Doctors Debate: Is Intensive or Low-Intensity Chemotherapy Plus BCR-ABL TKI Therapy Best for Treatment of Ph+ ALL? – Targeted Oncology

Philadelphia chromosomepositive acute lymphoblastic leukemia (Ph+ ALL) can be treated using either intensive chemotherapy with a BCR-ABL tyrosine kinase inhibitor (TKI) or nonintensive chemotherapy. Which strategy to employ is an ongoing clinical question that affects patients from the front-line to third-line settings.

During the Society of Hematologic Oncology Virtual Annual Meeting, Nicholas J. Short, MD, an assistant professor in the Department of Leukemia at the University of Texas MD Anderson Cancer Center in Houston, argued that intensive chemotherapy combined with a BCR-ABL TKI still holds the place of standard-of-care treatment for Ph+ ALL. Sabina Chiaretti, MD, PhD, a researcher in the Department of Translational and Precision Medicine at Sapienza University in Rome, Italy, made the case that less is more, arguing for a targeted approach to managing Ph+ ALL.1,2

Perhaps the best reason to use the standard-of-care strategy for treating patients with Ph+ ALL is that it is known to improve survival in the front-line setting and has demonstrated increased molecular responses and survival in the second- and third-line settings, Short explained in his presentation. When complete molecular responses (CMRs) are observed with a therapy, Short says, it increases the chance of cure in patients.1

The best opportunity to cure someone with newly diagnosed acute leukemia of any type, and in particular, Philadelphia chromosomepositive ALL, is in the frontline setting. It is therefore very important that you choose the frontline regimen appropriately. This an important debate because of the emerging data with lower-intensity regimens that have brought on some desire to treat patients with less chemotherapy, Short told Targeted Therapies in Oncology (TTO) in an interview.

Understanding How Patients Benefit

Prior to 2016, the impact of CMRs on patients with Ph+ ALL had not yet been defined. Findings from a study conducted by Short and colleagues showed that achieving a CMR at 3 months can potentially identify which patients will have long-term overall survival (OS) and relapse-free survival (RFS) on intensive chemotherapy without stem cell transplant (SCT) compared with those who have lower CMRs at 3 months.3

The study enrolled 202 patients with Ph+ ALL to receive the frontline intensive chemotherapy combination of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD). At 3 months, the OS was 127 months for patients who had higher CMRs compared with 38 months among those with lower CMRs (HR, 0.42; 95% CI, 0.21-0.82;P =.0). Also, at 3 months, the RFS among the higher-CMR population was 26 months versus 18 months for the lower-CMR population (HR, 0.43; 95% CI, 0.21-0.78;P =.01).

Overall, the findings showed that higher CMRs resulted in superior survival, whereas lower CMRs left patients with poor outcomes.

This research laid the groundwork for an understanding of how patients benefit from and which patients have the best responses to intensive chemotherapy.

Patient Outcomes With Intensive Chemotherapy Plus a BCR-ABL TKI

Short previously presented long-term safety and efficacy results from the combination of hyper-CVAD and the third-generation BCR-ABL inhibitor ponatinib (Iclusig) at the 2019 American Society of Hematology (ASH) Annual Meeting. Patients with newly diagnosed Ph+ ALL had sustained responses on this treatment without hematopoietic SCT (HSCT), demonstrating its potential for cure, Short noted.

The best outcomes that have been reported so far in the literature have been with the combination of intensive chemotherapy with hyper-CVAD plus ponatinib. For the study, we have long-term outcomes data available. Theres a 5-year overall survival rate of 74%, which is better than we see with other tyrosine kinase inhibitors and also better than what we weve seen to date with lower-intensity regimens, Short said.

This is likely driven by the higher rate of complete molecular response that we see with the combination of intensive chemotherapy plus ponatinib, he added.

Of the 68 patients evaluated, at a median follow-up of 43 months (range, 2-92), 71% were alive and still in remission at the time of data cutoff. After 3 years, the complete remission (CR) rate observed with the combination was 84%. Patients also achieved an event-free survival (EFS) rate of 70% and OS of 78% with hyper-CVAD plus ponatinib. It was estimated that the 5-year rates for CR, EFS, and OS would be 84%, 68%, and 73%, respectively.4

Notably, during this analysis, 11 patients relapsed after a median of 20 months in remission (range, 5-64 months). Three of the patients who relapsed were still receiving ponatinib, but 6 were being treated with another TKI, and 2 were not receiving any TKI. Among those who relapsed while receiving ponatinib, an ABL1 E255K kinase domain mutation was detected in 2 patients, which may have affected outcomes. The remaining patients who were treated with ponatinib but relapsed within 20 months did not have a tumor mutation.

It was also notable that a trend toward improved OS was observed in patients who did not undergo HSCT compared with those who did, according to a landmark analysis. Specifically, the OS rate for patients who did not undergo HSCT was 90% versus 66% for those who did (P=.07).

The safety profile of hyper-CVAD combined with ponatinib was tolerable in the newly diagnosed Ph+ ALL study population. The majority of adverse events (AEs) observed with the combination were grade 1 and 2 in severity. Still, dose reductions were necessary in 37% of patients as a results of AEs. The most common events that occurred were rash (n=7), liver function test abnormalities (n=5), pancreatitis (n=3), deep vein thrombosis (n = 2), and thrombocytopenia (n=2). There were 9 deaths in the study of patients who were in CR. Also, 2 ponatinib-related deaths occurred, leading to a protocol amendment regarding the dose level of the drug. After the amendment, no additional patients died.

Similar efficacy and safety were observed in earlier studies of hyper-CVAD plus a BCR-ABL TKI. First, results of the 2015 study of hyper-CVAD in combination with imatinib (Gleevac; NCT00038610) showed a 93% CR rate in the 45 patients with active disease at the time of enrollment. Additionally, at 5 years, the OS rate with hyper-CVAD plus imatinib was 43%.5

Satisfactory outcomes were reported with the intensive chemotherapy and BCR-ABL TKI combination of frontline hyper-CVAD and dasatinib (Sprycel) in patients with Ph+ ALL. Long-term follow-up results from the phase 2 study were published in the journal Cancer. The investigators concluded that the combination is able to achieve long-term remission in patients. In the 72 patients evaluated, the CR rate was 96% and the 5-year OS rate was 46%.6

Based on these 2015 data from 2 combinations, the 2019 data presented at ASH confirm the benefit of intensive chemotherapy combined with BCR-ABL TKI therapy, noted Short; however, the study conclusion mentioned that other BCR-ABL TKIs, such as blinatumomab (Blincyto), still must be evaluated in the frontline setting of Ph+ ALL.1,4

Is There a Role for Low-Intensity Chemotherapy?

To further support his argument around intensive chemotherapy plus TKI therapy, Short reviewed the emerging data of lower-intensity chemotherapy regimens. His overarching point was that the trials are too preliminary to change the current standard of care.

While I agree that lower-intensity therapies need to be evaluated, my argument is that those are not yet standard of care. There are not enough long-term data for those studies that show promise for treating patients with low-intensity chemotherapy outside of clinical trials, Short stated during the interview.

Short examined data from the 2007 study of imatinib plus chemotherapy in elderly patients with Ph+ ALL, which showed a superior CR rate compared with induction chemotherapy but did not show a survival benefit. The 1-year OS rate was 74%.7 In addition, the 2016 study of dasatinib with low-intensity chemotherapy in elderly patients, as well as the 2019 study of nilotinib (Tasigna) in patients with newly diagnosed Ph+ALL, demonstrated improved cure rates compared with induction therapy, but the OS was not satisfactory.8,9 Specifically, dasatinib plus low-intensity chemotherapy resulted in a 36% OS at 5 years, and nilotinib plus low-intensity chemotherapy led to a 2-year OS rate of 47%.

The most impressive survival results were observed with low-intensity chemotherapy plus ponatinib in elderly or unfit patients with Ph+ ALL treated in the phase 2 Gimema LAL1811 trial (NCT01641107). The combination led to a 2-year OS rate of 64%, which Short attributed to the higher CMR rate of 46%.10

After reviewing these data, Short maintained his argument that intensive chemotherapy combined with a BCR-ABL inhibitor is a proven frontline standard of care for Ph+ ALL. The only question that remains, Short told TTO, is whether the ability to skip transplant is an important accomplishment with the regimens.

Low-Intensity Chemotherapy as Ph+ ALL Treatment

Ph+ ALL is of the highest concern in patients 60 years and above. Perhaps due to the age of these patients, the satisfactory outcomes observed with intensive chemotherapy are often cancelled out by the overwhelming toxicity, Chiaretti explained during her presentation. Because of the toxicity of intensive chemotherapy, Chiaretti argues that long-term outcomes for this strategy are unsatisfactory, with ponatinib being the only exception.2

Today, we are lucky enough to be able to manage our patients with targeted therapies instead of chemotherapy. We should aim to use the best drugs that we have, which are TKIs and targeted therapies. The outstanding question is which are those patients who are at higher risk of relapse, so that we can use the best treatment for those patients, Chiaretti told TTO in an interview.

Success With Low-Intensity Chemotherapy and TKIs

In terms of low-intensity chemotherapy with a BCR-ABL TKI, the research around the GIMEMA strategy has shown high complete hematological response (CHR) rates, Chiaretti said, beginning with the study of imatinib in combination with steroids and without additional chemotherapy in elderly patients with Ph+ ALL (LAL0201-B; NCT00376467). Of the 30 participants aged 60 to 89 years, 29 were evaluable for response. The CHR rate achieved was 100%.11 Later, in the GIMEMA LAL1205 protocol study (NTC02744768), patients aged 18 to 84 with Ph+ ALL were treated with frontline dasatinib in combination with intrathecal chemotherapy and also achieved a 100% CHR rate.12

Chiaretti made note that all the GIMEMA protocols resulted in satisfactory CHR without additional chemotherapy, demonstrating that intensive chemotherapy may no longer be necessary for this patient population.

In the LAL0904 study (NCT00458848), a 96% CHR rate was observed in 49 evaluable patients. The regimen consisted of imatinib plus induction and consolidation chemotherapy in patients aged 16 to 60 years with Ph+ ALL. The treatment was deemed feasible for adult patients with Ph+ ALL based on this protocol.13 Similarly, 39 patients with Ph+ ALL 60 years and older in the LAL1408 study (NCT01025505) achieved a CHR rate of 94% on treatment with nilotinib in combination with imatinib. Investigators led by Giovanni Martinelli, MD, concluded that the results of this combination were not different from those observed with single-agent imatinib.14

For patients 60 years and older in the LAL1811 study, the CHR was 95% with ponatinib. This study confirmed the activity of ponatinib in this patient population.15

Finally, Chiaretti noted unpublished results from the LAL1509 trial (NCT01361438), which evaluated dasatinib total therapy in patients aged 18 to 60 . The CHR rate was reported as 97%.2 Notably, the safety profile of the drugs evaluated in all these GIMEMA studies were well tolerated.

Homing in on the difference in survival in patients treated with intensive chemotherapy versus de-intensified chemotherapy, intensive chemotherapy appeared to have better rates. Results of a 2012 study showed a 2-year event-free survival of 63% (95% CI, 39%-87%) with de-intensified chemotherapy in 29 patients with Ph+ ALL.16 In another study of 30 patients, low-intensity chemotherapy with imatinib led to a 5-year EFS rate of 32.1% compared with 42.2% with intensive chemotherapy. The 5-year OS rate in this study was 43% with low-intensity chemotherapy compared with 48.3% with intensive chemotherapy.17 Chiaretti noted, however, that the CT rate was not significantly different between these studies. Moreover, both responses and survival would be improved upon with a more target treatment approach, Chiaretti said.

Targeted Treatment of Ph+ ALL

Highlighting the results of the Gimema LAL2116 D-ALBA trial of front-line dasatinib in combination with blinatumomab as treatment of adults patients with Ph-ALL (NCT02744768), Chiaretti made the case of targeted therapy without addition of chemotherapy in this patient population.

