How a multidisciplinary team helped a paralyzed cancer patient walk again

In July 2024, James Ball, a retired lawyer from New Hampshire, was rushed to his local emergency department (ED) after experiencing a burning sensation in his hands and feet, along with weakness in his legs. Yet at the ED, he was told that nothing was wrong.

Convinced his symptoms were serious, Ball sought care at another hospital, where he was diagnosed with peripheral T-cell lymphoma (PTCL). He was subsequently admitted to the Mass General Brigham Cancer Institute Open external link in a new window at Massachusetts General Hospital (MGH), where he first came under the care of Salvia Jain, MD Open external link in a new window , a T-cell lymphoma specialist and founder of PETAL Consortium Open external link in a new window , a first-of-its-kind global network based at MGH dedicated to advancing care for PTCL.

Following his initial ED visit in July, Ball's condition deteriorated rapidly. By the time he arrived at MGH just one month later, he was quadriplegic - unable to walk or even get out of bed. His hands and feet felt like they were "on fire." His hands had also lost all dexterity, stiffening into curved, claw-like shapes.

In the end, Jain was one member of a large, multidisciplinary team whose specialized expertise and close collaboration delivered a tremendous outcome: complete remission of the lymphoma and the return of his mobility.

"Mr. Ball's case required exceptionally complex, high-intensity care involving multiple specialties, which enabled him to progress from quadriplegia to mowing his own lawn," Jain said. "A remarkable recovery like this in cancer-driven neurological conditions is exceptional and rewarding."

Multidisciplinary, team-based care

PTCL is a rare and aggressive subtype of lymphoma - a cancer of the white blood cells - that predominantly originates in internal organs. Common symptoms of PTCL include swollen lymph nodes, unexplained weight loss, fever and night sweats, fatigue and mouth sores.

"It wasn't clear whether Mr. Ball's mobility problems were caused by the lymphoma or by a separate issue affecting his nervous system," said Jain. "He received two types of chemotherapy: combination of drugs with different mechanisms of action to treat the cancer throughout his body and another designed to penetrate the brain, spinal cord and the fluids around it since standard treatments can't get there."

After completing the doublet chemotherapy targeting his body and central nervous system independently, his condition finally began to improve. Eventually, imaging revealed he achieved complete remission.

Once his health and mobility improved, Ball advanced to the next phase of treatment: consolidation therapy, which is intended to destroy any hidden or remaining cancer cells in the body. This would entail high-dose chemotherapy followed by an autologous stem cell transplantation, a procedure in which the person's own stem cells are harvested before treatment, frozen and then returned to the body after radiation or chemotherapy.

However, he faced two major hurdles. First, Ball had just spent five months hospitalized for treatment of his lymphoma and central nervous system disease, leaving him extremely weak. Second, he required an intensive chemotherapy regimen before infusion of his bone marrow stem cells, to further eradicate any residual lymphoma and fortify the response.

"To Mr. Ball's credit, he worked hard with his care team to steadily build enough strength to proceed to transplantation," said Steven McAfee, MD Open external link in a new window , clinical director of the Bone Marrow Transplant Program Open external link in a new window .

Ball worked with physical therapist Allie Zunick, DPT, to rebuild his strength and prepare for transplantation, with the goal of "maximizing his independence," said Zunick. Meeting three times a week, she focused on helping Ball regain mobility and relearn how to walk.

Over five months, he progressed from being nearly paralyzed to walking with the help of a ceiling-mounted harness, then using a walker and eventually a cane. He described the process as "really slow and difficult," but he credited his "very motivating" physical therapists for supporting him throughout his recovery.

"The most challenging part was learning to walk again and getting my hands to function," Ball explained.