An NCI-designated Comprehensive Cancer Center
April 12, 2018
Sergio Ramirez is sitting at the edge of an overstuffed couch in his living room, running his right thumb back and forth across his left palm nervously. He is recalling the moment, one year ago, when he met the man who saved his life.

“Words cannot describe how I feel about him,” he said. “Even now, a year later, thinking about what it means for me to be here with my family, I just want to cry. I want to cry.”

Last April, at the 41st annual City of Hope Bone Marrow Transplant Reunion, Ramirez stood on a stage before hundreds of people and met Michael Palacios, the donor who — remarkably and unbeknownst to him — lived just 20 minutes away from him in south Los Angeles.

Upon meeting for the first time, the two men fell into each other’s arms and cried.

“Today is a wonderful day,” said Palacios, 28, in an interview last year. “Knowing that my blood is running through somebody else’s body; it’s just phenomenal.”

After the reunion, Ramirez did what anyone would do in his situation: He conjured a scenario in which Palacios quickly became part of his family. They would have dinners together and reflect on the immensity of their bond.

But none of that happened. Instead, the swelling emotion of the reunion went away, like a pinprick in a balloon that slowly leaks air.

“Last time I got in contact, it was July 3rd, and I told him how grateful I am that he gave me life, and how it will forever be with me,” said Ramirez. “He replied back with a ‘Thank you,’ and I haven’t heard from him since.”

This past year has been a whirlwind. But not in the way Ramirez expected.

Something’s Wrong

Nine years ago, Ramirez sat on an examination table in a small hospital room. His legs were pressed against cold vinyl. His eyes were ringed with red.

He was waiting for his wife, Karelan, to arrive — to help him answer unanswerable questions like, “Why did?” and “How could?” a young father of three have an aggressive form of cancer multiplying in his bloodstream.

“My head goes, ‘Cancer? But why? How?’” said Ramirez. “I was like, ‘Oh my god, what am I going to go through? What’s going to happen to me? And what about my kids?’”

It was June 15, 2009, one day after his 27th birthday.

The day before, Ramirez had been playing soccer at a local park with his three sons, and other family members, before being overcome with dizziness.

“I was running toward the ball and my head started spinning,” said Ramirez. “I knew that wasn’t normal. That’s when it hit me that something was wrong.”

Ramirez had had hints about that “something wrong” for weeks. Karelan commented about the yellowish tinge to his eyes. His parents mentioned that his skin looked sallow. Friends remarked that his lips were pale.
Sergio Ramirez Bone Marrow Transplant Recipient
Ramirez during leukemia treatment

“He was also sleeping a lot,” said Karelan. “I kept thinking, ‘This is not right.’ I thought he had anemia, but then I saw his eyes and said, ‘Oh my god, this could be hepatitis.’

“We just kept telling him, ‘You have to go to the hospital. Something’s wrong.’”

Ramirez batted away everyone’s concerns. He figured, “I almost never get sick; I feel fine,” and besides — he had almost no symptoms except what others were observing, along with the nagging feeling of fatigue.

It was not until the dizzy spell on the soccer field that he decided to get checked. He made an appointment with his family physician for the next day.

During the initial exam, Ramirez says his family doctor seemed alarmed. Based on the results of blood tests, he suspected Ramirez was bleeding internally. What else could explain his unusually low hemoglobin count — a measure of red blood cells in the blood?

“He told me, ‘Something’s going on and you need to go to the emergency room right away,’” said Ramirez.

Not long after he checked in at the ER, Ramirez found out he had leukemia. A week later, pathologists provided a more specific diagnosis: acute lymphoblastic leukemia — ALL — a type of cancer commonly diagnosed in children.

“In less than 24 hours I went from celebrating my birthday to being told I had cancer,” said Ramirez, now 35. “That’s tough — it’s really tough.”

10-by-10 Room

Ramirez, a stocky, hardy man was trying to reconcile the helplessness he now felt. He had spent years on the road, on long hauls, driving trucks. Now he was being told he would be in the hospital undergoing chemotherapy for several weeks.

“I was going from being free and on the road to being told I was going to be in a 10-by-10 room for 42 days,” he said.

At the time, Ramirez was being treated at another local cancer center. He says going to the hospital became his job — a revolving door of intensive and crippling chemotherapy courses, spinal taps and blood draws that eventually succeeded in treating the leukemia.
Sergio Ramirez City of Hope Patient
Ramirez in the hospital with his wife, Karelan

After more than three years of treatment, he was in remission.

Ramirez returned to a routine. He was recuperating and slowly acclimating to normal life: hiking, playing sports with his children and contemplating returning to work.

But about six months after remission, Ramirez started getting flu-like symptoms. “My body was achy, my bones hurt and I got a fever that wouldn’t go away,” he said. “I said to my wife, ‘This is just a flu, right?’ But it was actually my leukemia coming back.”

It was just after New Year’s, 2013.

When Ramirez went to have his bloodwork done, both he and his doctor were stunned by the results. “My white blood cells were at 200,000,” he said. White blood cells fight infection; their normal range in the blood is between 4,500 to 11,000.

