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Acute Lymphoblastic Leukaemia 

In July 2000 I was diagnosed with Acute Lymphoblastic Leukaemia. In Australia about 40 children are diagnosed each year. Of all the leukaemias it is the most common with children. Sometimes it is written ALL for short.

What is ALL?
Leukaemia is a disease of the white blood cells. Blood cells are produced in the bone marrow. They come from stem cells which are blood cells at their very earliest stage of development. The diagram below shows the two routes a stem cell can take to become a particular type of white cell, the lymphoid line and the myeloid line.

Lymphoblastic leukaemia occurs when a cancer starts in the lymphoid line. Immature lymphocytic cells (lymphoblasts) are produced and this is known as lymphoblastic leukaemia.

What causes ALL?
As yet the cause is unknown. I wish I knew the reason.

What are the signs and symptoms?
As the leukaemia cells multiply in the bone marrow, the production of normal cells slows down. Kids may become tired and anaemic, which is caused by lack of red blood cells. Bruises may show up on the skin. This is because of having low platelets. Other kids have aches and pains in the limbs, or may have swollen glands. I was sore in my hip area and I woke up at night with pain.  

What tests are used?
A blood test usually shows low numbers of normal white blood cells and the presence of abnormal cells. A sample of bone marrow needs to be tested. This procedure is called a bone marrow aspirate.  

Treatment
Chemotherapy is the main treatment for ALL and has several stages:

Induction: This phase aims to get you into remission again and lasts for four weeks. You have to take many medicines.

Central Nervous System treatment: ALL may develop in the brain and spinal cord. This is prevented by injecting a drug, usually directly into to the spinal fluid by means of a lumbar puncture. Kids normally have an anaesthetic but I have a local and I have it without sleeping.

Intensification: Additional chemotherapy drugs are given so that remaining leukaemic cells are killed off.  

Continuing (maintenance) treatment: This phase of treatment lasts for around 18 mths and involves daily tablets together with monthly injections of chemotherapy. During maintenance treatment most kids go back to school.  

Bone Marrow Transplant: Because I relapsed I had to have a Bone Marrow Transplant. This is only indicated for children with high risk ALL or for those whose leukaemia has come back following standard treatment.

Follow-up
Over 80% of children with ALL are cured. If the leukaemia comes back it normally does so within the first three years after stopping treatment. Mine came back after 17 months.  

Bone marrow and stem cell transplant

A bone marrow transplant aims to give people a new lot of healthy bone marrow and is given with higher doses of chemotherapy and radiation. This can be done by using bone marrow donated by someone else. This is called an allogeneic transplant. I am very lucky that my sister Nina was a full match. Out of Nina’s marrow the doctors get the stem cells. This was taken from Nina’s hip. From 400ml,this came down to about 40 mls of fluid after treatment in the laboratory. Stem cells develop into red cells, white cells and platelets.  

Allogeneic bone marrow transplant
The aim of this treatment was to give me a healthy source of bone marrow and to give me the best chance of getting rid of the leukaemia for good. Doctors measure if someone is a match by Human Leukocyte Antigen (HLA) out of six. Every person gets at least three from one parent. Doctors test brothers and sisters first. It is possible to use an unrelated donor if tests have shown his or her white blood cells are a good match with yours. Nina my sister was a six out of six match.  I was very lucky as she is my only sibling.

Nina’s bone marrow was removed using a general anesthetic.

The first stage of my transplant was to destroy my bone marrow completely. This was done firstly with radiotherapy which I had eleven sessions over 4 days. This was followed by four days of high doses of chemotherapy. After this I had one day off before I received Nina’s Marrow on the morning of Good Friday. This was done by the doctor pushing the concentrated stem cells into my central line.  

The new marrow - known as a graft - takes a few weeks to settle in my bones and to produce the new blood cells I need. Because of my low immunity I have to take certain precautions to protect me from infections until my white blood count has recovered.

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