The study of 63 evaluable patients at a median age of 54.50 years (range, 24.1-81.7 years) achieved a CMR rate of 60.4% (95% CI, 46%-73.5%), meeting the studys primary end point. Median follow-up was 14.3 months (range, 0.9-25), and the OS rate observed with the amount of follow-up was 95.2% (95% CI; 90.1%-100%). The disease-free survival rate was 89.7% (95% CI, 82.2%-97.9%).18

In terms of safety, 148 AEs were observed, and 41 serious AEs were observed. The most common AEs included infections and infestations, general disorders, and gastrointestinal disorders.

The key takeaway from Chiarettis presentation was that although low-intensity chemotherapy with a TKI is less toxic than intensive chemotherapy, ultimately, patients would have better overall outcomes with chemotherapy removed from the course of treatment: We dont want patients to succumb to their disease. If we use chemotherapy, the risk of treatment-related morality is very high.

Chiaretti concluded that a chemotherapy therapy-free induction and consolidation approach may be best for patients with Ph+ ALL.

References:

1. Short N. Is less more? intensive vs non-intensive approach to adults with Ph+ALL: intensive approach. Presented at: 2020 Society of Hematologic Oncology Annual Meeting; September 9-12, 2020; virtual.

2. Chiaretti S. Is less more: intensive vs nonintensive approach to adults with Ph+ ALL: non-intensive approach. Presented at: 2020 Society of Hematologic Oncology Annual Meeting; September 9-12, 2020; virtual.

3. Short N, Jabbour E, Sasaki K, et al. Impact of complete molecular response on survival in patients with Philadelphia chromosomepositive acute lymphoblastic leukemia. Blood. 2016;128(4):504-507. doi:10.1182/blood-2016-03-707562

4. Short NJ, Kantarjian HM, Ravandi F, et al. Long-term safety and efficacy of hyper-CVAD plus ponatinib as frontline therapy for adults with Philadelphia chromosome-positive acute lymphoblastic leukemia. Blood. 2019;134 (suppl 1):283. doi:10.1182/blood-2019-125146

5. Daver N, Thomas D, Ravandi F, et al. Final report of a phase II study of imatinib mesylate with hyper-CVAD for the front-line treatment of adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Haematologica. 2015;100(5):653-661. doi:10.3324/haematol.2014.118588

6. Ravandi F, OBrien SM, Cortes J, et al. Long-term follow-up of phase II study of chemotherapy plus dasatinib for the initial treatment of patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Cancer. 2015;121(23):4158-4164. doi:10.1002/cncr.29646

7. Ottmann OG, Wassmann B, Pfeifer H, et al; GMALL Study Group. Imatinib compared with chemotherapy as front-line treatment of elderly patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL). Cancer. 2007;109(10):2068-2076. doi:10.1002/cncr.22631

8. Ottmann OG, Pfeifer H, Cayuela JM, et al. Nilotinib (Tasigna) and low intensity chemotherapy for first-line treatment of elderly patients withBCR-ABL1-positive acute lymphoblastic leukemia: final results of a prospective multicenter trial (EWALL-PH02). Blood. 2018;132(suppl 1):31. doi:10.1182/blood-2018-99-114552

9. Liu B, Wang Y, Zhou C, et al. Nilotinib combined with multi-agent chemotherapy in newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia: a single-center prospective study with long-term follow-up. Ann Hematol. 2019;98(3):633-645.doi:10.1007/s00277-019-03594-1

10. Martnelli G, Piciocchi A, Papayanndis C, et al. First report of the GIMEMA LAL1811 phase II prospective study of the combination of steroids with ponatinib as frontline therapy of elderly or unfit patients with Philadelphia chromosome-positive acute lymphoblastic leukemia. Blood.2017;130 (suppl 1):99.

11. Vignetti M, Fazi P, Camino G, et al. Imatinib plus steroids induces complete remissions and prolonged survival in elderly Philadelphia chromosomepositive patients with acute lymphoblastic leukemia without additional chemotherapy: results of the Gruppo Italiano Malattie Ematologiche dellAdulto (GIMEMA) LAL0201-B protocol. Blood. 2007;109(9):3676-3678. doi:10.1182/blood-2006-10-052746

12. Fo R, Vitale A, Vignetti M, et al; MIMEMA Acute Leukemia Working Party. Dasatinib as first-line treatment for adult patients with Philadelphia chromosomepositive acute lymphoblastic leukemia. Blood.2011;118 (25):6521-6528. doi:10.1182/blood-2011-05-351403

13. Chiaretti S, Vitale A, Vignetti M, et al. A sequential approach with imatinib, chemotherapy and transplant for adult Ph+ acute lymphoblastic leukemia: final results of the GIMEMA LAL 0904 study. Haematologica. 2016;101(12):1544-1552. doi: 10.3324/haematol.2016.14453

14. Martinelli G, Papyannidis C, Piciocchi A, et al. Extremely high rate of complete hematological response of elderly Ph+ acute lymphoblastic leukemia (ALL) patients by innovative sequential use of nilotinib and imatinib. a GIMEMA protocol LAL 1408. Presented at: American Association for Cancer Research Annual Meeting 2014; April 5-9, 2014; San Diego, CA. Abstract 5552.

15. Papayannidis C, De Benedittis C, Soverini S, et al. Ponatinib is well tolerated and active in patients with relapsed/refractory Philadelphia positive acute lymphoblastic leukemia (PH+ ALL) and advanced phase of chronic myelogenous leukemia (DML) harbouring T315i mutation: the Bologna experience. Blood. 2013;122(21):3911. doi:10.1182/blood.V122.21.3911.3911

16. Ribera JM, Garca J, Fernndez-Abelln P, et al; PEHEMA Group. Lack of negative impact of Philadelphia chromosome in older patients with acute lymphoblastic leukaemia in the thyrosine kinase inhibitor era: comparison of two prospective parallel protocols. Br J Haematol. 2012;159(4):485-488. doi:10.1111/bjh.12043

17. Chalandon Y, Thomas X, Hayette S, et al; Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL). Randomized study of reduced-intensity chemotherapy combined with imatinib in adults with Ph-positive acute lymphoblastic leukemia. Blood. 2015;125(24);3711-3719. doi:10.1182/blood-2015-02-627935

18. Chiaretti S, Bassan R, Vitale A, et al. A Dasatinib-blinatumomab combination for the front-line treatment of adult Ph+ all patients. preliminary results of the GIMEMA LAL2116 D-ALBA trial; on behalf of GIMEMA Acute Leukemia Working Party. Presented at: European Hematology Association 2019 Annual Meeting; June 13-16, 2019; Amsterdam, the Netherlands. Abstract S1617.

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Doctors Debate: Is Intensive or Low-Intensity Chemotherapy Plus BCR-ABL TKI Therapy Best for Treatment of Ph+ ALL? - Targeted Oncology

Record number of stem cell donors apply after Ex On The Beach star plea – expressandstar.com

Ashley Cain with his girlfriend Safiyya and daughter Azaylia Diamond

A blood cancer charity has seen record numbers of people applying to become stem cell donors following a plea from former footballer and Ex On The Beach star Ashley Cain.

Mr Cains 12-week-old daughter Azaylia Diamond Cain was diagnosed with an aggressive form of leukaemia when she was two months old.

Doctors recently told the reality star and his girlfriend Safiyya that, while their daughter had responded well to her chemotherapy and treatment, she would require a stem cell transplant from a stranger to be cured.

Anthony Nolan, a charity which recruits people aged between 16 and 30 to join the stem cell register, is now searching for a donor for Azaylia.

Mr Cain appealed for potential donors to sign up on Friday and the charity has since seen 41,000 people apply within 48 hours, compared to the usual 100 per day.

Mr Cain said: You know your own child and we knew she wasnt well.

She has a rare and aggressive form leukaemia thats made even rarer by her being only eight-weeks-old when she was diagnosed.

She has tumours on her lungs, stomach and kidneys.

Finding out that your baby has a serious and life-threatening illness is something no parent in the world should have to go through.

It was the single most upsetting, terrifying and heartbreaking experience we have ever been through.

Something that is not only incomprehensible, but it also has a devastating impact on our physical and mental health.

Azaylia has Caribbean, Indian and northern European ethnicity, which means she has a 20% chance of finding an unrelated stem cell donor match, compared to a 69% chance for people with white European heritage.

Mr Cain added: Its out of Azaylias hands now, shes almost climbed this mountain, but she now needs someone elses hand to help her get to the top.

She cant do this on her own, she needs a donor.

As well as appealing for more donors to apply, Anthony Nolan is appealing for financial support as it costs 40 for each donor to be registered.

Henny Braund, chief executive at the charity, said: We are extremely grateful to Ashley for using his platform to raise awareness of the need for more stem cell donors.

Its incredible that so many people have been inspired by Azaylias story to join the register.

Every single one of the new potential donors has the potential to give hope to little girls, like Azaylia, who are in desperate need of an urgent stem cell transplant.

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Record number of stem cell donors apply after Ex On The Beach star plea - expressandstar.com

Bisbee: A commitment to health care initiatives The Journal Record – Journal Record

Julie Bisbee

This month marks the 20th anniversary of voters creation of the Oklahoma Tobacco Settlement Endowment Trust, a grant-making state agency devoted to preventing cancer and cardiovascular disease, Oklahomas leading causes of death. Past accomplishments and new initiatives give Oklahomans reason to be proud of TSET.

In 1998, 46 states including Oklahoma reached the Master Settlement Agreement with Big Tobacco, resolving a lawsuit over the tobacco industrys practice of lying to the public about smoking dangers. In 2000, voters approved a constitutional amendment that safeguarded the bulk of the MSA payments in an endowment. Endowment investment earnings fund grants and programs to improve health.

On Nov. 3, voters affirmed the wisdom of TSETs structure, with each of Oklahomas 77 counties rejecting a state question that sought to reduce the contribution to the TSET endowment. This vote upholds the voter-created structure that funds tobacco use cessation and prevention, cancer research, community-based programs and other initiatives that improve quality of life.

Since 2000, TSETs funding of cancer research has given Oklahomans access to cutting-edge cancer treatment. TSETs funding of Phase 1 clinical trials helped the Stephenson Cancer Center achieve the prestigious National Cancer Institute designation.

To date, TSET has funded not only the Stephenson Cancer Center but also the TSET Health Promotion Research Center and the Oklahoma Center for Adult Stem Cell Research. For every dollar TSET has invested, research institutions have attracted an additional $3 in outside funding.

TSET also addresses physician shortages. This year, TSETs partnership with the Physician Manpower Training Commission filled all 42 slots in its loan repayment program, which helps pay off medical school loans when doctors agree to practice in rural and underserved areas.

TSETs Healthy Living Program is another success. Now in its second five-year grant cycle, the program works at the local level to improve health and make it easy for people to make healthy choices.

Policies help shape the environment. Tobacco-free policies protect the public from toxic secondhand smoke and encourage tobacco users to quit. Thanks to work of TSET grantees at the local level, more than 80% of school districts had adopted a tobacco-free policy before state law was enacted to protect all Oklahoma children from tobacco and e-cigarette use.

TSET remains committed to preventing cancer and cardiovascular disease. Visit tset.ok.gov.

Julie Bisbee is executive director of the Tobacco Settlement Endowment Trust, a voter-created grant-making trust devoted to preventing cancer and cardiovascular disease, Oklahomas leading causes of death.