Ninety percent of Ramirez’s marrow was leukemia cells.

The Donor

In 2011, two years after Ramirez was first diagnosed, Palacios, then a 19-year-old working as a hospital volunteer, finished his shift.

On a different floor was a "Be the Match" drive, a recruitment event for potential bone marrow donors. Palacios remembers his supervisor nudging him to get swabbed — the first step in a long process before getting matched with a person needing a transplant.

Palacios says he figured, “Why not?”

“When you donate you’re not only donating something from your heart, you’re donating an opportunity to give somebody hope,” said Palacios, in a previous interview. “It’s a chance for them to celebrate life.”

Palacios’ cheek was swabbed to get a sample of his cells. That sample was added to an international registry, in hopes that markers on his cells would one day match those of someone in need of a transplant.

For two years, Palacios went on with his life, not thinking much about something he did on a whim. Then, he got a call. He was a match for someone in need.

“I imagined being a patient, with your hopes diminished,” said Palacios. “Then, I imagined a doctor walking into that patient’s room and saying, ‘We have great news for you. We found someone willing to donate their bone marrow to give you a second chance.”

The night he got the call, Palacios says he felt a combination of excitement and fear.

He spent most of the night wide awake, and in tears.
Sergio Ramirez with Anthony Stein MD
Palacios (L) and Ramirez (R) speaking with Stein after reuniting in 2017

Last Hope

Moments after getting the abysmal white blood cell count, Ramirez was admitted to the hospital and put on combination chemotherapy. After 40 days, he had a bone marrow biopsy to find out whether the treatment was working.

It wasn’t. The marrow was still teeming with leukemia cells. Ramirez says his doctor was sober as she delivered the news.

“I asked my doctor, ‘What is my life expectancy?’” said Ramirez. “She told me, ‘I’m sorry but it does not look good. I would say you have a 15 percent chance of surviving.’”

She added that his last hope was a clinical trial at City of Hope; an immunotherapy study, led by Anthony Stein, M.D., co-director of the Gehr Family Center for Leukemia Research.

So, it was with dim hopes that Ramirez went to City of Hope.

“I could see myself, like I was outside my own body. I was terrified, wondering, ‘What’s going to happen to me?’” he said.

Two weeks later, Ramirez was enrolled in a trial of a drug called blinatumomab, an experimental therapy that would recruit his immune system to target the leukemia cells in his body.

The trial was small. Ramirez was one of only about 100 patients enrolled.

He underwent infusions, then 30 days later, got another bone marrow biopsy to gauge his progress. A few days after the biopsy, he sat in a waiting room at City of Hope. The 40 minutes he waited, he said, felt like an entire day.

By the time he reached the exam room to see Stein, Ramirez says he was nervous and shaking. His reeling mind was interrupted as Stein greeted him with a booming, “Hello!”

“He has a piece of paper in his hand and comes in with a smile,” said Ramirez. “He goes, ‘Congratulations! Your bone marrow has zero leukemia!’

“I could not believe that medication worked in 30 days. Happiness took over my body, like 100 pounds of weight off my back.”

But Ramirez was not done. Given his history, and the nasty relapse, he needed a bone marrow transplant to protect against the leukemia coming back.

The bone marrow registry was scoured and, within three days of completing immunotherapy, Ramirez had three potential matches. The first match backed out, but the second — Palacios — said yes.

“I was on the dark side and getting this match was like seeing the light and the sun once again,” said Ramirez. “I was given a new life.”
Sergio Ramirez and Family
Ramirez (center) and his family

One Year Post-Reunion

Ramirez is beaming.

It’s February and he is standing in front of a small group at a university near his home in south Los Angeles. Snippets of Spanish float across the room where the group, mostly Latinos, is lining up to have their cheeks swabbed with a Q-tip.

Ramirez clears his throat and begins to speak.

“A lot of us Hispanics and African-Americans don’t survive the type of cancer I got,” he said. “That’s because people like us don’t find that match that can save our lives.”

Ramirez says these words understanding how fortunate he was to find a match. Other cancer patients, especially those in minority communities, often wait years to be matched. Many never are.

Ramirez organized the event with the help of neighbors, and City of Hope, something he’d probably never have done if he wasn’t diagnosed with cancer.

He organized another event a month later, and plans to do even more this year. He is also making regular trips to his birth country, Guatemala, to help patients who cannot afford cancer treatment.

“It feels good to help other people,” said Ramirez during a recent interview at his home in south Los Angeles. “To inspire them, to give them that sense of hope that if I did it, they can do it, too.”  

While this year did not include the fairytale ending his mind conjured, one thing that came of his reunion with Palacios is a deeper understanding of the immeasurable pride that comes from helping others.

Ramirez was on the receiving end of that help. Now he is giving back. And that feeling, he says, is almost as difficult to put in words as the feeling of having his own life saved.

As for the man who is responsible for saving his life, Ramirez says he is OK with where things stand.

“It would be nice if we could get a little bit closer together and could have that bond,” he said. “But I don’t want to push it. I let it go. When he’s ready, I’m always here.”