Understanding Acute Lymphoblastic Leukemia
- A 19-year-old cancer survivor from East Kilbride in South Lanarkshire, Scotland, was diagnosed with acute lymphoblastic leukemia as a child. Now, in remission, she’s inher second year at Edinburgh Napier University and pursuing a degree in child health nursing.
- Acute lymphoblastic leukemia is a cancer of the bone marrow. This cancer occurs when the bone marrow makes too many immature lymphocytes — a type of white blood cell.
- Leukemia is the most common cancer diagnosed in young children, like Katie Currie. In fact, three out of four pediatric cancer patients (including children and teens) will be diagnosed with ALL.
Now, the 19-year-old from East Kilbride in South Lanarkshire, Scotland, is in remission after battling acute lymphoblastic leukemia(ALL) and says her goal of becoming a nurse derived from her life-changing clinical trial.Read More
“I am living proof that clinical trials work and feel proud I took part in a trial that helped change in a positive way how some childhood cancers are treated,” Currie told Cancer Research UK.
“I was so young when I was diagnosed that I don’t remember much from then, but I do remember being in hospital and I remember the nurses,” the aspiring nurse added. “It is surreal to think about what I went through then and how far I have come. Now I’m keen to do everything I can to put something back and help the NHS.”
The clinical trial Currie underwent, dubbed ALLR3 and focused on a drug called mitoxantrone, was led by the University of Manchester’s Vaskar Saha, who researched how to better treatment for those who relapse with cancer.
“At that time, there was really no straightforward standard pathway for treating children with relapsed acute lymphoblastic leukemia. But there were many new things happening in the research,” Saha, who is now the Head of Pediatric Hematology and Oncology at Tata Medical Center in Kolkata, explained.
“One important thing was the discovery that you could monitor the response to treatment using molecular tools, what we call minimal residual disease (MRD), where you can detect one in 10,000 cells.”
The trial compared a chemotherapy treatment known as idarubicin, which was a normal care procedure for any patients who relapsed with ALL, to mitoxantrone.
Currie was one of 216 children and young people to take part in the trial.
The study ultimately found that over six out of 10 children (64.6%) who had mitoxantrone had cancers that didn’t grow back three years post-treatment, compared to less than four out of 10 children (35.9%) who had idarubicin.
Now, in 2022, mitoxantrone is known for increasing the survival rate by more than 50% in children whose acute lymphoblastic leukemia returned after the first round of treatment.
“We took it day by day, especially after she relapsed,” Currie’s dad Neil said. “When the cancer came back, you fear everything, but we spoke to the team about the trial and put complete faith in them.”
“We believed that, with the clinical trial Katie had the best chance of recovery. Without these trials, amazing new treatments may never be found. Mitoxantrone probably saved Katie’s life,” the cancer-surviving teen’s mom Siobhan added.
In an interview with The Herald, Katie’s dad said, “Katie has been through so much but she is resilient and so upbeat in all that she does. She just gets on with things and is so kind too. At an early age, she talked about being involved in medicine and we did ask if she was sure she wanted to go into that after all she had experienced, but she was adamant.
“Thinking back to those days of Katie’s treatment and relapse when she was so young, it is just amazing to be here now and for her to be off to Edinburgh following her dreams. Back then, we put our faith in the research and everything that goes on behind the scenes,” he continued.
Following Katie’s leukemia treatment, she lost vision in one eye due to Cytomegalovirus (CMV) retinitis, but she hasn’t let that deter her from following her dreams.
In regards to her studies, Katie said, “I think that my own experience has really helped me with my understanding with patients. The course is three years long and then I can choose where I focus on. I am just so pleased to be able to do this after my experience and to give back for the help I had.”
What is Leukemia?
Leukemia is a blood cancer. Acute myeloid leukemia, or AML, which starts in the bone marrow (the soft inner part of the bones), but usually quickly moves into the blood, according to the American Cancer Society, and can spread to other parts of the body like the central nervous system (brain and spinal cord).
Leukemia develops when the body produces large quantities of abnormal white blood cells. Because they’re abnormal, they prevent the bone marrow from producing any other type of cell, namely red blood cells and platelets.
Dr. Nina Shah, a hematologist at the University of California San Francisco, explains blood cancers in layman’s terms.
“One cell got really selfish and decided that it needed to take up all the resources of everybody else,” Dr. Shah tells SurvivorNet, “and in doing so, took up space and energy from the rest of the body.”
“In general having a blood cancer means that your bone marrow is not functioning correctly,” she continues. “And when your bone marrow doesn’t function correctly it mans that you can have something happen to you like anemia. Or you can have low platelets, which makes it possible for you to bleed easily. Or your immune system is not functioning correctly.”
Understanding Acute Lymphoblastic Leukemia
In general, acute lymphoblastic leukemia is a cancer of the bone marrow. This cancer occurs when the bone marrow makes too many immature lymphocytes — a type of white blood cell. These blood cells are critical to the immune system, as they help fight infections by attacking bacteria, germs and viruses.
“ALL is a type of cancer that is very aggressive,” Dr. Olalekan Oluwole, a hematologist at Vanderbilt University Medical Center in Nashville, Tenn., previously told SurvivorNet. “It grows very fast. Within a few weeks, a few months, the person will start to feel very sick. And that’s why we will have to give it an equally aggressive type of treatment to break that cycle.”
He said that many times, leukemia rests in the bone marrow, and because it’s an abnormal growth, it just keeps dividing.
Dr. Oluwole explained, “It doesn’t follow rules, and it doesn’t stop. Not only that, because this is part of the immune system, the immune system is sorta like the police of the body. So, those abnormal cells that have now become cancer, they have the ability to go to many places. They go into the blood, and they often go into the tissue or the lining around the brain.”
“By the time somebody comes to us and they have ALL, we already assume that it has gone everywhere in the body, and we have to treat them like that,” Dr. Oluwole added.
He said that many patients present with fever or infections because the bone marrow has “failed in its ability to make other types of blood cells.”
Leukemia is the most common cancer diagnosed in young children, like Currie. In fact, three out of four pediatric cancer patients (including children and teens) will be diagnosed with ALL, according to the American Cancer Society.
Cancer and Milestones
Milestones are the same for most people, from graduating high school and starting college to getting married and having children.
However, these events have a far more significant impact on cancer survivors and their families, like Currie.
According to the American Cancer Society, these signposts can often elicit a strong emotional reaction in survivors, especially the 84% of pediatric cancer patients who survive five years or more after their diagnosis.
Contributing: SurvivorNet Staff