Meghan Jenkins had her hands full with her toddler, Malachi. He was energetic and inquisitive, eager to explore the world around him. He loved anything to do with the Miami Dolphins and played constantly with dinosaurs and monster trucks. He was settling in at day care while Jenkins returned to work after taking a year off. Life was busy, but happy.

In March 2021, Jenkins noticed Malachi was tired and lethargic. He also had a lingering cough. One day, he threw up. When Jenkins changed his diaper, she found black stool. Immediately concerned, she and Malachi went straight to the emergency room.

Things moved quickly then, Jenkins said. Malachi was "connected to all these cords." Someone said he might need a blood transfusion. Hours passed with no answers. Jenkins grew more scared by the minute. Finally, Malachi was admitted to the pediatric intensive care unit, where doctors performed a bone marrow biopsy.

Finally, a doctor sat Jenkins down for the diagnosis: Acute lymphoblastic leukemia. She was told her little boy's life expectancy could be just two and a half to three more years.

"In that moment, you question God. You ask him 'Why did this happen?'" Jenkins said. "I was so lost. This was my only child. I was young still, going through life, trying to figure things out. And then I had a big hit."

What is acute lymphoblastic leukemia?

Acute lymphoblastic leukemia, or ALL, is a rare cancer that starts in the bone marrow, according to the American Cancer Society's website. Only about 6,100 new cases of ALL are diagnosed a year, according to the American Cancer Society, with children under the age of 5 having the highest risk of developing the disease.

ALL is a fast-growing cancer that results in the body producing immature white blood cells. Malachi's white blood cell count was more than 10 times higher than it should be. The white blood cells were crowding out healthy cells, weakening his immune system and making it impossible for his body to fight off infections.

ALL can quickly spread throughout the body and affect the lymph nodes, liver, spleen and other organs, as well as the central nervous system. Because the cancer grows so quickly, immediate treatment is key.

Malachi was already "quite sick" when he was diagnosed, said Dr. Julio Barredo, the director of pediatric cancer programs at Sylvester Comprehensive Cancer Center. She started Malachi on chemotherapy immediately.

Treating acute lymphoblastic leukemia

For the first month of treatment, Malachi was hospitalized. The first weeks of chemotherapy are intense, so staying in the hospital is often safer, said pediatric hematologist Dr. Aditi Dhir. Malachi had side effects including nausea and fatigue. He regressed in his potty training. Jenkins needed to wear gloves to hold him because of his compromised immune system. The toddler milestones she'd expected to celebrate were nowhere to be seen.

"There were days I didn't even think I was going to go on, but I had to," Jenkins said. "It was stressful. It was depressing, constantly being in there."

Still, the chemotherapy was clearly helping Malachi, Dhir said. She recalled seeing him run around the PICU within a week of starting treatment. Barredo said that Malachi handled the chemotherapy "as well as anybody could have handled it given the circumstances."

After the first month, Malachi continued chemotherapy at home. He took eight medications a day, Jenkins said, and spent several days a week in the hospital. Next came the "maintenance" phase, Barredo said. During this time, Malachi remained on oral medication and only needed to go to the hospital every few weeks, Dhir explained. The maintenance phase lasted for two years.

Finally, in August 2023, "the storm blew over," Jenkins said. Malachi was able to ring the bell that signified the completion of cancer treatment.

"You can't tell he ever had leukemia"

Today, Malachi is a "very loving" 7-year-old who excels in school, takes gifted classes and regularly appears on the honor roll, Jenkins said. He still cheers for the Dolphins and plays with dinosaurs and trucks. He's become a big reader and loves to share fun facts.

Most importantly, he is in remission. With acute lymphoblastic leukemia, the highest risk of relapse is within the first year of completing therapy, Barredo said. Malachi passed that milestone with flying colors. There's "some risk" of relapse in the second year, Barredo said, but Malachi and Jenkins marked that in August without incident. After two years, it "is quite unusual" for an ALL patient to relapse, Barredo said. Malachi has outperformed his initial prognosis, and the success of his treatment means "his life expectancy is like that of any other kid his age."

"You look at him, you can't tell he ever had leukemia," Barredo said. "For all practical purposes, he is pretty much cured at this point in time. ... He'll be able to do whatever he wants to do."

Malachi's immune system remains compromised, Jenkins said, but she hopes to build it up so can have a normal childhood going forward. The family is looking forward to "finally blossoming" after the years of treatment and trauma.

"This whole process was very hard. It's still hard. I have moments sometimes where I'm in shock, like I don't believe we went through this or this even happened," Jenkins said. "But there is a brighter situation. Every situation doesn't have this outcome. But there are brighter outcomes. There are happier days than just being in the hospital and being sad."

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