hematopoietic stem cell transplantation for acute leukemia
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Acute leukemia might be usually perceived as uncommon blood cancer. In fact, it can suddenly attack anyone at any age, which includes Mr. Narongrit Wittayapreechakul, a 56-year-old patient. The initial condition was diagnosed as Myelodysplastic Syndromes (MDS), a group of cancers in which immature blood cells in the bone marrow do not mature and therefore do not become healthy blood cells including impaired platelet cell production. Disease subsequently progressed to “acute leukemia” in which the rates of being cured are considerably limited. After he received hematopoietic stem cell transplantation, a complete remission could be successfully achieved with improved quality of life. He can actively resume his daily life and activities.
“Unexpected day in my life”
I usually had a regular check-up every year. Until October 2017, my annual check-up results obtained from the hospital not far away from my residential area indicated that my number of platelet count was considerably low. A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood and mine was only 100,000. At that time, the doctor recommended me to have close follow-ups without no given treatments. Few months later, in December, I unfortunately slipped and got my mouth injured by hitting with the tree pots. Since there was severe bleeding in my mouth, it brought me to see the dentist in nearby hospital. The blood test revealed that my platelet count dramatically decreased to 70,000 platelets per microliter of blood. Some medications were then prescribed. And after taking these medicines, I came back for another follow-up in January 2018. This time, my platelet count became extremely low which was only 50,000 platelets per microliter of blood. It severely indicated the abnormalities of my blood system.
After I underwent bone marrow aspiration and biopsy, the result showed “Myelodysplastic Syndromes (MDS)”, defined as conditions that the blood-forming cells in the bone marrow are damaged. I further received oral medications with close monitoring. Nevertheless, my platelet count remained unchanged, only in the range of 50,000 – 70,000 platelets per microliter of blood without any significant improvements. After a 6-month treatment, my conditions progressed badly. I was additionally suggested to have advanced treatment in the injection form to prolong my life, otherwise I would be able to continue living only in the next 6 – 18 months. I truly admitted that it was probably the toughest time in my entire life. I was feeling so desperate. But I did not give up because I did not want to die. I was not ready to die. I started searching for other treatment options that might bring me hopes to survive and increase chances of being cured. From that initial point, I looked determinedly for expert and highly experienced hematologist who could light up my hopes.
Hematopoietic stem cell transplantation is a way to survive
After taking me a long while for searching, I eventually found “Professor Dr. Surapol Issaragrisil” a senior director of Hematology Center and Bone and Marrow Stem Cell Transplant Center, Bangkok Cancer Hospital. After realizing that he is highly specialized in bone marrow and stem cell transplantation, I decided to make an immediate appointment with him. After a full examination, the confirmative diagnosis was made that I had acute leukemia which was derived from my previous condition, Myelodysplastic Syndromes. The close follow-ups were made every 3 months in order to monitor my platelet levels. Until the worst time had hit me in July, 2018 when the platelet count went critically down to only 20,000 platelets per microliter of blood with the presence of immature blood cells in my bloodstream. I was informed by Prof. Dr. Surapol that it finally came to the point that we had to reduce leukemia cells urgently before treating this critical condition with hematopoietic stem cell transplantation.
“Hematopoietic stem cell transplantation or HSCT” is an effective method used to treat blood cancers (hematologic malignancies) including acute leukemia. Transplantation is considered new hope of a cure. It helps restoring the body’s ability to produce healthy blood cells after administration of high-dose chemotherapy to destroy most of leukemia cells. The marrow and stem cells could be obtained from an appropriately 100% Human Leukocyte Antigen (HLA)-matched blood related donor such as siblings or unrelated donor from The Red Cross Society. Collected marrow and stem cells are subsequently infused to the patient through a central intravenous catheter. As a result, leukemia cells are replaced with healthy functioning bone marrow, therefore the chances of being cured considerably increase especially in patients who received timely treatment.
Keeping my hopes alive
It was an extremely challenging task to find appropriate donor for me. Human Leukocyte Antigen or HLA is a group of complex proteins coated on white blood cell surfaces to determine whether a patient has a suitable donor for stem cell and bone marrow transplant. Unluckily, my older brother and younger sister are not my HLA-matched donors. My hopes were desperately diminished. However, Prof. Dr. Surapol extended my hopes by telling me that my last chance would be my daughters. During that period of time, I had continual blood transfusions since my platelet levels were consistently low, leading to active bleeding in gum and mouth cavity. I had to take pain killer drugs since I always had eating difficulties. Because my blood group is AB so it was increasingly difficult to find platelet transfusion with AB group. If it was emergency, blood transfusions with A, B or O groups were unavoidably accepted. Fortunately, I did not develop any serious effects after blood transfusions. I was only a bit tired. And I could actually continue my normal daily life, nearly 100% normal as before.