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Bisbee: A commitment to health care initiatives The Journal Record - Journal Record

California election results: Where state propositions stand as of Thursday at 5 p.m. – Desert Sun

Associated Press Published 2:01 p.m. PT Nov. 4, 2020 | Updated 11:53 p.m. PT Nov. 5, 2020

Uber and Lyft decals are shown on a vehicle at Palm Springs International Airport on Wednesday, Jan. 22, 2020 in Palm Springs, Calif.(Photo: Vickie Connor/The Desert Sun)

Access to Uber and Lyft rides proved to be important to California voters Tuesday, but raising property taxes on commercial properties in the statewas narrowly defeated in one of the most hotly contested of 12 state propositions.

Voters also gave a huge defeat to an attempt to require certified doctors at kidney dialysis clinics and also rejected anattempt to re-establish affirmative action in hiring in California.

Following are results as of Thursday at 5 p.m. as reported by the California Secretary of State.

Uber, Lyft and other app-based ride-hailing and delivery services spent $200 million in a winning bet on Proposition 22 to circumvent California lawmakers and the courts to preserve their business model by keeping drivers from becoming employees eligible for benefits and job protections.

The titans of the so-called gig economy bankrolled the most expensive ballot measure in state history, which was decided Tuesday with 58.5% of voters choosing to keep drivers classified as independent contractors able to set their own hours.

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More: Photos: Election Day voting across Coachella Valley, Riverside County

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The outcome was a defeat for labor unions that had pushed for a state law aimed directly at Uber and Lyft, mandating they provide drivers with protections like minimum wage, overtime, health insurance and reimbursement for expenses.

Supporters of Proposition 22 said the outcome showed voters wanted to preserve the flexibility of the current system. Opponents said the companies had bought their own law and vowed to continue fighting for drivers' rights.

A ballot measure to partially dismantle Californias longtime system of tying property taxes to the last sales price appears to have lost byjust over 400,000 among the 11.5 million ballots cast. No votes on Proposition 15 garnered 51.8%of the votes.

The measure would have reassessed commercial and industrial properties every three years. Residential property would have remained under current rules. Since a 1978 ballot measure Proposition 13 sparked a national outcry for tax cuts and helped pave Gov. Ronald Reagans path to the White House, California has limited tax increases to 2% a year for inflation until a property is sold.

Supporters saidasplit-roll system would go a long way toward fixing inequities that shield wealthy corporations, depriving property tax proceeds for schools and local governments.

Opponents called it a massive tax increase that will cripple businesses in a pandemic-wracked economy. Their advertising portrayedit as a step toward completely dismantling the system established under 1978's Proposition 13, even though supporters disavowed plans to change how residential property is assessed.

A ballot measure to reinstate affirmative action in California government saw a 56.1% No vote Tuesday. Public polling had indicated that Proposition 16 was struggling, suggesting that voters were not inclinedto repeal a quarter-century-old ban on affirmative action in the state.

A national awakening on race drove a well-funded campaign to reinstate preferential treatment based on race and gender in public hiring, contracting and college admissions. Supporters said such programs are critical to undoing generations of systemic racism and sexism. Opponents said merit alone should determine whether someone gets a job or gets accepted into college.

Democratic vice presidential nominee Kamala Harris backedthe effort. Opponents saidthe government should treat every person equally, and never use race, ethnicity or gender to promote or discriminate against an individual.

The biggest margin of victory on the night belonged to No votes on Proposition 23, the second ballot measure on kidney dialysis in the state in as many elections. Voters rejected the ballot measure to require a doctor or highly trained nurse at each of Californias 600 dialysis clinics, with "no" votes taking64%.

The measure drew more than $110 million in spending. Supporters said a doctor is needed at clinics whenever the states 80,000 dialysis patients are being treated to make sure they get quality care. Opponents, financed by dialysis clinic companies, said the measure would have created a financial burden that could lead some clinics to close.

Proposition 23 was the second attempt by the unions to increase regulation of dialysis clinics in California, where DaVita Inc. and Fresenius Medical Care two of the countrys largest for-profit dialysis providers operate about three-quarters of the states dialysis market.

California voters also voted to maintain the status quo on criminal justice. They rejected an attempt to eliminate cash bail, with Proposition 25 losing with 55.5% of thevotes cast as No.

On Proposition 20, which would have scaled back two earlier ballot measures approved by voters in 2014 and 2016, about 62% of voters were opposed. The proposition would again bar those convicted of certain serious offenses from earlier release and increase penalties for repeated retail thefts.

By rejecting Proposition 25, voters in the most populous state overturned a 2018 law that stalled when the bail industry challenged it at the ballot box through the proposition.Supporters of the change had said the traditional bail system punishes the poor often racial minorities because they lack the money to buy their freedom or can least afford to pay a bail bondsman.Opponents included some prominent civil rights groups who said the alternatives risk assessment tools also are racially and socioeconomically biased.

A proposition that would keep alive Californias first-of-its-kind stem cell research program appears to have won in a tight race. Proposition 14 saw voters give it 51% Yes votes Tuesday. The measure would authorize a $5.5 billion bond sale to bail out the California Institute for Regenerative Medicine, which was created by a similar $3 billion bond measure in 2014 but is now nearly broke. With dozens of stem cell research trials underway, supporters say the money is desperately needed. Opponents saidthat in a pandemic-induced economic crisis, California simply cant afford it.

Voters rejected a measure that would have allowed cities to expand rent control. Proposition 21 would have let cities limit rent hikes on properties that are more than 15 years old. No votes led with 59.8% of the vote. Opponents argued that the measure would have discouraged new home construction at a time when its sorely needed. Proponents said the measure was an urgent attempt to slow spiraling rent increases. A recent report said more than half of Californias renters spend over 30% of their incomes on rent.

A measure to expand California's digital privacy law easily won with 56.1% of the voters approving Proposition 24. The measure would update a law approved two years ago that gave Californians the right to know what personal information companies collect about them online. The proposition also would triple the fines for companies that violate kids privacy.

Proponents saidthe measure will strengthen Californias privacy law and help hold big business accountable. Opponents argued that the 52-page initiative was too complicated for voters and its too soon to rewrite a law that just took effect.

California voters appeared to give narrow approval to Proposition 19, which would give Californians 55 or older a big property tax break when buying a new home. To fund that new tax break, the measure would curtail a separate tax break Californians may receive on homes inherited from parents and grandparents.

Yes on Prop. 19 was leading with 51.4% of the vote.

In one of two measures involving voting rights, voters decisively passed a ballot measure restoring the right to vote for felons on parole. Proposition 17 will change the state Constitution to allow an estimated 50,000 felons to vote, with 59% ofvoters approving the measure.

Another voting rights measure, Proposition 18, which would have allowed 17-year-olds to vote in primaries if they turn 18 before the general election, was rejected by55.% of voters.

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California election results: Where state propositions stand as of Thursday at 5 p.m. - Desert Sun

City of Hope Doctors Present New Research on Bone Marrow Transplants, Immunotherapy and Other Blood Cancer Treatments – Business Wire

DUARTE, Calif.--(BUSINESS WIRE)--City of Hope announced today that it will present data on new findings on bone marrow transplants, immunotherapies and other blood cancer treatments at ASH 62nd Annual Meeting and Exposition on Dec. 5 to 8, a virtual event.

City of Hope is addressing some of the hardest-to-treat cancers by accelerating innovative clinical research approaches. The comprehensive cancer center was a pioneer in bone marrow and stem cell transplants and the transplantation program is now one of the largest and most successful programs of its kind in the U.S. For the 15th year in a row, the Center for International Blood & Marrow Transplant Research has ranked City of Hope as providing exceptional care and strong clinical outcomes for patients who received bone or stem cell transplants; it is the only cancer center to hold this distinction.

During the ASH virtual conference, City of Hope researchers will make presentations on the following and other data:

Title: Efficacy of Post-Transplant Cyclophosphamide as Graft-Versus-Host Disease Prophylaxis After Peripheral Blood Stem Cell HLA-Mismatched Unrelated Donor Hematopoietic Cell Transplantation; A Prospective Pilot Trial

Publication Number: 298

Type: Oral

Session Name: 732. Clinical Allogeneic Transplantation Results III

Session Date and Time: Saturday, Dec. 5, 2020, 2 to 3:30 p.m. ET

Presentation Time: 2:30 p.m.

Presenter: Monzr M. Al Malki, M.D., City of Hope Director of Unrelated Donor BMT Program and Haploidentical Transplant Program, Assistant Clinical Professor, Department of Hematology & Hematopoietic Cell Transplantation

Title: Consolidation With Nivolumab and Brentuximab Vedotin After Autologous Hematopoietic Cell Transplantation in Patients With High-Risk Hodgkin Lymphoma

Publication Number: 472

Type: Oral

Session Name: 624. Hodgkin Lymphoma and T/NK Cell LymphomaClinical Studies: Clinical Studies in Hodgkin Lymphoma Session Date and Time: Sunday, Dec. 6, 2020, 2 to 3:30 p.m. ET

Presentation Time: 2:30 p.m.

Presenter: Alex Herrera, M.D., City of Hope Assistant Professor, Department of Hematology & Hematopoietic Cell Transplantation

Title: Total Marrow and Lymphoid Irradiation (TMLI) at a Dose of 2000cGy in Combination With Post-Transplant Cyclophosphamide (PTCy)-Based Graft Versus Host Disease (GvHD) Prophylaxis Is Safe and Associated With Favorable GvHD-Free/Relapse-Free Survival at 1 Year in Patients With Acute Myeloid Leukemia (AML)

Publication Number: 192

Type: Oral

Session Name: 721. Clinical Allogeneic Transplantation: Conditioning Regimens, Engraftment and Acute Transplant Toxicities

Session Date and Time: Saturday, Dec. 5, 2020, Noon to 1:30 p.m. ET

Presentation Time: 12:45 p.m.

Presenter: Anthony S. Stein, M.D., City of Hope Associate Director, Gehr Family Center for Leukemia Research; Clinical Professor, Department of Hematology & Hematopoietic Cell Transplantation

Title: A Multi-Center Biologic Assignment Trial Comparing Reduced Intensity Allogeneic Hematopoietic Cell Transplantation to Hypomethylating Therapy or Best Supportive Care in Patients Aged 50-75 with Advanced Myelodysplastic Syndrome: Blood and Marrow Transplant Clinical Trials Network Study 1102

Publication Number: 75

Type: Oral

Session Name: 732. Clinical Allogeneic Transplantation: Results I

Session Date and Time: Saturday, Dec. 5, 2020, 7:30 to 9 a.m. ET

Presentation Time: 7:30 a.m.

Study Co-chair: Ryotaro Nakamura, M.D., City of Hope Director, Center for Stem Cell Transplantation; Professor, Department of Hematology & Hematopoietic Cell Transplantation

About City of Hope

City of Hope is an independent biomedical research and treatment center for cancer, diabetes and other life-threatening diseases. Founded in 1913, City of Hope is a leader in bone marrow transplantation and immunotherapy such as CAR T cell therapy. City of Hopes translational research and personalized treatment protocols advance care throughout the world. Human synthetic insulin and numerous breakthrough cancer drugs are based on technology developed at the institution. A National Cancer Institute-designated comprehensive cancer center and a founding member of the National Comprehensive Cancer Network, City of Hope has been ranked among the nations Best Hospitals in cancer by U.S. News & World Report for 14 consecutive years. Its main campus is located near Los Angeles, with additional locations throughout Southern California. For more information about City of Hope, follow us on Facebook, Twitter, YouTube or Instagram.

Original post:
City of Hope Doctors Present New Research on Bone Marrow Transplants, Immunotherapy and Other Blood Cancer Treatments - Business Wire

Critically ill Indonesian woman thanks Taiwan for saving life – Taiwan News

Indonesian caregiver thanks Taiwan for life-saving stem cell transplant

By Central News Agency

2020/11/06 10:40

Nina Herlina (right) and her 5-year-old younger sister. Nina Herlina (right) and her 5-year-old younger sister. (CNA photo)

Taipei, Nov. 5 (CNA) An Indonesian migrant worker who received a stem cell transplant in Taiwan in June thanked the nation on Thursday for expediting her treatment by lifting travel restrictions for her family amid COVID-19 thereby facilitating the operation that saved her life.

