Friday, July 9, 2021

Warriors and Survivors

 Children Cancer Stories by Rukh Yusuf - Blog # 13


















I am Rukh Yusuf, Clinical Pharmacist, also specialized in Total Parenteral Nutrition and Bone Marrow Transplant. I have been working in Pediatric Oncology unit of a public hospital for several years. The mission of this blog is to bring to you the real-life stories of child patients suffering from cancer. Cancer is still a difficult disease to handle and treat. However, when it strikes the children, some so young that they cannot even speak, their agony is beyond expression and words. Let us pray especially for children suffering from cancer for early and complete remission. May Allah shower His Merciful Blessings upon them. Aameen.


It is difficult to call “Warrior” or even “Survivor” to a two-year-old Zainab who is too young to understand her disease and condition. Zainab is the first child of her parents and belongs to middle class family of Lala Musa.

Few months ago, Zainab’s mother felt mumps and swelling on her face and neck. The parents consulted a physician in Lala Musa and Zainab got better after some initial treatment. After few days, she developed swelling on her arm at canula site.

She was examined by a couple of pediatricians one after another in her city, but nothing was diagnosed and her condition did not improve as well. The Child Specialist asked for CBC and blood culture, CBC showed raised WBCs and the physician suspected infection or some malignancy. She was referred to pediatric hospital in Lahore. Zainab was diagnosed as case of T-cell ALL after few tests at a hospital in Lahore.

T-cell acute lymphoblastic leukemia (T-ALL) is aggressive and progresses quickly. It affects the lymphoid-cell-producing stem cells, in particular a type of white blood cell called T lymphocytes as opposed to acute lymphoblastic leukemia (ALL) which commonly affects B lymphocytes.

In most cases of T-Cell ALL there is no obvious cause, and it is not passed on from a parent to a child (inherited). T-ALL is most common in children and T-ALL affects males more than females at all ages.

Symptoms may include anemia, weakness, tiredness, shortness of breath, palpitations. Infections are more frequent, more severe, and last longer. Fever, malaise (general feeling of illness) and sweats, purpura (small bruises in skin), nosebleeds and bleeding gums are also common symptoms. Other important signs and symptoms include swollen lymph nodes in the middle part of the chest (mediastinum) which may affect breathing or the circulation.

Diagnosis usually involves blood counts, bone marrow biopsy and flow Cytometry.  Staging is not used for T-ALL, because it spreads throughout the body when first diagnosed. Most cases of T-ALL are classed as high risk. With appropriate treatment, they have a very good chance of successful treatment.

Virtually all patients with T-ALL should start treatment immediately. The main ways in which leukemia is treated are chemotherapy, steroids, and radiation therapy. Radiation therapy is usually given only as part of a stem cell transplant in T-ALL. Younger, suitable patients may be given a stem cell transplant (bone marrow transplant). This is done using healthy stem cells from a donor. Transplant is usually done for T-ALL if chemotherapy does not cure the disease.

Zainab received chemotherapy and completed her induction successfully; her post induction report was satisfactory. The parents were satisfied about treatment and relaxed to see progress. But their relief did not last longer. To their dismay, after couple of weeks she again developed fever and swelling and was admitted again. Treatment and diagnostic tests were done, and it revealed that her disease had relapsed.  Doctors said, her further treatment was not possible as patients with relapsed T-cell acute lymphoblastic leukemia (T-ALL) have limited therapeutic options and the disease had poor prognosis. 

The news was disheartening for a mother whose only child is suffering with such a disease with no or minimal hope for cure. Zainab is on palliative treatment only; her parents and family are approaching different experts to find some solution for the sickness of their little angel with tears and hope in their eyes.  Poor Zainab is not in a position to know about her current and future life. She is living as happily as she can, in her innocence.

There is some development in Zainab’s treatment, some new finding have been found in more diagnostic tests. I will update about this when the information is completed.

We all pray for Zainab’s recovery and ease for her family. Aameen

 

Note: names have been changed to protect identity.

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Blog Post # 03 by Rukh Yusuf