I have realized that my condition is not easy to be successfully treated but I am utterly lucky to receive treatments provided by Prof. Dr. Surapol. He has tried his best and put his effort to find treatment plan with the best possible outcomes. As a matter of fact, my bone marrow did not function properly and chemotherapy was highly recommended. If bone marrow were not normally produced, it might lead me to fatal complications and death. Prof. Dr. Surapol always ensured that his treatment plan provides both effectiveness and safety with less possible risks while my preferences and personal concerns were taken into his consideration at all times. In December 2018, my oldest daughter decided to donate her stem cells for my transplant. However, I was infected and my chin was swollen. This delayed the stem cell transfusion. I was praying for a quick recovery but it did not go that well. My overall health status was not healthy enough to receive bone marrow and stem cell transplantation. During my weak period before transplant could be performed, Prof. Dr. Surapol prescribed new chemotherapy drug, Venetoclax to prevent the aggravation of symptoms. In a combination with AraC, result was highly satisfied. In March 2019, I was healthily ready for bone marrow and stem cell transplant. Unfortunately again and again, I had terrible luck. Stem cells obtained from my oldest daughter could not be further used because my body had developed particular antibody during receiving previous platelet transfusions from different blood donors. This antibody reacts against the stem cells collected from my oldest daughter.
New life with diminished hope
My hope to survive was diminished day by day until Prof. Dr. Surapol decided to choose my youngest daughter to be the last choice of my donor. Her blood test conducted in January 2019 indicates that she does not have any antibody to specifically react against mine. As soon as she was defined to be my donor, her bone marrow and stem cells were collected. Eventually, I successfully underwent bone marrow and stem cell transplantation. After the transplant was performed, I had to continue being hospitalized for almost a month to make sure that my immune system worked properly with no serious reactions. Overall health status during hospitalization was actually appreciated apart from having blood in the urine which required the use of a urinary catheter. After being discharged, I had urinary retention that additional treatment was required. It was treated by bladder endoscopy, which was performed to stop active bleeding in the bladder. The follow-up interval was every 2 weeks. And blood tests had continuously showed positive outcomes even though anti-infectious drugs were prescribed during the first few months for fungal infections in the oral and ear cavity, skin peeling on hand as well as cracked and broken toenails due to suppressed immune function after transplant process. Other minor reactions caused by “graft versus host disease” such as eye and skin problems have been treated symptomatically. Currently, I have felt extremely close to normal since I could resume my daily activities and normal life. Good news that I recently can get back to the gym.
“Whatever it takes, I must survive”
During the whole treatment period, the most important thing to vitally drive me to survive is my family. I held my wife’s hand and hugged her every single day. We were totally committed to fight against this condition with our best hope to be cured. I have kept telling myself that I must survive, I must continue living my life with my beloved ones. I will never ever give up because my life is so precious. More importantly, Prof. Dr. Surapol is the candle of my life. He lights up my hopes and never lets me down whatever had happened. Every time when I meet him, he is incredibly warm and the way he reacts really touches my heart. From his great sympathy, compassion and mental support, I could complete my mission to fight with hopes. It brings me “new life” which I have never expected. I would like to also thank all nurses in the Hematology Center and Bone and Marrow Stem Cell Transplant Center at Wattanosoth Bangkok Cancer Hospital for their warm and excellent care. Whenever I need any help, they are always here to give hand with a true heart. Everyday of my hospitalization, my feeling is like being home with smile, laughs and happiness. What I have received is another lovely family that I will never ever forget.
From my heart to my patient
Mr. Narongrit was initially diagnosed with Myelodysplastic Syndromes (MDS) and subsequently it turned to be acute leukemia. Fortunately, he responded considerably well to the given chemotherapy drugs and achieved remission after bone marrow and stem cell transplantation. However, the most challenging part of his condition is his antibody production caused from platelet transfusions with different blood donors. Luckily, his youngest daughter could donate her bone marrow and stem cells to him, resulting in successful treatment outcomes. I always tell him that although this is difficult to treat, it can be treated and we must find the way.”