Little Mighty Mack is cancer free!

On 5 January 2022, Mackenzie "Mighty Mack" Friedman turned one.

Her family created this moving tribute to their little girl who was admitted to hospital a day after her first birthday. She was admitted to hospital to begin the processes required for her to undergo a life-saving bone marrow stem cell transplant - one that would hopefully clear her of all traces of cancer.

Mackenzie's mom, Megan Harrington-Johnson, describes Mackenzie's journey

One day everything was just perfect - Mackenzie was a happy, healthy four-month-old little girl. Within a week we were in an oncology unit! She'd never been sick before and when she became a bit restless at night, we thought it was a normal sleep regression phase.

On Saturday, 8 May she woke up a little fussy with a slight fever, which she'd never had before. As a first-time mom I naturally overthought it, so we took her to our GP, Dr Colin Kahanowitz. He couldn't detect any signs of infection but told us to come back the next day if she was still ill. Although her fever had broken, we decided to take her back to him. He told us that "Something's just not sitting right with me" and sent us to Mediclinic Sandton to see a paediatrician. We stayed overnight while they did some tests.

Receiving Mack's diagnosis

My husband, Bronson, and I were in complete shock when we were told our little girl had acute myeloid leukaemia (AML), cancer of the white blood cells. We received the news from Dr Nadia Beringer, our oncologist, five days after the onset of her symptoms. Cancer had thankfully never been close to home for us. We'd heard about other people's parents being diagnosed with cancer, but never someone's child. You kind of go from completely normal - Mackenzie having a fever and a possible bacterial infection - to total disbelief at the fact that she has been diagnosed with cancer.

• Acute myeloid leukaemia (AML) occurs when young abnormal white blood cells called blasts (leukaemia cells) begin to fill up the bone marrow, which prevents normal blood production.
• It's diagnosed when 20% of white blood cells in the bone marrow are blast cells.

Getting our ducks in a row

My husband and I were both all over the show, struggling with every imaginable type of emotion - anxiety, denial, terror and more. Strangely enough, Bronson's practical side as an independent wealth manager kicked in straight away. One of the very first things he did was phone Discovery Health Medical Scheme, as he knew we were going to need their support. Aside from being Discovery Health Medical Scheme members, our portfolio also includes Discovery's short term and life insurance products as well as income protection. For that, we thank God as we are both self-employed. Just having the confirmation that they were going to be with us on our journey gave us some much-needed reassurance.

Starting the cancer treatment journey

Mackenzie was transferred to the Donald Gordon Paediatric Oncology Unit and the two of us moved to the hospital to be with her. There are so many unknowns when it comes to childhood cancer. There are also many different types of childhood leukaemia and we had no idea what we were dealing with. Every child's journey is different. You can't predict and you can't dictate. Everything happened so fast and although we felt like we couldn't breathe sometimes, we were thankful for the fast action of all the doctors. It meant a very early diagnosis, which offers the best chance for a better outcome.

Starting Mack on chemotherapy

Two days after Mackenzie was formally diagnosed, she started chemotherapy (chemo). Unfortunately, her cancer turned out to be extremely aggressive, so she needed aggressive treatment. It was terrifying. We knew that there were huge risks (because babies can die from chemo) but we had no choice.

While she was undergoing all her tests, we'd hoped she would be diagnosed with a less aggressive, more common cancer that is easier to treat, but it was not so. It was a huge blow to hear that she has a very rare variant that can't be treated with chemo alone. The only real solution was for her to have a bone marrow transplant at a later stage, but she had to go through two rounds of chemo before we could get there.

For 11 days, our little girl endured a very intense round of chemo (24 doses) and regular blood and platelet transfusions. She was an absolute star and did very well, until the last day of chemo on May 24 when she picked up an infection.

More and more infections

From then, Mackenzie dealt with one infection after another. Although this was expected with chemo in a very small child (chemotherapy weakens their immune system), her infections were relentless, draining her, and us, of all our energy.

Our lives became a day-to-day emotional roller coaster ride. We soon understood why our oncologists manage their patients' conditions only for hours at a time, because things can change so quickly. That's what continually happened with our little girl.

Going onto a ventilator

Mackenzie was first put onto a ventilator soon after finishing chemo at the end of May. She had very high potassium levels because of a bacterial infection. This meant she was in acute renal failure (kidney failure) and was going into septic shock. Thankfully, she bounced back very quickly and came off the ventilator the next day. Her infections unfortunately continued.

On Bronson's first Father's Day, the doctors decided to put Mackenzie into an induced coma and move her back onto a ventilator as a precautionary measure. It was a chance to give her tired little body a break after fighting so hard against all those infections. It was so difficult not being able to hold her, hear her or even see her eyes - a real low for us both.

Going from bad to worse

A week later, the doctors became concerned about a spot (a mass) on her lung. She then started having seizures. This led to all sorts of concerns about the cancer spreading to her brain or causing meningitis. A lumbar puncture gave her the all-clear, but a CT scan showed that the lung mass had grown.

They suspected a cancerous growth, but she was too weak to be operated on or to even have a biopsy. We had no choice but to wait it out. It was our worst day in the journey so far.

Then Bronson and I tested positive for COVID-19.

Coping with COVID-19 and being away from our little one

For the first time in eight weeks, we had to leave the hospital. I couldn't bear the thought of Mackenzie being alone. We scrambled to get permission for her granny to move in with her after she had a negative COVID-19 test. She stayed with Mackenzie for five days and then she tested positive for COVID-19 too.