At a press conference that day to celebrate being discharged from the hospital, 23-year-old Nina Herlina thanked Taiwan for giving her a new lease of life and said her treatment was a testament to Taiwan's healthcare capabilities. In November last year, Nina began suffering from bouts of menorrhagia that lasted for about 20 days and came with symptoms that included dizziness, tiredness, and fever.

In February, she turned to the Taiwan International Workers' Association (TIWA), a local NGO that promotes migrant workers' rights when she was fired, shortly after a doctor diagnosed her as suffering from aplastic anemia, an autoimmune disease in which the bone marrow stops making new blood cells. With the help of the TIWA, the young woman was allowed to remain in Taiwan, where she had worked as a caregiver since October 2018.

In March, she was confirmed as having severe aplastic anemia, requiring an allogeneic stem cell transplant to treat the disease, according to the TIWA. However, at that time the COVID-19 pandemic was worsening and Nina's family were in rural Indonesia and local medical institutions lacked the technology and techniques to identify a donor in time for a bone marrow transplant.

At that time she was being kept alive in Taiwan by weekly blood transfusions. However, frequent blood transfusions can have a detrimental effect on the success of a transplant.

In addition, she also had leukopenia, a condition when a person has a reduced number of white blood cells, which increases the risk of infection. As a result, doctors at Taipei Veterans General Hospital (TVGH) determined the patient was in urgent need of a transplant, according to TIWA.

With the assistance of TIWA, a TVGH medical team explained the condition to Herlina and her family members in Indonesia via video calls. Doctors said the healthy cells for the transplant should ideally come from a family member, making her two younger sisters, aged 5 and 14, the best candidates for the operation, TIWA said.

Based on humanitarian considerations, the Central Epidemic Command Center decided in June to lift travel restrictions for her mother and sisters to visit Taiwan.

After undergoing special blood tests arranged by TVGH, the 5-year-old sister was identified as a suitable donor for a transplant. The operation was carried out after the three family members completed their 21-day quarantine in Taiwan and provided two consecutive negative COVID-19 test results.

After having received medical treatment in Taiwan for nine months, Nina was discharged from the hospital Thursday, after doctors confirmed she had recovered from the life-threatening illness.

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Critically ill Indonesian woman thanks Taiwan for saving life - Taiwan News

Daily Edition for Wednesday, November 4, 2020 – California Healthline

Latest From California Healthline:

A Biden Win and Republican Senate Might Lead to Gridlock on Health Issues

If Democrat Joe Biden is successful in his bid for the presidency but the Senate remains in GOP control, Democrats plans for major changes in health care may be curbed. The federal role in those policies is at stake as is Californias ambitious health care agenda. (Julie Rovner, 11/3)

Los Angeles Times: Prop. 23, Which Would Have Imposed New Regulations On Dialysis Industry, Fails A $100-million effort to impose new regulations on the dialysis industry was defeated Tuesday. Proposition 23 would have required dialysis clinics to employ at least one doctor who would be on site whenever patients are receiving treatment. Supporters of the measure, including the Service Employees International Union-United Healthcare Workers West, said dialysis clinics were putting profits over patient care by not having a doctor available in the event of complications or an emergency. (Gutierrez, 11/3)

San Francisco Chronicle: Prop. 23: California Measure To Stiffen Regulations At Dialysis Clinics Fails California voters have rejected Proposition 23, a ballot initiative that would have created new safety regulations for kidney dialysis clinics that serve 80,000 patients. The initiative sought to require that clinics always have a doctor on site during treatments, which patients with kidney failure must receive routinely to stay alive. Prop. 23 was behind by a wide margin in unofficial returns, with a simple majority needed for passage. (Gardiner, 11/3)

Los Angeles Times: Prop. 14 Leading In Early Results On Stem Cell Bond A ballot measure to authorize $5.5 billion in new funding for stem cell research was leading in early returns Tuesday. Proposition 14 asked voters to approve an infusion of cash for the California Institute for Regenerative Medicine, known as CIRM, for stem cell studies and trials. California voters created CIRM in 2004 after approving a bond measure that year for $3 billion. CIRM used that bond money for research grants, new laboratories and training programs, but unallocated funds ran out last year, prompting supporters of the agency to return to taxpayers for additional money. (Gutierrez, 11/3)

Los Angeles Times: A Close Race On Proposition 15 To Loosen Californias Business Property Tax Rules The fate of Proposition 15, an effort to remove high-value business properties from the low-tax protections enacted by California voters more than four decades ago, was unclear in early election returns Tuesday, after an expensive and fierce campaign over how much to spend on government services and the economic effects of raising taxes. The ballot measure was opposed by a razor-thin majority with more than 9.5 million ballots counted, a shortfall that was far from certain with millions of votes left to count. (Myers, 11/3)

Los Angeles Times: California Voters Approve Prop. 22, Allowing Uber And Lyft Drivers To Remain Independent Contractors Californians sided with the $200-million Proposition 22 campaign led by Uber and Lyft, voting to pass the measure and grant ride-hail and delivery companies an exemption from California employment law to continue treating workers as independent contractors. The fight was one of the most closely watched ballot measure contests in the country and the costliest in state history. A win for the app-based companies has the potential to create a new campaign paradigm, with companies sidestepping government and spending large sums of money to sway voters with traditional advertisements and more unconventional direct marketing to customers. The measures passage also deals a blow to Californias powerful labor unions, underdogs in the race with far fewer financial resources than their foes. (Luna, 11/3)

Los Angeles Times: Californians Once Again Reject Bid To Expand Rent Control In The State The failure of Proposition 21 means that, once again, landlord groups have convinced voters that stricter limits on rent hikes are not a solution to Californias housing affordability problems. A statewide ban on most new forms of rent control will remain in effect. Yet again, California voters clearly understood the negative impacts Prop. 21 would have had on the availability of affordable housing in our state by clearly rejecting this radical ballot measure, said Tom Bannon, chief executive of the California Apartment Assn., in a statement. It is now time to move from ballot-box battles and enact policies through the Legislature that allow the state to build more affordable housing that will once again make California an affordable place to live for our families. (Dillon, 11/3)

Santa Rosa Press Democrat: Measure O: Sonoma County Voters Backing Tax Measure For Mental Health, Homeless Services Voters early Wednesday were supporting a ballot measure that would raise sales taxes in Sonoma County to boost local spending on mental health and homelessness services by $25 million annually. (Silvy, 11/4)

AP VoteCast: California Voters Sour On State Of Nation Voters in California made their pick for president while holding negative views about the countrys direction, according to an expansive AP survey of the American electorate. The race between President Donald Trump and Democratic rival Joe Biden concluded Tuesday as the nation remains in the throes of a global public health crisis and mired in the economic downturn it brought on. AP VoteCast found that almost three-fourths of California voters said the U.S. is headed in the wrong direction and about a quarter of voters said it is on the right track. (Keller, 11/4)

AP: California Chooses Biden, State GOP Hoping For US House Wins California delivered a strong rebuke to Donald Trumps presidency on Tuesday as Democrat Joe Biden ran up the score in the liberal state with a victory of 4 million votes in an election upended by the coronavirus pandemic. Bidens supersized victory didnt derail the state GOPs hopes of clawing back some of the seven U.S. House seats he party lost two years ago. Republican candidates had narrow leads over two Democratic incumbents in Orange County while another GOP incumbent clung to a small lead in the Central Valley. (Beam, 11/4)

AP: Some California Legislative Incumbents Fighting To Survive California Democrats were hoping to expand their supermajorities in the state Legislature as votes were tallied Tuesday. Several Republican incumbents in the 80-member Assembly and 40-member Senate were in danger of defeat. And with Californias top-two balloting, voters in some cases set up contests within the same political party by advancing the two highest vote-getters from the March primary election. Several in Orange County, the greater Los Angeles area and in the San Francisco Bay Area face challengers and have drawn high spending from interest groups. (Thompson, 11/4)

Bay Area News Group: Californias COVID-19 Cases Continue To Rise COVID-19 cases are continuing to climb, furthering a pattern thats trending in the wrong direction following two months where the numbers were stagnant. The seven-day average for the state increased for the second straight day, from about 4,162 cases per day through Sunday to 4,306 on Monday. It had decreased for four straight days following an eight-day stretch in which the number went up each day. The seven-day average no longer reflects the artificial increase of 6,300 backlogged tests in Los Angeles that were added in late October. (Hurd, 11/3)

Modesto Bee: Announcement Delayed For States Coronavirus Tier System. Stanislaus Cutting It Close Citing Tuesdays national election, California health officials postponed an update on coronavirus tier assignments until Wednesday. The weekly updates assigning counties to different levels of COVID-19 restrictions are usually released on Tuesdays. Dr. Julie Vaishampayan, health officer for Stanislaus County, told the Board of Supervisors the countys daily case rate was right at the key metric of 7 per 100,000 population. The county needs to stay below that limit to meet criteria for the red tier, which places lighter restrictions on restaurants, retail shopping areas, fitness centers and worship services. (Carlson, 11/3)

Sacramento Bee: 11 Dead Of COVID-19 At Woodland Skilled Nursing Home A skilled nursing facility in Northern California has been ravaged by two separate coronavirus outbreaks, with at least 11 residents dead and dozens still sick. Nearly 100 combined residents and staff at Alderson Convalescent Hospital in Woodland have tested positive for COVID-19 in two waves of infection occurring three months apart, according to Yolo County health officials. In early July, 17 residents and 10 staff members at the 140-bed facility contracted the respiratory disease, and three of the residents died, Yolo officials said. (McGough, 11/3)

Fresno Bee: If Fresno-Area COVID-19 Cases Spike Again, These Local Schools Could Still Reopen Classrooms Fresno County has remained in the red-tier according to Californias color-coded Blueprint for a Safer Economy, meaning schools can start to re-open. Many schools continue to apply for re-opening waivers as a safety measure if the area falls back into the most restrictive purple tier. A 14-day rolling average shows the county continues to report an average of at least 100 new coronavirus cases per day. Health professionals are also concerned with rising COVID-19 cases as winter approaches in lockstep with cold and flu season. (Dieppa, 11/3)

The Bakersfield Californian: Housing Project For Homeless Women, Children Slated For Panorama Bluffs Draws Opposition From Neighbors Plans to convert a single-family home overlooking the bluffs of northeast Bakersfield into a transitional residence for homeless women and children has drawn opposition from neighbors but received an endorsement from the city's planning department last week to proceed.(Shepard, 11/2)

The Bakersfield Californian: Please Don't Burn Wood At Home, Air Officials Beseech Residents In 'Worst Wildfire Season' "To protect the health of their families and their neighbors, we encourage residents to not burn wood this winter and instead choose to upgrade to natural gas devices through our grant program," he said. (Mayer, 11/3)

San Francisco Chronicle: One Bay Area Hospital Is Prepping For A Rise In Heart Attacks Caused By Election Stress Regional Medical Center in San Jose put extra staff on call Tuesday to handle what doctors believe could be a 15% increase in patients experiencing an array of cardiac issues caused by the stress of election day. These kind of stresses cause a well-documented increase in cardiovascular events, said Dr. Paul Silka, director of the emergency room at Regional Medical Center of San Jose. The 45-bed emergency room usually sees 185 patients a day. Because of the election, Silka expects that to go up to 210 patients or so. (Rubenstein, 11/3)

Becker's: California Health System To Lay Off 31 Workers NorthBay Healthcarewill lay off31 full-time workers as part of its pandemic recovery plan, the system said Nov. 2.The Fairfield, Calif.-based nonprofit health system said it needs to adjust operations to fit a new healthcare reality brought by the COVID-19 pandemic.(11/3)

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Daily Edition for Wednesday, November 4, 2020 - California Healthline

‘We’re truly blood brothers’ – Stanford coach David Shaw and his recent fight to save his brother, Eric – ESPN

David Shaw walks into the hospital room and takes a seat next to the bed. He does this nearly every day, right around lunchtime.

