It was just another school day for nine-year-old Divya (name changed). About a year ago, she went to school on a Friday with what seemed like just a terrible headache. She returned home and her parents took her to the doctor.
Her family paediatrician knew it was more than just a headache, but she could not quite put a finger on what was wrong with her. Blood tests were ordered immediately, and when the results arrived the next day, everyone was in for a shock. For a healthy child, the white blood cell count in the body should not be more than 10,000. Her count was at 4,00,000 – forty times higher.
“This made her blood very thick, because of which it was not circulating properly. Brain activity was being affected, which is why she was having a headache, and she was slipping into a coma. While we had to save her life immediately, what was also becoming clear was that she had blood cancer, which presents with these symptoms,” explains Dr. Revathi Raj, Consultant Paediatric Haematologist at Apollo Cancer Hospital in Chennai.
Divya was rushed to Apollo Cancer Hospital, and despite being a Saturday night, all the necessary teams swung into action. “We knew her white blood count had to be brought down immediately. What we had to do to achieve that is remove her blood in small volumes and replace it with fresh blood from donors. This is called leukapheresis, which we have been doing for 15 years. There is a machine which does that and Apollo has it,” Dr. Revathi explains.
This is where facilities such as Apollo are required, the doctor says, because you need the paediatric critical care team, emergency team and the oncology team to work together as a single unit to treat children coming in with such medical conditions.
“We were able to bring the count to 100,000, so the girl gained some consciousness and spoke to us. But that was only going to last a couple of days. Her cancer was growing fast, and we had to start chemotherapy immediately,” she says.
Young Cancer
In India, at least 15,000 children (up to 18 years) are diagnosed with leukaemia – commonly called blood cancer – every year. In Apollo, it is the biggest cancer group that doctors see in children, which is why paediatric haematology and oncology are a single speciality. Several cases of brain tumours, lymphoma, abdominal tumours, bone tumours and eye cancer are also seen in children, but blood cancer is the most common, and is also an area of expertise at Apollo.
Blood cancer can present with either a very low or a very high blood count. When it is as high as in the case of Divya, it is a medical emergency. There are two types of blood cancer, acute lymphoblastic and acute myeloid. Divya had the myeloid type, which is more difficult to treat.
Cancer in children, generally speaking, presents with a major challenge and a minor advantage. Since kids grow at a much faster rate than adults, the growth of the cancerous cells is also faster. And because of that, they also present the symptoms clearly, making diagnosis easier in comparison with adults. “Which is why, although we see children of all age groups coming with blood cancer, we see a lot more cases in the 3-6 age group,” explains Dr. Revathi.
File image of Dr. Revathi with a patient.
The most important message for parents is that they should be convinced that leukaemia is curable. “And when we say ‘curable’, it means that the kids will grow up healthy, lead a normal life, go to school, go to college and will be able to give back to society – and that is in 9 out of 10 cases,” says Dr. Revathi. She says that the cure rate is just about 30% in adults with blood cancer, but 90% of the children can be saved.
This is not to say that the path to recovery is easy, and it certainly wasn’t for Divya.
Finding a permanent cure
While Divya’s cancerous cells were cleaned out with chemotherapy, it wasn’t the end of the road for her. Chemotherapy is tough on the body. “For leukaemia, we need to give high doses of chemotherapy, and that means there will be a lot of side effects like mouth ulcers, loose stools and pain in different parts of the body. The child needed a lot of supportive care for at least three weeks.” By then, all her leukaemic cells were gone.
Just as she was getting healthier under post-chemotherapy care, the results of some of the advanced molecular tests arrived. Not many hospitals in India conduct these tests, and Apollo has been doing it for the past two years. “Here we have an edge over other hospitals. With these tests, we are able to predict the types of cancer that are likely to come back despite the first round of treatment. If we know that the cancer will relapse, we can offer them a bone marrow transplant right at the start,” Dr. Revathi explains.
These molecular tests are state of the art. Through these tests, doctors examine the DNA of the cancer cells, enabling them to go to battle knowing the strengths and weaknesses of the cancer, and of the patient.
In Divya’s case, unfortunately the tests proved that she needed a bone marrow transplant. The cancer was destined to return later. A ‘haematopoietic stem cell transplantation’ was performed in her case. While chemotherapy is treatment, bone marrow transplant ensures the disease doesn’t get back and is only done for high risk patients.
“We also utilize advanced technologies in transplantation. For instance, in Divya’s case we did not get a complete bone marrow match anywhere in the world, among the 25 million people who have registered to be donors. She was very unique. However we now have the technology to even use the bone marrow from the half-matched marrow of her father, to create new stem cells, which are then transplanted. It is called haplo-identical transplantation and we have been doing such transplants for the last 4 years,” she explains.
“She is now in remission and has been coming for follow up treatment,” Dr. Revathi says with a smile.
“We want parents to understand that they should never lose hope. And when the cancer is curable, no child should die for the lack of funding, which is also our main focus. We have run several successful crowd funding campaigns. We can ensure a healthy future for these children,” she says.
This article is a part of a partnership series between The News Minute and Apollo Hospitals to bring you latest medical developments and inspiring stories. The article was produced by TNM Marquee in association with Apollo Hospitals.