In less than 4 days, an athletic 10-year-old boy went from a happy-go-lucky kid to a leukemia patient fighting for his life. With a genetic mutation stacking the odds against him, Dominick was out of time and out of options until his parents found a potential life-saving clinical trial over 900 miles away.
Dominick Nino came home from soccer practice on a Thursday night in January with a sore right foot and a mild fever. Over the weekend the foot pain and fever returned intermittently, but never enough to cause great concern. By Monday night, the pain had spread to both feet with small pockets of blood pooling under the skin between the boy’s toes. His parents, Cristian and Yesica, had no idea what the problem was, but their intuition told them that Dominick needed to be taken to their hospital’s pediatric emergency department right away.
Cristian stayed home with the couple’s younger two daughters, while Yesica sat with her son through multiple X-rays and blood tests waiting for a diagnosis. Yesica was told that Dominick needed to be transported immediately by ambulance to the dedicated children’s hospital 32 miles away. Worried and confused, Cristian asked his in-laws to stay with his daughters so he could join his wife and son. Dominick was admitted directly to the ICU. They soon learned that his blood was too thick, his hemoglobin was low, and his white blood cell count was through the roof. He urgently needed dialysis to reduce the risk of a stroke.
Several hours later, they finally heard the diagnosis they had feared but could not believe: Acute Myeloid Leukemia.
Life Turned Upside Down
The Ninos are a close knit, loving family. Like most kids, Dominick and his younger sisters Bianca and Shayla love playing at the beach and going to amusement parks. Dominick is an avid soccer player -- happy to play on the field or even in the goal. He is passionate about video games, and he enjoys baseball. He is a smart, thoughtful boy with a heartwarming smile.
Cristian and Yesica never imagined the “nightmare day” that followed their son’s heartbreaking diagnosis. They met with the hospital’s oncology team and social workers to learn about the cancer that threatened their son’s life. The next day, Dominick started his first round of chemotherapy that lasted 7 days.
The biopsy after the first treatment cycle showed no trace of leukemia; the chemotherapy was successful. However, Dominick’s genetic test identified a mutation that indicated he was high-risk for relapse and would need a bone marrow transplant to ensure a long-term recovery. Nino family members were screened as possible donors and two weeks later the test results revealed that Dominick’s younger sister, Bianca, was a full match – which is highly uncommon. Although he had a donor available, Dominick still needed to complete two more rounds of chemotherapy through the spring before a transplant would be possible.
The bone marrow biopsy following Dominick’s second round of treatment was also favorable and the Nino family began meeting with children’s hospitals in their home state to discuss the transplant that would follow an anticipated third successful round of the chemotherapy. Instead, after the third course of treatment, the Nino family received the shocking news that the leukemia had returned.
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Running Out of Options
Devastated, Cristian began frantically researching top pediatric leukemia programs in the country, looking for a second opinion or a new treatment option for his son. However, he met repeated obstacles as out-of-state physicians needed to evaluate Dominick in person. His local oncologist prescribed a month-long oral chemotherapy regimen, but Dominick’s genetic mutation was resistant to the protocol. After the 30 days of treatment, his biopsy showed that the leukemia was worse.
Shortly after that on June 30th, Dominick was hospitalized for an infection. In July, he received an intense treatment known as FLAG for his leukemia relapse. The potent chemotherapy mixture was considered Dominick’s last hope for inducing remission so his transplant could be possible.
A Rainbow in a Cloudless Sky
While the FLAG protocol initially seemed successful, Dominick’s leukemia cells returned. Out of options, Dominick’s physician suggested a menin inhibitor clinical trial at MD Anderson in Houston. The Ninos had already contacted the renowned cancer center to review Dominick’s case, and they were eager to pursue any option to give their son a second chance for a healthy life.
The Ninos needed to transport their very sick, immunosuppressed 11-year-old son over 900 miles to Houston, Texas for the only treatment option left for him. A friend and healthcare professional referred the family to Angel MedFlight, one of the largest air ambulance providers in the country. The Angel MedFlight team was ready to help, and immediately got started by preparing air and ground logistics, confirming acceptance at MD Anderson, and coordinating flight preauthorization with the Nino’s health plan.
Cristian and Yesica worried that they would hit another obstacle until Cristian spotted a vivid rainbow in a cloudless sky. He told his wife that seeing a rainbow in such a rare circumstance was a positive sign that everything was going to work out.
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Flying High and Fast
With advanced certifications for in-flight care, Angel MedFlight’s Critical Care Nurse and Paramedic teams are highly experienced and well trained to handle high-acuity patient transports every day. But when the Medical Flight Team arrived at Dominick’s bedside that afternoon, they realized he was a very special patient. Dominick had touched the lives of those who had cared for him during his lengthy stay. The hospital staff lined the hallways to wish Dominick well. As the Angel MedFlight team wheeled his stretcher out, Dominick’s physicians and nurses assured him that he was on his way to the best treatment possible.
The Angel MedFlight team transported Dominick and Yesica in a ground ambulance to the airport for departure. After safely transitioning Dominick’s stretcher on board the Learjet 45 and making him comfortable, the Angel MedFlight team explained that the medically configured aircraft flies higher and faster than a commercial airliner. With the knowledge that his flight would be the fastest in the sky, Dominick smiled.
Cristian watched the airplane race down the runway with his son and wife on board and lift off. He didn’t know what to expect in Houston, but he knew that it was his son’s only chance for survival.
Waiting for Results
Dominick’s body chemistry was so out of balance from his previous treatments that he initially had a wait for his system to normalize before he could start the first 28-day clinical trial cycle. During the four-week regimen, Dominick’s frequent blood work did not indicate if the treatment was working, and the Ninos prepared for possible bad news. At the end of the cycle, Dominick’s biopsy showed that his leukemia blasts had dropped from 37% to 2%. Dominick was in clinical remission, and he had one of the clinical trial’s quickest responses to the medication.
He was discharged to complete the two additional cycles as an outpatient. Yesica and Dominick stayed in Houston close to the hospital while Cristian split his time between Houston and their home, so he could continue to work and spend time with their daughters who were staying with family. With Dominick’s continued remission, he was eligible again for a bone marrow transplant. The Ninos selected the MD Anderson Transplant Team to collect the donor cells from Bianca and transfer them to Dominick through stem cell infusion.
Ringing the Bell & Moving Forward
On the 10th of February – 13 months after his diagnosis and two days before his 12th birthday -- Dominick rang the bell at MD Anderson marking the end of his treatment. It was an emotional milestone for the entire Nino family. Dominick endured severe nausea, hair loss, infection, painful esophageal sores, debilitating fatigue, and weakness…but he beat the odds and he survived. And now he is looking forward to going home to spend time with his family and friends. He is even excited to return to school in the fall.
Cristian and Yesica are certain that making the decision to transfer Dominick to MD Anderson saved their son’s life. Angel MedFlight is thankful that we could contribute to Dominick’s Incredible Outcome.
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The Angel MedFlight team delivers bedside-to-bedside care for patients around the world. If your patient needs an air medical transport, call us anytime – we’re here for you 24/7!