He looks at his younger brother, Eric, tubes snaking across his arms, machines beeping and whirring. Eric does not look like Eric anymore, his skin darkened, scars deepened, features altered. They both know this but never mention it.

They talk about movies, or random memories from their childhood when they were often inseparable, riding bikes, playing video games and challenging each other to one-on-one basketball. They avoid talking about why David comes as often as he does to visit, though they know the reason.

Eric is dying, a rare, aggressive skin cancer rampaging through his body with such ferocity that his doctors are nearly out of options. Radiation failed. Chemotherapy failed. Two bone marrow transplants failed.

As Stanford's head football coach, David Shaw is relied on to always know what to say, how to say it and when to say it; but he cannot find the words now that he and his brother are staring down what seems to be an inevitable fate.

"What do you say, where you think you've pulled at the last thread and there are no more threads?" David said. "All I could tell him was that I loved him and that I was there for him. The rest of it was really just ... I thought it was only a matter of time before he passed away."

Two years later, what happened between David and Eric remains real, present and raw -- changing their entire relationship, redefining what it means to be a brother. The words are still difficult to say, so they tip-toe around the crushing physical and mental toll Eric's cancer took on them.

David and Eric are sure to think about it all this weekend, when Stanford opens its season at Oregon on Saturday. Because the last time the Cardinal visited Eugene, neither one knew whether Eric would live or die.

After Stanford came from behind to win that game 38-31 in overtime, David delivered a message at the end of his postgame television interview, looking at the camera and saying, "To my brother Eric: I love you." He tapped the lime green pin on his black Stanford sweatshirt before he left the screen.

When Shaw became head coach at Stanford in 2011, it was the culmination of a family journey. His father was a longtime coach there; David played receiver for the Cardinal and eventually returned as an assistant under Jim Harbaugh. The entire Shaw family -- parents Willie and Gay, along with David, Eric and their sister, Tawnya -- all call the Bay Area home.

To this day, David says the day he was introduced as coach was "one of the better days in all our lives."

Yet something started to happen to Eric that no one could quite figure out. That same year, Eric found strange looking spots on his torso. His wife, Crystal, noticed the first one under his arm. Maybe it was eczema, they thought. Then the spots started to spread. He went to the doctor. They prescribed an ointment, but the spots kept popping up, until they covered his entire body. Eventually, tumors started to grow. It looked as if someone had pushed marbles under his skin. Doctors remained confounded. Eric itched uncontrollably, insatiably. His skin itched so badly, it became difficult to put on clothes, shower, sleep and go to work. He eventually needed sleep medication so he could get uninterrupted rest.

Even then, he itched subconsciously, only realizing what happened when he woke up in the morning to find his arms and sheets covered in blood. Some nights, he tried to sleep on his forearms so his body wouldn't touch the sheets, because his skin grew too sensitive to any touch. At one point, he had more than 30 open wounds on his body.

"It's something that's so pervasive and so destructive that a lot of people have mental problems -- you can't do anything without extreme pain," Eric said. "You bleed a lot through the tumors, through the lesions, through the scratching. A lot of people don't survive, really, because of the mental stress that comes with it."

Doctors had a hard time diagnosing his disease because it is often confused with psoriasis, eczema or other skin conditions. Eventually, they determined he had a rare form of skin cancer called mycosis fungoides, a type of T-cell lymphoma that affects one in 6 million people in the United States and Europe. At the time, Eric Shaw was 38.

In 2013, he and Crystal pushed for a referral to Stanford Cancer Center, which has leading experts in the disease. Mycosis fungoides is so rare, it accounts for only 4% of all non-Hodgkin lymphoma cases; among those who suffer from it, only 20% have the type of itching Eric experienced. Rarer still is to find it in people under the age of 40, and African American men often end up with the worst prognosis. All the odds were firmly against him.

"When you first hear skin cancer, your mind doesn't go too far," David said. "So initially I was like, 'There are creams and other minor surgeries. I think it'll be OK.' And then Eric said, 'No, this is not the typical skin cancer. This is inside my body. This is inside the layers of my skin, and it's not one spot. It's everywhere.'

"I didn't really get it for weeks after that because, rectifying something that I didn't think was so serious to [then thinking] ... 'Oh my gosh. So this is really cancer. This is really scary now.' It took a long time for that to sink in."

David turned it over in his mind. He was the big brother, the protector, the one who always made sure Eric would be OK. They were supposed to raise their kids together, grow old together, and reminisce about the randomness of a life spent together.

He kept coming back to one thought: You're not supposed to lose your little brother.

David and Eric Shaw grew particularly close as children as they moved from place to place when their father, Willie, took new coaching jobs. Tawnya, their older sister, fit in anywhere socially. But David and Eric, who is two years younger, stuck together.

"Like a pair," David said.

They loved riding their bikes and, when they moved to Arizona, they took advantage of the wide-open spaces in the new development where they lived. They rode for miles and miles, setting up their own ramps and doing tricks and wheelies, visiting friends along the way before returning home after dark. They played sports, too, and though David loved football as much as their dad, the basketball court is where the brothers had their epic battles.

"I was always kind of a little bit stronger and I'll never forget the last time we played one-on-one basketball," David said. "He just got better than me, and he won, and once I got over the anger and disappointment, I was proud because my younger brother had grown and was gaining confidence."

Said Eric: "I wanted nothing more than to beat him, and he wanted nothing more than to keep beating me. But, during those times, it was just us, it was me and him. He was my best friend."

David went on to play at Stanford and eventually got into coaching, against his mother's best wishes. Eric did not pursue a career in athletics. He went to San Diego State and got into a career in marketing at a financial services company, where his gregarious nature, big smile and easy laugh made him a perfect fit. Though their personalities are different -- David is stoic and introspective, Eric makes anyone feel as if they have been friends forever -- they are grounded in the same values they learned at a young age: family and faith above everything else.

Those principles only grew stronger after they found themselves in the Bay Area as adults.

After David was hired by Stanford, the entire Shaw family made it clear it would always be around to support him. Family members all have a standing invitation to come for dinner on Tuesdays. And they always attend home football games, waving and hugging David during the team's pregame walk, cheering from the stands, and then waiting for some time together once the game ends.

Even as Eric grew sick, he made it a point to go cheer for his big brother. "It's not just the football game. Our family comes together," he said. "We celebrate, we come to watch the game and cheer the team on and support David. And then afterwards, win or lose, we all wait for him to come out. It's a family day. It's been wonderful to share that experience with David."

Stanford eventually drew them even closer, and it had nothing to do with football.

Eric did not understand the gravity of his situation until his first meeting in 2013 with the doctors at Stanford Cancer Center. They put it bluntly: He had such an aggressive form of the disease that he needed immediate treatment. They would start with total skin radiation, preparing Eric to lose his hair, eyebrows, eyelashes, fingernails and toenails.

If that did not work, they would try chemotherapy next.

"All these thoughts are running through your mind," Crystal said. "'Is he going to make it? Is it going to work? What's going to happen?' At the time, our youngest daughter was 3 months old, so it was pretty overwhelming. We were just putting our lives together and then boom: you're in the middle of this cancer war."

The next week, Eric took a leave of absence from work and began four-times-a-week trips from their home east of Palo Alto, California, to Stanford Hospital, often driving as many as three hours one way in traffic. When he arrived, he went into a box and his whole body was exposed to the radiation light for about an hour. Then, he would make the drive back home to see Crystal and their four kids -- Caleb Michael, Jared Spann-Shaw, Madison Shaw and Olivia Shaw.

The radiation charred his skin. He lost weight. When he looked in the mirror, Eric no longer recognized the man looking back at him.

"Nothing prepares you for something like this," he said. "Knowing that other people were looking at me and knowing that something was very wrong, that was a daily grind to get myself up out of bed and get ready for the day, knowing that that was going to be my life."

He did this for three straight months, all to keep the disease from growing to a point where it would kill him. It worked for a short time, but the disease came back more aggressively six months later. Doctors moved on to chemotherapy treatments, some of them experimental, but also began discussing the last-resort option: a bone marrow transplant.

David and Tawnya immediately volunteered to become donors, and underwent testing. In most cases, siblings are the best chance at a donor match. Unfortunately, in their case, neither was close. On a 10-point match scale, Tawnya registered a 3, David a 5. Neither qualified to donate.

"I wanted to jump to the front of the line and say, 'Whatever I have to do, whatever you have to take out of me, however you have to do it, just do it,'" David said. "For them to come back and say that you're not a strong enough match was disheartening. It hurt me. The fact that we had to put our trust and faith in people that we didn't know, and that we're going to have to go out to registries and try to find someone who was a better match than I was, that uncertainty, and that doubt, it's hard to keep it at bay at that point. It starts to creep in."

In late 2017, the disease came back so strong, doctors determined Eric needed the long-discussed bone marrow transplant. Finding a suitable match was exceedingly difficult: Only 4% of donors on the bone marrow registry are African American, resulting in only a 16% chance to find a match.

Doctors eventually found two donors whom they believed could work, but they were not perfect matches. In early 2018, Eric and his family moved into a two-bedroom apartment near Stanford Hospital to prepare for the transplant. For three months, he went through radiation, then chemotherapy to prepare his body to accept the donor cells.

He underwent the transplant in April, feeling confident and inspired it would work. After a month, doctors did an initial check to see how many of the donor cells had survived the transplant.

None survived.

"It was like I never even had the transplant," Eric said. "That was so devastating. We just knew it was going to work. I mean, we're people of faith, and we knew everybody was praying for us, and that we were praying that this six-year journey was going to finally be over. And it wasn't over. It was crushing for them to say, 'It didn't work. We're going to have to try again.'"

The second attempt happened in September. Crystal bought lime green pins for the family to wear for lymphoma awareness. Without telling Eric or Crystal, David decided he would wear his on his shirt for the 2018 football season. In addition to that, he had lime green and yellow ribbons placed on the back of Stanford helmets as a way to show support for both cancer patients and cancer survivors.

He told his team that his brother was fighting cancer, and briefly mentioned the helmet ribbons publicly during an early-season news conference. But beyond that, David kept the severity of what was happening to his brother to himself, masking his growing nervousness, fear and anxiety as the clock ticked toward the next transplant. He had a hard time processing what was happening. He did not want to put that at the feet of his players, or his staff.

The doctors used the same donor cells that failed the first time for the second transplant on Sept. 11, 2018, because that was the only option available. But this time, doctors used even stronger drugs to prepare Eric's body to receive the donor cells -- hoping that would do enough to stop his immune system from attacking them.

When Stanford played Oregon on Sept. 22, no one in the Shaw family knew whether the transplant had worked. But the situation was more dire than the first transplant. The stronger chemotherapy caused major complications, and Eric became severely ill.

David coached the game with this in the back of his mind. Stanford rallied from a 21-7 deficit to win an overtime thriller, moving to 4-0 on the season, with a top-10 matchup against Notre Dame the following week. Back in Palo Alto, Eric watched the entire game alone in an apartment he rented near the hospital, the comeback buoying his spirits.

He had no idea his brother would speak to him through the television until he heard the words, "To my brother Eric ..."

"In that moment, I didn't feel any sickness at all," Eric said. "I can't really describe what I felt, just how proud I am of him and how awesome it made me feel that he would do that for me."

Said David: "If that transplant didn't work, I didn't know how many more games he was going to be able to see. That was an opportunity for me on national TV to speak to him, to say to my brother that against the odds, we came back and throughout the entire game, I was thinking about him."

Eric soon returned to Stanford Hospital. The chemotherapy destroyed his blood system, so he needed daily blood transfusions to stay alive. It came as no surprise when doctors told him the second transplant had failed. They had no plan now, no other donor options. David came by to visit as often as he could, but he had a hard time finding the words to say to his dying brother.

