Acute lymphoblastic leukemia in children | Dana-Farber Cancer Institute
Stephen Sallan, MD, of Dana-Farber/Childrens Hospital Cancer Center, describes symptoms, diagnosis and treatment for acute lymphoblastic leukemia in children. He also discusses the importance of creating a trusting relationship with young patients and their families. More on treatment for ALL: http://www.dana-farber.org/Ped....iatric-Care/Treatmen
Transcription:
Acute Lymphoblastic Leukemia is the most common malignancy in children. It’s malignancy of the bone marrow, where the blood is made. It presents itself in the children, because the bone marrow no longer is functioning. So, they come to us tired or pale, because they’re anemic. They come to us with fever or persistent infection, because they’re not able to make normal infection fighting cells. They come to us bleeding or bruising, because they can’t make the usual elements that clot the blood. And, using very sophisticated methodology, we make the diagnosis, usually on the day of their arrival. We start treatment on the day of their arrival, and today, we cure close to ninety percent of the children who come to us with this diagnosis.
Acute Lymphoblastic Leukemia is treated with chemotherapy, and we use many drugs over prolonged periods of time. The treatment regimen is pretty rigorous. It’s long; it’s about two years, total: The first three or four weeks often at the hospital, at Children’s, and the next couple of years in and out of outpatient clinic at the Dana-Farber and the Jimmy Fund Clinic.
The initial discussions with the families—who, by definition, are strangers to us and, we, strangers to them—starts with an interpersonal relationship: Who we are and to the best of our ability, who they are, the circumstances are always, always, highly distressing. We tell people the truth. We tell the parents, sometimes, the brutal truth, because they have to know all parts. We tell the children what I call the humanely tempered truth, which is, in fact, the truth. No lies, no lies. They need to trust us, because we’re going to ask a lot of them. So, from the truth, comes trust, and from conversations—one on the first day, or more. One or more on the second day—and gradually, over the course of the first few days, as we’re making the diagnosis and recommending the treatment, we establish a relationship. And, one of the absolute best parts of the whole kind of business and job, if you will, is maintaining those relationships for twenty-five, thirty, and forty years.
There is no question that, if you have to have a cancer diagnosis made, today is the best day in the history of the planet to have it, because today is better than yesterday and better than the day before. That’s universal. And I think, it’s really the interaction between so many different people: Our surgeons, our radiologists, our radiation oncologists, our pathologists, all the laboratory people behind the scenes, are all part of what makes this better each day. We just couldn’t do it without all members of the Children’s hospital and Dana-Farber communities
My greatest satisfaction is when one of my patients comes back to me years later, maybe for an annual checkup, and brings with them their own healthy child. That’s my definition of being cured.
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