I've never been more terrified or felt more out of control. I have a Type A personality and I'm an attorney who runs my own business, and this was the worst situation imaginable. I'd handed my child's life over to doctors. I was trying to come to terms with the horrors of her illness, and now Bronson and I were dealing with something just as frightening and unpredictable. We didn't think it possible, but things got even worse.

The nightmare continues

Mackenzie initially improved while we were in quarantine, but the lung mass continued to grow. Then we got the call that every parent dreads. The mass was pressing against her heart and they needed to perform an urgent thoracotomy - a surgical procedure where a cut is made between the ribs to see and reach the lungs or other organs in the chest or thorax. It was so extreme (even for a healthy adult) that they allowed us to come into the hospital in full PPE to see our baby before the surgery - and possibly to say goodbye. She lost a third of her lung during the procedure, but once again Mighty Mack recovered so well that the doctors were all blown away.

Miracles do happen!

The good news was that the mass was not cancerous! It was an abscess - a combination of bacteria and fungi which created this mass in her lung and was resistant to antibiotics. This was the cause of her ongoing infections and the seizures.

Mackenzie came out of the coma on July 18 and off the vent four days later. We then received the most incredible news: the results of her latest bone marrow biopsy. Despite her count having been at 6% at her last extraction six weeks before (after round one of chemo), she somehow managed to kill her own cancer cells while in a coma and her latest count was 0.1%!

There was literally no explanation for this and our oncologist called it a miracle! What this meant was that she was technically in remission. It also meant we could do the bone marrow transplant far earlier than expected and our transplant physician began scrambling to sort out donors.

Mackenzie started her second round of chemo on Monday, 26 July. It took 28 days, then we could do the transplant. We prayed that she would get her minimum residual disease count even lower as this would make the chance of relapse after the transplant far less.

• Follow @mightymack21 on Instagram for the latest on Mackenzie's progress.

Mack's transplant is successful

In early August 2021, Mackenzie was in remission and the process of looking for a bone marrow stem cell donor in South Africa and abroad could begin. On 25 August, we found out she had a match.

We needed to get her strength up after the coma. She'd lost so much strength, she couldn't hold up her own head or suck on a bottle. Mack was discharged in September. She had to return to hospital every 10 days for two weeks for more chemo to make sure she stayed in remission. We moved back to hospital in January 2022 for chemo which completely kills off the patient's existing bone marrow and entire immune system and then allows for the donor marrow to be infused and take over.

I was pregnant with our second daughter (who was born in late April 2022) so I could not be in hospital with Mack and Bronson. The chemo she was having was too dangerous to expose a pregnant woman to, so it was very frightening for me that it was going into my one-year-old. For two weeks, I visited and waved at her and Bronson through the window. On 14 January I was allowed to move back in with them - the day of the bone marrow stem cell transplant.

Then began the agonising wait to see if the new stem cells would graft. Reaching the 100-day post-transplant milestone was key. Those were not easy days. Mack contracted some serious infections along the way, and we and her army prayed for her health and progress. Thankfully, she made it through them all.

11 months and four days after Mack was first admitted to the Donald Gordon Paediatric Oncology Unit - as this Instagram post shows - she rang the unit's bell three times loudly to signal the end of her treatment and her total healing.

Today we have a perfectly happy, healthy little girl. She would never have survived had it not been for the person who signed up to the bone marrow registry where we found her match. It's all confidential so we don't know who they are, but we cannot thank them enough.

We couldn't have done this alone

We've learnt that the only way to deal with a cancer journey like this is in bite sized chunks. You take one step at a time, otherwise it becomes too overwhelming. We had a long road ahead of us but Mack is a truly spirited little fighter who kept beating the odds and amazing her doctors. We knew that she would continue to do so until we could get her through her transplant.

We couldn't have survived this extremely tough journey without the support of our incredible doctors, our wonderful family, friends and extended community, Mack's amazing Army. Mack's Army is literally hundreds of people working behind the scenes organising blood and bone marrow drives - and Discovery Health who really went the extra mile.

We are eternally grateful to every one of them for all their help and their care as well as their love and prayers.

• For more information on Mighty Mack's journey, visit the family's Instagram and Facebook pages.

A call to blood donors - please donate regularly

Mackenzie needed a blood transfusion every second day and platelets every other day because of her type of cancer. Mack's Army created so much awareness about donating blood that, according to Donor Relations Petitioner, Gladness Sathekge, the South African National Blood Service (SANBS) has received a lot of new donors. "We would like to request that those donors become regular donors. You can donate blood every 56 days," says Gladness.

Please register as a bone marrow donor and potentially save a life

Signing up to the registry is free and so easy. A simple cheek swab will determine whether you are a match. If you are ever matched to a person in need, the actual bone marrow donation is similar to undergoing a blood platelet donation - painless and simple too. Donors also don't pay a cent for the processes they go through.

You can join the following bone marrow stem cell registries in South Africa:

• Join the South African Bone Marrow Registry (SABMR). Registration is free and the recruitment process is quick and easy.
• Join the DKMS Africa bone marrow stem cell registry. Follow the simple steps outlined on their website. Registration is free and the recruitment process is quick and easy. This excellent DKMS Africa video explains it all in three minutes.

Megan adds: "We urge as many people as possible to sign up. These registries especially need people of colour to sign up. Mack was the only white child in the ward and the only one to receive a match. This is likely because we have European ancestry and there are more such people on local and global registries. DKMS Africa and the SABMR frequently share posts showing the wide range of people - adults and children - who need bone marrow donor matches. Their social media pages are worth following to understand the need."