"I thought about Crystal. I thought about their kids," Shaw said. "I thought about, 'How can we help?' And then I kept going, 'We just can't get there. There has to be something else.' And we all prayed and we all comforted each other and trusted the doctors and prayed for the doctors. And just kept saying, 'Just tell us whatever options there are. Just tell us what to do and we'll do it.'"

During the day, Eric had his mother, Crystal, David, or David's wife, Kori, at his side, helping to keep his mind off what was happening to him. But in the evenings, when he was alone in his hospital room, he couldn't help but think about the dwindling medical options and his own death, slowly accepting what he believed would inevitably come.

Over seven years, everything the doctors tried had failed, and the disease always came back more aggressively. He felt exhausted in every possible way, desperate to feel better. He didn't want to die. All he wanted to do was get better, and see his kids again, hug his wife and go home. But that possibility seemed as far off as the stars.

"The doctors couldn't help us," Eric said. "They had lost all hope. There was nothing left, but we were in the deepest part of the valley, and there was nobody there but God. I said, 'You're going to take me off this Earth.' And he told me, 'Eric, you're not going to die.' That was the point at which my faith really took over, and I really had true peace."

His team of doctors huddled together again and came up with a plan many of their colleagues questioned, simply because they had never attempted it. In mid-October of 2018, they told Eric they wanted to try a third transplant.

Only this time, they wanted David to be the donor and they had only weeks to make it happen.

Eric thought, "Are they trying to kill me?"

When David was initially rejected, doctors had worked for 25 years to find a way to do half-match transplants but had virtually no success. By 2018, doctors explained that a different way to do the transplant had emerged, opening up the potential to try it with Eric. These transplants, called haploidentical transplants, typically use donor cells from a family member.

Dr. Wen-Kai Weng, Eric's bone marrow transplant physician, explained, "It was relatively new at this time. We decided to go ahead, because we knew if we didn't do it, the disease would really come back with a vengeance."

No one had ever done a third transplant with donor cells at Stanford.

"If he didn't go for this risk, he wouldn't be here," said Dr. Youn Kim, who treated Eric and heads Stanford's multidisciplinary Cutaneous Lymphoma Clinic/Program. "He wouldn't be living."

Doctors told Shaw there was a 15% chance he would not survive the transplant itself. If he did survive it, there was only about a 30% to 40% chance the donor cells would work. Compared to much steeper survival odds with no transplant at all, the decision -- filled with multiple layers of danger -- did not feel risky at all.

They had to try.

"They might have told us what the odds were, and I honestly just pushed it out of my brain," David said. "If this is the Hail Mary, hey, we're going to drop back and throw it as far as we can and send prayers along with it and hope that it works."

Without hesitation, David said to his brother, "Tell me what I need to do."

Stanford gathered in its team hotel early on Oct. 27 to begin final preparations before hosting Washington State later that day. David checked in for a 9 a.m. meeting and when it finished, he checked out of the hotel without saying a word. He walked toward the back exit, careful to make sure no one saw him, and snuck out the door to a waiting car.

Shaw sat in the passenger seat, headed toward campus and Stanford Hospital, praying all the while that what he was about to do would work.

He arrived at the hospital and was hooked up to an IV for the first dose of medication. This would not be the more traditional bone marrow transplant, where cells are extracted with a needle through the hips. Rather, the medication flowing through the IV would stimulate his body to overproduce the stem cells needed for the transplant, flooding his blood with them. The cells would then be extracted from his blood, and transplanted into Eric.

Doctors told him to expect to start feeling joint pain and tiredness within 24 hours. Those symptoms would grow only stronger over the coming days, when he came in for more medication. They told him he should stay off his feet, rest and remain hydrated.

That would be nice, David thought. But he had a game to coach. Only two people inside the program knew he had gone that morning: assistant athletic director for football operations Callie Dale, who drove him to the hospital, and defensive coordinator Lance Anderson.

"The way that I do my job, I work really hard not to make it about me," David said. "Although I wanted my team to know what my family was going through, college football is about the student-athletes. I wanted them to focus on what they needed to do. I didn't want to pull from that. I didn't want to, all of a sudden, now make it about me and my family."

A few hours later, he returned to the team hotel and acted as if he had been there the entire day, speaking nothing about his trip to the hospital. Shaw put on his lime green pin and made his way toward the bus. The short ride to the stadium felt long that day. His mind wandered before returning to the flip card in front of him.

As he exited the bus and finished the walk to the stadium, his two young nieces ran up to him. They squeezed him, holding on longer than usual, as if they knew their Uncle David was their only option, too.

David started to feel pain in his knees and legs during the game, a heartbreaking 41-38 loss to the Cougars. That pain only intensified in the coming days as he continued to go in for daily treatments, driving himself on a golf cart from the football facility to the hospital without anyone knowing. It felt as if he had a 50-pound backpack strapped on at all times. He normally jogs from place to place during practice but found it difficult to walk because his legs, hips and shoulders hurt so badly.

He worried players would notice him moving around so slowly. If they did, no one said a word. Shaw kept pushing the pain aside, shoving his emotions down deep, saying prayers every chance he got.

On Wednesday, Shaw woke up and was so lethargic, he felt as if he was moving like a sloth. He went to the hospital for the final procedure: extracting the cells from his blood. Shaw wore comfortable clothes, arranged his pillows and settled in for a long day ahead. Doctors hooked him up to a machine that would do the work through two IVs: One took his blood so the needed donor cells could be siphoned out; the other IV would put the blood back in his body.

Eric rested on another floor in the same hospital.

David worked on his game plan, watched a few movies and occasionally stared at his own blood in the IVs, willing it to save his brother. He kept saying to himself over and over again, "God, I hope this works."

After eight hours, he was finished. Shaw then went out to practice.

"I remember walking up to him and just asking him, 'How are you doing, how are you feeling?'" Anderson said. "I could see it in him that he wasn't his normal self. He paused for a little bit and then he's like, 'I'm OK. A little bit tired, but I'm OK.' You know, just trying to put the most positive light that he could on it."

The next day, Nov. 1, 2018, Shaw went back to the hospital. It was transplant day, and he had to be with Eric to witness what they hoped would be a miracle. David and Crystal watched as Eric received a transfusion of David's stem cells, a shimmering light pink fluid flowing into his body. They sang and prayed. Already, they had received one small bit of good news: Doctors extracted 28 million cells from David's blood, about 20 million more than what they had hoped to get.

Stanford traveled the following day to Seattle, for a game against Washington. David felt guilty for leaving, but he knew there was nothing else he could do. Eric struggled in the hospital, not only from the transplant, but from the heavy chemo and radiation doctors used to prepare his body for the new cells.

Eric ran a fever of 105 degrees and vomited for days. The pain grew so intense he was put on a morphine drip and was in and out of consciousness. In Seattle, Shaw remembers being locked into the game, "except for those little moments where my heart was with my brother."

Stanford lost another heartbreaker, 27-23.

"I know us losing had nothing to do with everything David was going through," Dale said. "But just piling that on with everything else he was dealing with, it was a lot for him. He brought that up many times, about how Eric would tell him the biggest excitement for him every week was watching us play and watching us win. I know David had a lot of pressure on himself, amongst the pressure he already has as a head coach, to win for Eric. And I know that every time he did, he really felt like it was for him. And when we came up short, I know he was probably even harder on himself than he normally would have been."

Back at Stanford, David visited Eric when he could. But the waiting game took an increasing mental toll. David prides himself on his ability to compartmentalize, to focus on the only thing in front of him. He never spaces out, and he rarely gets emotional. But Shaw was falling apart on the inside.

He often found himself staring at cut-ups of red zone plays, not realizing the film had been paused for 20 minutes while his mind drifted off. Whenever that happened, he would stop and call someone, either his brother, his wife, his mother or Crystal just to see how they were doing.

"There were times where I thought life was slow motion, but it was actually moving and I was the one who was in slow motion," David said. "I found myself sometimes saying, 'Is this real? Is this really happening? This shouldn't happen.'"

In the middle of every single meeting, in the middle of every single film session, he silently prayed, "God help my brother. Just please let this one work."

"I look back now and I know more of everything that was going on and the situation," Anderson said. "I realized how much he was dealing with and how much he had to bear that week. And it's amazing that he was able to go through that week without really letting any of us really know exactly what he was going through and what a big deal this really was."

Within a few weeks, Eric started to turn a corner. Though they did not know whether the transplant had worked just yet, he showed enough improvement to leave the hospital after 52 days. David arrived for the big day, and Eric slowly put on a protective mask before shuffling to a waiting wheelchair. Doctors, nurses and support staff lined the hallway, clapping and cheering.

David cries when recalling that moment, his pent-up emotions flooding out as he describes it publicly for the first time.

"This is my little brother, after years of cancer, getting to leave the hospital," Shaw said, his voice quavering. He pauses to wipe tears from his eyes. "The nurses were crying. The doctors were crying. Because a few months earlier, they were preparing us for him to die. And he got to go home."

Three days later, doctors met with Eric and Crystal to deliver the results from the transplant. After only 27 days, Eric had none of his own blood coursing through his body.

It was all David's.

Eric picked up the phone.

"Dave," Eric said. "You have a twin. We're truly blood brothers."

See the article here:
'We're truly blood brothers' - Stanford coach David Shaw and his recent fight to save his brother, Eric - ESPN

‘We’re really blood brothers’ – Stanford coach David Shaw and his current battle to save lots of his brother, Eric – The Shepherd of the Hills Gazette

David Shaw walks into the hospital room and takes a seat next to the bed. He does this nearly every day, right around lunchtime.

He looks at his younger brother, Eric, tubes snaking across his arms, machines beeping and whirring. Eric does not look like Eric anymore, his skin darkened, scars deepened, features altered. They both know this but never mention it.

They talk about movies, or random memories from their childhood when they were often inseparable, riding bikes, playing video games and challenging each other to one-on-one basketball. They avoid talking about why David comes as often as he does to visit, though they know the reason.

Eric is dying, a rare, aggressive skin cancer rampaging through his body with such ferocity that his doctors are nearly out of options. Radiation failed. Chemotherapy failed. Two bone marrow transplants failed.

As Stanfords head football coach, David Shaw is relied on to always know what to say, how to say it and when to say it; but he cannot find the words now that he and his brother are staring down what seems to be an inevitable fate.

David Shaw and the Stanford Cardinal open their pandemic-delayed season Saturday, when they travel to face Pac-12 rival Oregon.John Todd/isiphotos.com

What do you say, where you think youve pulled at the last thread and there are no more threads? David said. All I could tell him was that I loved him and that I was there for him. The rest of it was really just I thought it was only a matter of time before he passed away.

Two years later, what happened between David and Eric remains real, present and raw changing their entire relationship, redefining what it means to be a brother. The words are still difficult to say, so they tip-toe around the crushing physical and mental toll Erics cancer took on them.

David and Eric are sure to think about it all this weekend, when Stanford opens its season at Oregon on Saturday. Because the last time the Cardinal visited Eugene, neither one knew whether Eric would live or die.

After Stanford came from behind to win that game 38-31 in overtime, David delivered a message at the end of his postgame television interview, looking at the camera and saying, To my brother Eric: I love you. He tapped the lime green pin on his black Stanford sweatshirt before he left the screen.

When Shaw became head coach at Stanford in 2011, it was the culmination of a family journey. His father was a longtime coach there; David played receiver for the Cardinal and eventually returned as an assistant under Jim Harbaugh. The entire Shaw family parents Willie and Gay, along with David, Eric and their sister, Tawnya all call the Bay Area home.

To this day, David says the day he was introduced as coach was one of the better days in all our lives.

