survivors that offers medical and psycho-social support services to identify and manage any long-term effects of childhood cancer. 

But right now, his mom says, Alex is focused on finally getting to be the active, healthy kid he always wanted to be.

Next Steps & Resources:

            Meet our sources: Stacey Rifkin-Zenenberg, D.O., Burton Appel, M.D. and Keith Kuenzler, M.D. To make an appointment with one of them or a doctor near you, call 800-822-8905 or visit our website.

            Learn more about nationally recognized pediatric cancer care at Hackensack Meridian Health.

 The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.