Kristy Martin: Atypical Presentation of Acute Myeloid Leukemia

On March 5, 2020, Kristy Martin woke up to find her legs weren’t working correctly. The 46-year-old mother of four was scheduled to see her primary care for a follow-up appointment for back pain that day. “Since I couldn’t drive, I called an Uber car to take me to my appointment,” she says. “I didn’t think it was urgent.”

When Martin arrived at the offices of primary care physician Douglas Tsuchida, MD, on the campus of Memorial Hermann Memorial City Medical Center and explained what she was experiencing, Dr. Tsuchida wheeled her directly into the hospital’s Emergency Center. 

There, an MRI revealed a large mass in the region of her lower spine. In the operating room, a team of neurosurgeons, led by affiliated UTHealth Neurosciences neurosurgeon Spiros Blackburn, MD, associate professor in the Vivian L. Smith Department of Neurosurgery at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), removed the tumor (as much as could safely be removed without causing further damage to the spinal cord). In addition, the team performed a laminectomy, a surgical procedure to ease the pressure on her spinal cord and nerve roots that was causing her pain and her inability to walk. Tumor samples were sent to a pathology lab for analysis.

Martin was transferred to the Neuroscience Center at Memorial Hermann Southwest Hospital, one of the most advanced neuroscience centers in Houston, where where she began receiving inpatient occupational and physical therapy under the care of neuro-oncologist Jay-Jinguang Zhu, MD, PhD, professor in the Vivian L. Smith Department of Neurosurgery at McGovern Medical School.

“That was where my story took a turn,” says Martin. The pathology laboratory results indicated the tumor was a myeloid sarcoma, acute leukemia outside the bone marrow. Given the diagnosis was not a neurological tumor but rather an unusual form of acute leukemia, Dr. Zhu brought in Adan Rios, MD, professor in the Division of Oncology at McGovern Medical School, whose special interests include hematological malignancies (leukemia, lymphoma and multiple myeloma). 

Describing Martin’s diagnosis, Dr. Rios says, “The presence of leukemic tissue outside the bone marrow occurs in about 3% to 9% of patients with acute myeloid leukemia. It can occur in the skin or in any organ. In her case, it occurred as a very large mass that compressed her spinal cord on the right side from the level of the thoracic vertebral body eight (T8) down to the lumbar vertebral body L1 in the lumbo-sacral region, extending into the anterior portion of her abdomen.”

Dr. Rios, who Martin describes as a “collaborative genius,” consulted with colleagues across multiple disciplines to create a care plan for Martin. In tandem, plans were made to initiate dose-intensive inpatient chemotherapy at Memorial Hermann-Texas Medical Center and to initiate a rehabilitation program at TIRR Memorial Hermann in the Texas Medical Center.

“In injuries of the spinal cord, the immediate restoration of function and rehabilitation are essential for recovery of these patients,” says Dr. Rios. “Even when she was at TIRR, she was getting her chemo treatment. There aren’t many institutions where this type of dose-intensive chemotherapy and multidisciplinary team are available.”

Martin’s care plan would eventually include radiotherapy, provided by radiation oncologist Mark Amsbaugh, MD, assistant professor of neurosurgery at McGovern Medical School and medical director of radiation oncology at Memorial Herman-TMC, and oral chemotherapy maintenance treatment, prescribed by Dr. Rios to prevent recurrence. 

As if Martin’s medical challenges weren’t enough, just as she was diagnosed, the COVID-19 pandemic hit, and hospital visitation restrictions were put in place. “It was hard because I couldn’t see my kids and the rest of my family,” she says. “But the nurses and chaplains really helped lift my spirits. They helped me video chat with my family and even shared their own stories with me.”

Martin was discharged from the hospital on June 5, 92 days after arriving via Uber car at her primary care physician’s office for her follow-up visit. Throughout her journey, she was cared for by over a dozen UTHealth and Memorial Hermann affiliated specialists—emergency physicians, surgeons, neurologists, hematologists, oncologists, radiologists and neurorehabilitation specialists—plus a host of physical and occupational therapists, nurses, social workers, chaplains, home health providers and others, who worked in concert to ensure the best possible outcome.

Martin has regained some use of her legs, although she’s mostly wheelchair dependent. But that’s not holding her back. She recently relearned to drive a car using hand controls. (“It’s so cool to be on the road again!”) A self-described “good home chef,” she’s relearning to chop at a different angle.

“My whole life changed. Everything changed,” she says. “But it has been such a positive journey. It made me realize what’s important and what’s not. Everyone worked together. It all worked out.”