Treatment for ALL with CNS relapse

12/20/2018

Respected Sir,

This is regarding my son SANIDHYA, Age10 years/Male and a case of B-cell ALL with CNS relapse. Child was diagnosed with B-cell ALL (SR) CALLA + in 26 March, 2013 and was started on chemotherapy as per ICICLE protocol. Therapy was completed on 29 /9/2015, however, the child started complaining of headache, nausea & vomiting from May, 2015. Fundus exam revealed features of papilledema. Cerebrospinal fluid (CSF) were done and showed CSF infiltration by leukemic blasts in a known case of leukemia on 16/10/2015. BMA studies were normal. Child was started treatment on CNS relapse protocol (UKALLR) ON 17/10/2015 and subsequent CSF studies were normal (cellular). Received cranial radiotherapy in February, 2016 and subsequently phase VI Maintenance cycles were continued. Since 1/5/2017, child again started having headache, nausea & vomiting. After repeat CSF studies showed CNS relapse (second time) on 17/5/2017. BMA was normal. It was decided that the child may be given palliative care treatment with triple intrathecal biotrexate (cytarabine, hydrocortisone and biotrexate) twice weekly, weekly, monthly and later in a gap of two months. The child again started complaining of headache on 14/8/2018 and was admitted for administering triple intrathecal and collection of CSF sample. The CSF study showed presence of blast cells. On 28/8/2018, the child was admitted for complaints of eye pain, seizures. He was given Inj. Phenytoin. BMA and MRD were also done. The BMA report revealed presence of few blast cells while MRD was positive with 4.4 percent. At that time, the child was continuously having seizures (despite administering of phenytoin tablet and levetiracetum oral solution) difficulty in swallowing, not able to speak, walk, see anything and not passing urine. The doctors give up the case and told that the disease has spread and the child was sent home. In the meantime, the child also developed frequent watery motions with mucus and pus passing out. When contacted over phone, they said that only support treatment could be given , if the child is brought to the hospital. This was the time, when the father of the child shouldered upon him the responsibility of caring and curing him his little one with his little knowledge of herbs, herbal medicines, over the counter medicines and allopathic medicines also. At present, the child has recovered from majority of the problems mentioned above except his vision (complete blindness), speaking ability (speaking in-articulated words only) and hemiparesis in right shoulder. The CECT head reveals: Findings likely sequelae to ischaemic changes with cerebral atrophy.

Thanks & regards,
SUKHDEV DUBRUWAL,
Mobile No. 9958045593,
E- Mail Address: sdubruwal@gmail.com

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