Yet something started to happen to Eric that no one could quite figure out. That same year, Eric found strange looking spots on his torso. His wife, Crystal, noticed the first one under his arm. Maybe it was eczema, they thought. Then the spots started to spread. He went to the doctor. They prescribed an ointment, but the spots kept popping up, until they covered his entire body. Eventually, tumors started to grow. It looked as if someone had pushed marbles under his skin. Doctors remained confounded. Eric itched uncontrollably, insatiably. His skin itched so badly, it became difficult to put on clothes, shower, sleep and go to work. He eventually needed sleep medication so he could get uninterrupted rest.

It took several years before Eric Shaws illness was properly diagnosed as a rare form of skin cancer called mycosis fungoides. Early signs were spots all over his body, similar to psoriasis, before tumors began to form underneath his skin.Courtesy Shaw Family

Even then, he itched subconsciously, only realizing what happened when he woke up in the morning to find his arms and sheets covered in blood. Some nights, he tried to sleep on his forearms so his body wouldnt touch the sheets, because his skin grew too sensitive to any touch. At one point, he had more than 30 open wounds on his body.

Its something thats so pervasive and so destructive that a lot of people have mental problems you cant do anything without extreme pain, Eric said. You bleed a lot through the tumors, through the lesions, through the scratching. A lot of people dont survive, really, because of the mental stress that comes with it.

Doctors had a hard time diagnosing his disease because it is often confused with psoriasis, eczema or other skin conditions. Eventually, they determined he had a rare form of skin cancer called mycosis fungoides, a type of T-cell lymphoma that affects one in 6 million people in the United States and Europe. At the time, Eric Shaw was 38.

In 2013, he and Crystal pushed for a referral to Stanford Cancer Center, which has leading experts in the disease. Mycosis fungoides is so rare, it accounts for only 4% of all non-Hodgkin lymphoma cases; among those who suffer from it, only 20% have the type of itching Eric experienced. Rarer still is to find it in people under the age of 40, and African American men often end up with the worst prognosis. All the odds were firmly against him.

When you first hear skin cancer, your mind doesnt go too far, David said. So initially I was like, There are creams and other minor surgeries. I think itll be OK. And then Eric said, No, this is not the typical skin cancer. This is inside my body. This is inside the layers of my skin, and its not one spot. Its everywhere.

I didnt really get it for weeks after that because, rectifying something that I didnt think was so serious to [then thinking] Oh my gosh. So this is really cancer. This is really scary now. It took a long time for that to sink in.

David turned it over in his mind. He was the big brother, the protector, the one who always made sure Eric would be OK. They were supposed to raise their kids together, grow old together, and reminisce about the randomness of a life spent together.

He kept coming back to one thought: Youre not supposed to lose your little brother.

David and Eric Shaw grew particularly close as children as they moved from place to place when their father, Willie, took new coaching jobs. Tawnya, their older sister, fit in anywhere socially. But David and Eric, who is two years younger, stuck together.

Like a pair, David said.

They loved riding their bikes and, when they moved to Arizona, they took advantage of the wide-open spaces in the new development where they lived. They rode for miles and miles, setting up their own ramps and doing tricks and wheelies, visiting friends along the way before returning home after dark. They played sports, too, and though David loved football as much as their dad, the basketball court is where the brothers had their epic battles.

I was always kind of a little bit stronger and Ill never forget the last time we played one-on-one basketball, David said. He just got better than me, and he won, and once I got over the anger and disappointment, I was proud because my younger brother had grown and was gaining confidence.

Although they have different personalities, brothers David, left, and Eric Shaw formed a strong bond as children. They were like a pair, David said.Courtesy Shaw Family

Said Eric: I wanted nothing more than to beat him, and he wanted nothing more than to keep beating me. But, during those times, it was just us, it was me and him. He was my best friend.

David went on to play at Stanford and eventually got into coaching, against his mothers best wishes. Eric did not pursue a career in athletics. He went to San Diego State and got into a career in marketing at a financial services company, where his gregarious nature, big smile and easy laugh made him a perfect fit. Though their personalities are different David is stoic and introspective, Eric makes anyone feel as if they have been friends forever they are grounded in the same values they learned at a young age: family and faith above everything else.

Those principles only grew stronger after they found themselves in the Bay Area as adults.

After David was hired by Stanford, the entire Shaw family made it clear it would always be around to support him. Family members all have a standing invitation to come for dinner on Tuesdays. And they always attend home football games, waving and hugging David during the teams pregame walk, cheering from the stands, and then waiting for some time together once the game ends.

Even as Eric grew sick, he made it a point to go cheer for his big brother. Its not just the football game. Our family comes together, he said. We celebrate, we come to watch the game and cheer the team on and support David. And then afterwards, win or lose, we all wait for him to come out. Its a family day. Its been wonderful to share that experience with David.

Stanford eventually drew them even closer, and it had nothing to do with football.

Eric did not understand the gravity of his situation until his first meeting in 2013 with the doctors at Stanford Cancer Center. They put it bluntly: He had such an aggressive form of the disease that he needed immediate treatment. They would start with total skin radiation, preparing Eric to lose his hair, eyebrows, eyelashes, fingernails and toenails.

If that did not work, they would try chemotherapy next.

All these thoughts are running through your mind, Crystal said. Is he going to make it? Is it going to work? Whats going to happen? At the time, our youngest daughter was 3 months old, so it was pretty overwhelming. We were just putting our lives together and then boom: youre in the middle of this cancer war.

David, left, and Eric Shaw back in 2014, roughly around the time Eric started undergoing treatments for a rare, aggressive skin cancer.Courtesy Shaw Family

The next week, Eric took a leave of absence from work and began four-times-a-week trips from their home east of Palo Alto, California, to Stanford Hospital, often driving as many as three hours one way in traffic. When he arrived, he went into a box and his whole body was exposed to the radiation light for about an hour. Then, he would make the drive back home to see Crystal and their four kids Caleb Michael, Jared Spann-Shaw, Madison Shaw and Olivia Shaw.

The radiation charred his skin. He lost weight. When he looked in the mirror, Eric no longer recognized the man looking back at him.

Nothing prepares you for something like this, he said. Knowing that other people were looking at me and knowing that something was very wrong, that was a daily grind to get myself up out of bed and get ready for the day, knowing that that was going to be my life.

He did this for three straight months, all to keep the disease from growing to a point where it would kill him. It worked for a short time, but the disease came back more aggressively six months later. Doctors moved on to chemotherapy treatments, some of them experimental, but also began discussing the last-resort option: a bone marrow transplant.

David and Tawnya immediately volunteered to become donors, and underwent testing. In most cases, siblings are the best chance at a donor match. Unfortunately, in their case, neither was close. On a 10-point match scale, Tawnya registered a 3, David a 5. Neither qualified to donate.

I wanted to jump to the front of the line and say, Whatever I have to do, whatever you have to take out of me, however you have to do it, just do it,' David said. For them to come back and say that youre not a strong enough match was disheartening. It hurt me. The fact that we had to put our trust and faith in people that we didnt know, and that were going to have to go out to registries and try to find someone who was a better match than I was, that uncertainty, and that doubt, its hard to keep it at bay at that point. It starts to creep in.

[The doctors] had lost all hope. There was nothing left, but we were in the deepest part of the valley, and there was nobody there but God. I said, Youre going to take me off this Earth. And he told me, Eric, youre not going to die. That was the point at which my faith really took over, and I really had true peace.

Eric Shaw, on the point when he thought he ran out of options to treat his cancer

In late 2017, the disease came back so strong, doctors determined Eric needed the long-discussed bone marrow transplant. Finding a suitable match was exceedingly difficult: Only 4% of donors on the bone marrow registry are African American, resulting in only a 16% chance to find a match.

Doctors eventually found two donors whom they believed could work, but they were not perfect matches. In early 2018, Eric and his family moved into a two-bedroom apartment near Stanford Hospital to prepare for the transplant. For three months, he went through radiation, then chemotherapy to prepare his body to accept the donor cells.

He underwent the transplant in April, feeling confident and inspired it would work. After a month, doctors did an initial check to see how many of the donor cells had survived the transplant.

None survived.

It was like I never even had the transplant, Eric said. That was so devastating. We just knew it was going to work. I mean, were people of faith, and we knew everybody was praying for us, and that we were praying that this six-year journey was going to finally be over. And it wasnt over. It was crushing for them to say, It didnt work. Were going to have to try again.'

The second attempt happened in September. Crystal bought lime green pins for the family to wear for lymphoma awareness. Without telling Eric or Crystal, David decided he would wear his on his shirt for the 2018 football season. In addition to that, he had lime green and yellow ribbons placed on the back of Stanford helmets as a way to show support for both cancer patients and cancer survivors.

During the 2018 football season, coach David Shaw and players donned green ribbons to raise awareness for lymphoma.David Bernal/isiphotos.com

He told his team that his brother was fighting cancer, and briefly mentioned the helmet ribbons publicly during an early-season news conference. But beyond that, David kept the severity of what was happening to his brother to himself, masking his growing nervousness, fear and anxiety as the clock ticked toward the next transplant. He had a hard time processing what was happening. He did not want to put that at the feet of his players, or his staff.

The doctors used the same donor cells that failed the first time for the second transplant on Sept. 11, 2018, because that was the only option available. But this time, doctors used even stronger drugs to prepare Erics body to receive the donor cells hoping that would do enough to stop his immune system from attacking them.

When Stanford played Oregon on Sept. 22, no one in the Shaw family knew whether the transplant had worked. But the situation was more dire than the first transplant. The stronger chemotherapy caused major complications, and Eric became severely ill.

David coached the game with this in the back of his mind. Stanford rallied from a 21-7 deficit to win an overtime thriller, moving to 4-0 on the season, with a top-10 matchup against Notre Dame the following week. Back in Palo Alto, Eric watched the entire game alone in an apartment he rented near the hospital, the comeback buoying his spirits.

He had no idea his brother would speak to him through the television until he heard the words, To my brother Eric

In that moment, I didnt feel any sickness at all, Eric said. I cant really describe what I felt, just how proud I am of him and how awesome it made me feel that he would do that for me.

Said David: If that transplant didnt work, I didnt know how many more games he was going to be able to see. That was an opportunity for me on national TV to speak to him, to say to my brother that against the odds, we came back and throughout the entire game, I was thinking about him.

Eric soon returned to Stanford Hospital. The chemotherapy destroyed his blood system, so he needed daily blood transfusions to stay alive. It came as no surprise when doctors told him the second transplant had failed. They had no plan now, no other donor options. David came by to visit as often as he could, but he had a hard time finding the words to say to his dying brother.

I thought about Crystal. I thought about their kids, Shaw said. I thought about, How can we help? And then I kept going, We just cant get there. There has to be something else. And we all prayed and we all comforted each other and trusted the doctors and prayed for the doctors. And just kept saying, Just tell us whatever options there are. Just tell us what to do and well do it.'

During the day, Eric had his mother, Crystal, David, or Davids wife, Kori, at his side, helping to keep his mind off what was happening to him. But in the evenings, when he was alone in his hospital room, he couldnt help but think about the dwindling medical options and his own death, slowly accepting what he believed would inevitably come.

They might have told us what the odds were, and I honestly just pushed it out of my brain. If this is the Hail Mary, hey, were going to drop back and throw it as far as we can and send prayers along with it and hope it works.

David Shaw on when doctors revisited the idea of him being a donor for his brother

Over seven years, everything the doctors tried had failed, and the disease always came back more aggressively. He felt exhausted in every possible way, desperate to feel better. He didnt want to die. All he wanted to do was get better, and see his kids again, hug his wife and go home. But that possibility seemed as far off as the stars.

The doctors couldnt help us, Eric said. They had lost all hope. There was nothing left, but we were in the deepest part of the valley, and there was nobody there but God. I said, Youre going to take me off this Earth. And he told me, Eric, youre not going to die. That was the point at which my faith really took over, and I really had true peace.

