At 16, Janelle Bombalier is grateful for the simple things that her peers take for granted. Taking classes, going to the mall —even being able to walk and run.
“I don’t even remember ever feeling like this,” Janelle said. “I don’t remember a time when I wasn’t sick.”
The Kendall high school junior is not exaggerating. When she was 8, she was diagnosed with papillary thyroid cancer, the most common type of thyroid cancer. It was an aggressive form that spread to her lungs.
“She maxed out on therapy,” said her mother, Yenissel Bombalier. “Her lung function had deteriorated so much she could barely walk; she had to take oxygen with her wherever she went. She was losing weight. The quality of her life was very, very poor.”
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In January, the family finally got a break. Janelle became the first known pediatric patient in the United States, and only one of a few in the world, to have a lung transplant after having thyroid cancer spread to her lungs.
“I’m feeling really good,” Janelle said. She has to be careful of infection but she’s planning to go to college. “I can do almost everything — and no oxygen.”
Physicians see Janelle’s outlook as as a breakthrough for at least certain pediatric patients..
“It’s unusual to have thyroid cancer at that age,” said Dr. Janine Sanchez, a thyroid expert at Sylvester Comprehensive Cancer Center, part of UHealth-University of Miami Health System.
“From the beginning, it was very extensive,” said Sanchez, Janelle’s pediatric endocrinologist. “And what was unusual was the extent in the lungs.”
Janelle’s thyroid was removed and she began getting radioactive iodine treatments that cured the cancer in her lungs, “but repeated therapies destroyed lung tissue” and took a toll on her health, said UHealth pediatric lung expert, Dr. Andrew Colin.
“The amount of subsequent damage had put her life at risk,” he said. “She had become a pulmonary cripple.”
A transplant looked like the the best option, but the first person physicians had to convince was Janelle.
“When I first heard about the idea, I was really frightened,” said the teen. “It sounded really complicated and really dangerous and I was scared. I didn’t want to do it.”
Janelle said she was most frightened by the aftermath of the transplant. “There was the risk of rejection and I was one of the first people to have this transplant.”
She and her family, who run a tree nursery and landscaping business in Homestead, decided they would take the risk.
“She was not getting any better,” Bombalier said. “Janelle needed the transplant.”
One of the biggest concerns was post-transplant treatment, which requires hard-core drugs that suppress the immune system. Transplant surgeons feared the immunosuppressants would make her more vulnerable to infections and if she still had cancer, the disease could take over.
“Pursuing the option of a transplant was an “almost revolutionary” decision,’’ Colin said. “A surgeon would have to be courageous because if we were wrong, it would be condemning her to death,” he said. “No one wanted to take her.”
The teen’s prospects changed when transplant surgeon Dr. Matthias Loebe arrived at the University of Miami in 2015. He had spent 15 years directing the thoracic transplant program at Houston’s Methodist DeBakey Heart and Vascular Center, considered one of the best in the country.
“I saw a tremendous need here in South Florida for lung and heart transplantation,” Loebe said. So when he heard about Janelle, he studied comparable cases. “I came across three in the world — one in Australia, one in France and one in Germany,” Loebe said. “All three cases were doing well several years after the transplant.”
He agreed to do the procedure.
“It was obviously a difficult situation,” Loebe said. But after performing close to 1,000 transplants, he felt “more than comfortable’’ doing the transplant.
As a general rule, patients have to be free of cancer for five years before they’re considered for a transplant, Loebe said. But research on thyroid cancer and transplants was more encouraging. Janelle’s thyroid cancer had been localized in the thyroid, which was removed, and there was no longer any sign of cancer in the lungs.
Once Loebe agreed to the procedure, the family had to wait about six months until a lung was available. Janelle received an adult lung that Loebe adjusted. He performed the surgery, which her mom said took about eight hours, at Jackson Memorial Hospital.
The transplant is “very encouraging” for children like Janelle, who have had their lungs damaged because of thyroid metastasis, Sanchez said. As it turned out, when Janelle’s lungs were removed during the transplant, there was no cancer present.
“It’s extremely gratifying to see how well she’s doing,” Loebe said. “That’s why we do what we do. It’s worth pushing the envelope to find a solution for these really sick patients.”
The Bombalier family is also grateful.
“It was a tough decision, but I don’t know if she’d be here if not for the transplant,” Yenissel Bombalier said. “She has a second chance at life now.”