He thought gout caused his sore knee; doctors said he needed hospice before a clinical trial saved his life

A sore knee led to diagnosis

Goepel knew he had not always managed his gout as well as he should. When his knee became sore, he did not expect the visit to a doctor to lead to a leukemia diagnosis.

He recalled being urged to go straight to the hospital because he had no immune system. At the hospital, he said, he was told he had leukemia; his family was warned that he might not survive.

Standard treatment posed risks

Dr. Justin Watts, the hematologist-oncologist who treated Goepel, said his AML was adverse-risk. The chemotherapy commonly used for patients like him was unlikely to control the disease and could weaken his body, potentially leading to death within weeks.

Even if chemotherapy initially worked, Watts said, Goepel would face a greater risk of relapse and future disease. The severity of his condition led doctors to consider a clinical trial instead.

Trial results brought remission

A study published in Haematologica in September reported that 25 of 36 patients had cancer shrink or disappear during a 28-day treatment course. Nineteen entered complete remission, including Goepel, who reached remission the same month he first noticed the soreness.

Dr. Mihir A. Shukla of NYU Langone's Perlmutter Cancer Center, who was not involved in the study or Goepel’s care, said the results and another Phase 2 study raise questions about the long-standing standard approach for patients who cannot receive standard chemotherapy.

Transplant and continued monitoring

After a transplant, Goepel spent three weeks in hospital while his immune system began to rebuild, then remained isolated at home for another 100 days. He developed rotavirus and pneumonia, both of which were treated, and tests show the transplant is working correctly.

Watts said Goepel probably would not be alive today if he had received standard treatment. Further research into options for adverse-risk AML patients is underway, while Goepel continues to meet with his care team to monitor the transplant and his remission.

Goepel said he is no longer constantly afraid that cancer has returned, though ordinary symptoms can still make him worry. He said he is learning to relax and enjoy life again.