His team of doctors huddled together again and came up with a plan many of their colleagues questioned, simply because they had never attempted it. In mid-October of 2018, they told Eric they wanted to try a third transplant.

Only this time, they wanted David to be the donor and they had only weeks to make it happen.

Eric thought, Are they trying to kill me?

When David was initially rejected, doctors had worked for 25 years to find a way to do half-match transplants but had virtually no success. By 2018, doctors explained that a different way to do the transplant had emerged, opening up the potential to try it with Eric. These transplants, called haploidentical transplants, typically use donor cells from a family member.

Dr. Wen-Kai Weng, Erics bone marrow transplant physician, explained, It was relatively new at this time. We decided to go ahead, because we knew if we didnt do it, the disease would really come back with a vengeance.

No one had ever done a third transplant with donor cells at Stanford.

If he didnt go for this risk, he wouldnt be here, said Dr. Youn Kim, who treated Eric and heads Stanfords multidisciplinary Cutaneous Lymphoma Clinic/Program. He wouldnt be living.

Doctors told Shaw there was a 15% chance he would not survive the transplant itself. If he did survive it, there was only about a 30% to 40% chance the donor cells would work. Compared to much steeper survival odds with no transplant at all, the decision filled with multiple layers of danger did not feel risky at all.

They had to try.

They might have told us what the odds were, and I honestly just pushed it out of my brain, David said. If this is the Hail Mary, hey, were going to drop back and throw it as far as we can and send prayers along with it and hope that it works.

Without hesitation, David said to his brother, Tell me what I need to do.

David Shaw went through an unusual bone marrow transplant procedure to help his brother, Eric. Instead of stem cells being extracted from his hips, he was given medication that stimulated his body to overproduce the cells needed for the transplant.Courtesy Shaw Family

Stanford gathered in its team hotel early on Oct. 27 to begin final preparations before hosting Washington State later that day. David checked in for a 9 a.m. meeting and when it finished, he checked out of the hotel without saying a word. He walked toward the back exit, careful to make sure no one saw him, and snuck out the door to a waiting car.

Shaw sat in the passenger seat, headed toward campus and Stanford Hospital, praying all the while that what he was about to do would work.

He arrived at the hospital and was hooked up to an IV for the first dose of medication. This would not be the more traditional bone marrow transplant, where cells are extracted with a needle through the hips. Rather, the medication flowing through the IV would stimulate his body to overproduce the stem cells needed for the transplant, flooding his blood with them. The cells would then be extracted from his blood, and transplanted into Eric.

Doctors told him to expect to start feeling joint pain and tiredness within 24 hours. Those symptoms would grow only stronger over the coming days, when he came in for more medication. They told him he should stay off his feet, rest and remain hydrated.

That would be nice, David thought. But he had a game to coach. Only two people inside the program knew he had gone that morning: assistant athletic director for football operations Callie Dale, who drove him to the hospital, and defensive coordinator Lance Anderson.

On the same day he underwent a bone marrow transplant for his brother, David Shaw received a surprise pregame hug from his two young nieces, Olivia and Madison.John P. Lozano/isiphotos.com

The way that I do my job, I work really hard not to make it about me, David said. Although I wanted my team to know what my family was going through, college football is about the student-athletes. I wanted them to focus on what they needed to do. I didnt want to pull from that. I didnt want to, all of a sudden, now make it about me and my family.

A few hours later, he returned to the team hotel and acted as if he had been there the entire day, speaking nothing about his trip to the hospital. Shaw put on his lime green pin and made his way toward the bus. The short ride to the stadium felt long that day. His mind wandered before returning to the flip card in front of him.

As he exited the bus and finished the walk to the stadium, his two young nieces ran up to him. They squeezed him, holding on longer than usual, as if they knew their Uncle David was their only option, too.

David started to feel pain in his knees and legs during the game, a heartbreaking 41-38 loss to the Cougars. That pain only intensified in the coming days as he continued to go in for daily treatments, driving himself on a golf cart from the football facility to the hospital without anyone knowing. It felt as if he had a 50-pound backpack strapped on at all times. He normally jogs from place to place during practice but found it difficult to walk because his legs, hips and shoulders hurt so badly.

He worried players would notice him moving around so slowly. If they did, no one said a word. Shaw kept pushing the pain aside, shoving his emotions down deep, saying prayers every chance he got.

On Wednesday, Shaw woke up and was so lethargic, he felt as if he was moving like a sloth. He went to the hospital for the final procedure: extracting the cells from his blood. Shaw wore comfortable clothes, arranged his pillows and settled in for a long day ahead. Doctors hooked him up to a machine that would do the work through two IVs: One took his blood so the needed donor cells could be siphoned out; the other IV would put the blood back in his body.

Eric rested on another floor in the same hospital.

David worked on his game plan, watched a few movies and occasionally stared at his own blood in the IVs, willing it to save his brother. He kept saying to himself over and over again, God, I hope this works.

After eight hours, he was finished. Shaw then went out to practice.

I remember walking up to him and just asking him, How are you doing, how are you feeling?' Anderson said. I could see it in him that he wasnt his normal self. He paused for a little bit and then hes like, Im OK. A little bit tired, but Im OK. You know, just trying to put the most positive light that he could on it.

The next day, Nov. 1, 2018, Shaw went back to the hospital. It was transplant day, and he had to be with Eric to witness what they hoped would be a miracle. David and Crystal watched as Eric received a transfusion of Davids stem cells, a shimmering light pink fluid flowing into his body. They sang and prayed. Already, they had received one small bit of good news: Doctors extracted 28 million cells from Davids blood, about 20 million more than what they had hoped to get.

Stanford traveled the following day to Seattle, for a game against Washington. David felt guilty for leaving, but he knew there was nothing else he could do. Eric struggled in the hospital, not only from the transplant, but from the heavy chemo and radiation doctors used to prepare his body for the new cells.

Eric Shaw endured a dangerously high fever, pain and vomiting in the initial days after his third transplant attempt, using his brother Davids cells. A few weeks later, Eric started to turn a corner for the better.Courtesy Shaw Family

Eric ran a fever of 105 degrees and vomited for days. The pain grew so intense he was put on a morphine drip and was in and out of consciousness. In Seattle, Shaw remembers being locked into the game, except for those little moments where my heart was with my brother.

Stanford lost another heartbreaker, 27-23.

I know us losing had nothing to do with everything David was going through, Dale said. But just piling that on with everything else he was dealing with, it was a lot for him. He brought that up many times, about how Eric would tell him the biggest excitement for him every week was watching us play and watching us win. I know David had a lot of pressure on himself, amongst the pressure he already has as a head coach, to win for Eric. And I know that every time he did, he really felt like it was for him. And when we came up short, I know he was probably even harder on himself than he normally would have been.

Read the original:
'We're really blood brothers' - Stanford coach David Shaw and his current battle to save lots of his brother, Eric - The Shepherd of the Hills Gazette

Mark Drought: Are we on the brink of another civil war? – The Advocate

Illustration for election 2020 column

Illustration for election 2020 column

Photo: M. Ryder / M. Ryder

Illustration for election 2020 column

Illustration for election 2020 column

Mark Drought: Are we on the brink of another civil war?

This was written during the run-up to Election Day. Its possible we will have chosen a president by the time you read it, but it could remain unsettled well into December. Some are calling this the most important election in American history. That might be hyperbole; however, it is likely to be the most critical vote since Lincolns reelection in 1864.

Coming at the end of a year in which governmental incompetence may contribute to a quarter-million deaths, this election is more tense than usual. Many of us are voting angrily this time, because of whats been taken from us during the past four years, and what could be lost during the next four. For some, belief in their country has rapidly eroded, as events have transpired that they had never imagined possible.

It started when the GOP toyed with the idea of a game show host as its standard bearer. A majority of the Americans who consider themselves righteous and on the Right decided Trump had the right stuff to lead the free world. This possibility seemed far-fetched, until it began happening. I never thought the Republicans would nominate the worst human being since George Wallace to run for the White House, nor did I think the most vulgar, dishonest, unqualified and unfit candidate in recent memory would receive a minority of votes sufficiently large to put him in the Oval Office.

Four years later, the country has changed in ways wed never have predicted. Candidate Trump promised to drain the swamp, which now smells worse than ever, and would have been a sewer into the prison system, had the Justice Department not joined the executive branch in this cesspool. Yet they tell us not to trust the deep state the functioning part of the government (e.g., the CIA, FBI and NSC) that actually gets things done because it doesnt slavishly parrot the policies and fiats of the Dear Leader enough.

This has also been extended to his handpicked lackeys, such as former Attorney General Jeff Sessions, who was fired for being insufficiently ruthless in running the Justice Dept. as Trumps own personal law firm. His intensely obsequious replacement, Bill Barr, has been enough of a boot-licker to keep the boss happy, thus keeping his job.

In the Trump orbit, sycophants are considered both necessary and virtuous. Ted Cruz whose wife Trump called ugly and whose father Trump called complicit in the Kennedy assassination has failed to defend his familys honor; instead, hes become one of The Donalds more craven lapdogs. The GOPs labeling of liberals as snowflakes seems ironic at a time when the spineless Cruz and gelatinous Lindsey Graham typify Trump Republicans. GOP mavericks such as John McCain are as extinct as the Stegosaurus.

Speaking of snowflakes, did you ever imagine youd see the day a U.S. president would moan that the questions Leslie Stahl asked during a 60 Minutes interview were tougher than those asked of his opponent? Trump looked like he was ready to cry after he fled this unfair interrogation, but we now live in a time when a tough guy who cant face tough questions and calls a free press the enemy of the American people prefers to simply run from both. Its what youd expect from a whiny, fact-averse, habitual liar.

And who would imagine that, in the midst of a 21st century pandemic, Trump Republicans would reject science? We already knew their attitudes toward evolution, stem cell research and climate science, but the scary Trumpian warning that, if elected, Biden would, listen to the scientists, seems as weird as his bizarre accusation that, Doctors get more money if someone dies from COVID.

The Trump era has become a time when you can literally claim anything from birtherism to Obamagate to COVID is a hoax for which hydroxychloroquine is the cure just by saying it. More ominously, Trumpists are undermining our system of governance by claiming the election is rigged and rife with voter fraud, with no evidence whatsoever, just in case they lose.

Meanwhile, they work to restrict peoples ability to vote by sabotaging the postal system and by encouraging armed, thuggish poll watchers to suppress the vote. By the time this election is over, the Orange Mans militias will have diminished Americas faith in free elections, which were once a hallmark of democracy.

The Right threatens a civil war if the election is closely contested. I suspect many of them believe the wrong side won the previous civil war and take exception to the self-evident statement that Black lives matter. Obviously, everyones life should matter, so why do Trump cultists consider Blacks who want to protect their own lives to be anti-American radicals? Could it be because American exceptionalism has become largely about white supremacy, and reflects the views of Klansmen and neo-Nazis, whom our president refers to as some good people?

Walmart has reportedly removed guns and ammo from its shelves due to fears of potential violence brought on by a close election, and some businesses have increased insurance coverage in the face of possible looting. This situation is worsened by the presidents refusal to accept a peaceful transfer of power should he lose. Hes stated that he could lose only if the Democrats cheated, and no prominent GOP leaders oppose his unwillingness to respect the decision of the American people in a free election.

Many Americans have lost respect for their country and their countrymen. Even if Trump loses, nearly half the nation will have voted for a buffoonish bigot responsible for thousands of deaths, whos no friend of democracy or the U.S. electoral system. And should he be reelected, it will be as hard to get his first Trump-Biden debate performance out of my head as it will be to unsee the image of him dancing to the Village Peoples YMCA at his campaign rallies.

Greenwich native Mark Drought (markdrought4@gmail.com) is an editor at a Stamford IT firm and was an adjunct English professor at the University of Connecticut-Stamford.

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Mark Drought: Are we on the brink of another civil war? - The Advocate