Daniel Mădălin Răduță

In brief

Leukemia is a a cancer of the blood. Unlike other types of cancer, it is an insidious disease, but one which first manifests itself suddenly and acutely.

Within the tissue of the bone marrow, there are cells which differentiate (produce specialized copies of themselves) into blood cells, both red (oxygen-carriers) and white (the agents of immunity, which fight diseases). Some mutations can lead to production of new, disfunctional types of white blood cell-producing cells. This is called leukemia.

Worse, sometimes these “broken” cells reproduce an increased rate, so that they eventually replace all the normal ones in the bone marrow. Eventually, no healthy blood cells are produced by the bone marrow, which means the sufferer’s immunity is reduced to zero and the blood doesn’t clot normally so even trivial problems like otitis or a scratched knee can be lethal.

I was diagnosed with acute lymphoblastic leukemia in October 2009. I have been following a cytostatics regimen ever since. The treatment has worked so I am now in a remission, which means that I have no outwardly symptoms of the disease. However, the type of leukemia I have and my case history indicate an increased risk of relapse (that is, the illness could come back
at any time, indeed it is somewhat probable that it will do so).

The recommended course of treatment for me at this time is that I undergo hematopoietic stem cell transplant (that is, I should get bone marrow from a donor). There is some urgency to this recommendation, as my chances of surviving and leading a disease-free life after such a transplant are the greatest now, after the first remission and before a relapse.

In my case, this procedure cannot be performed in Romania, but only abroad. The cost of such a transplant is somewhere between 120 000 and 150 000 €.

Survivors

Leukemia is a killer. However, with the right treatment, a positive attitude and a bit of luck, it can be defeated – and many have! Here’s a couple of examples:

Jose Carreras, the famous tenor, had a bone marrow transplant in 1987 – you know the rest.

Maarten van der Weijden, a Dutch swimmer was diagnosed in 2001. In 2008, he won an olympic title.

The long story

If someone were to see me now, while I am in remission, their first thought would be “What on earth do you need a transplant for?!? You look great!”. I do look fine and I also feel OK, right now. However…

The kind of leukemia I suffer from – acute lymphoblastic leukemia, is characterized by a fulminating evolution – cancerous cells multiply
extremely fast. If it isn’t treated, it kills the sufferer in only two or three months.

I am no exception to that rule: In March 2009 I had excellent results in a routine blood test, while in October I was down with a fever of 40 degrees Celsius, I was only active and awake for six hours a day. This was because my bone marrow was 99% cancer cells and my blood was 70% cancer cells.

After being diagnosed I had a pretty rough course of chemo, which has taken me all the way to remission – that is, I have now less than 5% cancerous cells in my bone marrow, so I can say that the disease is under control.

Chemotherapy is a name for medicines which are injected into the bloodstream to kill cancerous cells, but which also kill most of the
healthy cells. It is hoped that in the end only the normal cells will remain and “take over”. unfortunately, these medicines are very toxic and damage everything, especially the internal organs such as my liver. Large doses of chemotherapy drugs can even produce permanent damage to internal organs.

The fact that I entered remission after a relatively long period of chemo and the type of cancerous cells place me at high risk of relapse. A relapse would mean that the disease would come back even more forcefully than before. A longer chemo regimen, with higher doses and lower chances of remission would be my only option in this case, leaving me with a pessimistic prognosis.

That’s why my doctors have recommended that I have a bone marrow transplant as soon as possible. A transplant would greatly reduce the risk of relapse, as my sick hematopoietic stem cells would be replacced with stem cells from a healthy person. However, I cannot get healthy stem cells from just any person – the new cells need to resemble my own (this is called biocompatibility), so that my body doesn’t reject them and try to kill them (such an over-reaction would be fatal, eventually).

So, the more similar the donor’s cells, the less treatment I would need to avoid an immune reaction. In Romania, today, bone marrow transplant is only possible between 100% compatible donor and acceptor pairs – only 25% of leukemia patients are ever paired with a 100% compatible donor. In comparison, in Italy for instance, stem cell transplants from donors which are only partially compatible are routinely perfomed since 1995! This is because the Italian medicine was a bit better managed.

In conclusion, my best chance at survival would be to undergo a stem cell transplant in a hospital in Italy or elsewhere in the developed world, where there is knowledge, experience and equipment available. The only (big) hurdle I have to pass is that such a transplant (and the associated care) costs very much, to the tune of 120 000 to 150 000 €.