Mitoxantrone

A long time since I blogged anything about leukaemia and medicine.

However, I have been pointed (thanks Andy - didn't realise until today you had commented way back when!) to this report on the Beeb about research just published in The Lancet regarding the highly successful use of Mitoxantrone in the treatment of relapsed childhood Acute Lymphoblastic Leukaemia. So successful in fact that the trial abandoned use of the traditional medication, Idarubicin - "Randomisation was stopped in December, 2007 because of differences in progression-free and overall survival between the two groups".

And seemingly the drug is cheap as well!

The Christie Hospital

The Christie Hospital in southern Manchester is the foremost treatment centre of adult and late "teenage" (sorry, Lucia) cancer in the north-west of England. My sister-in-law received treatment there and now my friend Rosie is being seen to there.

The hospital recently lost £6.1 million in the Icelandic banking system collapse. Most of this sum came from charitable donations. The government has set up a compensation scheme for those effected by the collapse, considering each application on a case-by-case basis. It has refused the Christie Hospital application. See the Christie Hospital press release here.

Although two planned "out-station" radiotherapy units in Salford and Oldham are not threatened, several important cancer research projects are unlikely to proceed.

There is an online petition on the Prime Minister's 10 Downing Street website protesting this decision. If you are a UK citizen, please sign it. Two parliamentary Early Day Motions (1037 and 1043) have been tabled about this. I note the Liberal Member of Parliament for my constituency has lent his support to the Christie campaign.

There is also Downing Street petition about the UK Bone Marrow Registry (sign up before April 6). Given the support Secretaries of State for Health, and for Children, Education and Families, as well as the Prime Minister's, for the late Adrian Sudbury's campaign for bone marrow donor education in schools and the DoH's cancer reform strategy, I am (not-) surprised at their negative attitude to the Christie Hospital application for compensation.

Unconnected Afterword: as a longtime (and still) socialist, I am rather impressed by my Liberal MP. As well as responding positively to my requesting he sign EDMs 754 and 900 regarding cancer, I am cynical that his delay in signing EDM 900 was due to his attendance at a UN meeting in Geneva on human rights in Kashmir. My cynicism? Many of his constituents are of Kashmiri-origin and his support of the Palestinian cause because they are Muslim. Anyway, I am happy that he has made cancer one of his "causes" (can I claim credit for that?).

Adrian Sudbury

Adrian Sudbury of Baldy's Blog, who led a massive campaign for bone marrow donation education, died from leukaemia last night. A Book of Remembrance can be signed here.

Gay men can donate bone marrow

Adrian Sudbury reports that although gay men cannot donate blood, they can join the two UK bone marrow registries.

Ironically, as I have reported before, I cannot as I live in a malarial zone ...

"MALARIA

Generally Not Acceptable

No - especially if within the last 12 months

Exception - if you have taken a full course of anti-malarial tablets, the timespan was longer than 12 months ago, and no symptoms are being experienced" (source - Anthony Nolan Trust)

- although Kezia could receive a bone marrow transplant from a donor who lives in a malarial zone.

Adrian on AlJazeera

Adrian Sudbury was interviewed by AlJazeera on Monday (Adrian's blog, AlJazeera and YouTube Part 1 and Part 2) - I hope it was put out on their Arabic channel as well.

A list of bone marrow registries worldwide can be found here.

Bone Marrow Donation - Education Policy Petition

Sign the petition to change education policy to require schools/colleges/other institutions to educate students about bone marrow donation on the Downing Street Website here.

The Politics of Bone Marrow

Following on from our post on the DWIB Leukaemia Trust, its attempts to establish a bone marrow register in an African malarial zone, and its attempts to register with the International Bone Marrow Register, I have been doing some research into why First World bone marrow donor registers refuse potential donors from a malarial zone, whatever their ethnicity (which, in this post for the sake of brevity I will refer to as Black, Asian and Caucasian. Equally, for the sake of simplicity, I will use the expressions 1^st, 2^nd and 3^rd worlds).

Results of my research:

1. There are two types of bone marrow transplant (BMT) – one through direct extracts of stem cells from bone marrow, one through stem cells present in the donor’s blood.
2. Malaria, whether symptomatic or asymptomatic (i.e. no symptoms but it is in your body) can produce alterations of stem cells necessary for bone marrow transplants) in that it produces immuno-depression and anaemia.
3. First World Registers appear to think that both of the two methods of stem cell transplant can result in malaria infection.

• First, they understand that a complete blood transfusion could transmit malaria. True.
• Second, I understand that a bone marrow transplant will not, in itself, transmit malaria as modern methods of stem cell extraction from blood separate the red blood cells attacked by malaria from the stem cells in the blood when it is donated and before transplant.
• Third, it would seem likely that asymptomatic malaria would lead to lower levels of stem cells in both bone and blood as the donor would likely be anaemic. However, anaemia can be tested for. It is also unclear (to me at least) what effect the stem cell growth factors, given to donors-by-blood before donation, would have on an anaemic donor.

The Canadian Blood Service even claims it cannot test for malaria! Bullshit - when everyday thousands of people across the world are tested for malaria with a simple technique that takes but an hour.

The results of First World bone marrow policies are prejudicial, and probably racist to say the least ...

Black and Asian people in the First World are prejudiced against in that they do not have access to donations from the Third World – an enormous potential, but as yet unrealized, resource. The DWIB Leukaemia Trust is setting up an example in Ghana. The health service in India and several other Third World countries (but not in Africa) are performing BMTs.

If the International Bone Marrow Register guidelines are not to use donors from malarial zones, then Third World countries are prejudiced against in that they cannot use donors from other malarial zones.

Certainly, I think international and national guidelines need to be revised along the following lines:

• First World donor searches should not reject searches in malaria zone registers but, if more than one equal match is found, then donor origin should be taken into account. If the matches are slightly unequal, a risk assessment protocol should be followed.
• First World donors recently resident in the Third World and Third World donors recently resident in the First World, both groups having recently been in malarial countries, should be allowed to register and have their blood tested for malaria/anaemia. This can be annotated to their records.
• Malarial zone to malarial zone matches should basically be totally permitted.
• If First World non-malarial countries do not want donors from malarial countries, they should at least allow access Third World countries to First World donors through the international register.

There we have it.

Medical/scientific/political knowledge greater than mine will be appreciated – please post in the comments or email me.

As one medical author I read put it, better a match with a donor from a malarial zone than no donor at all.

Let us hope Kezia never goes there.

Update: I note the South African register, a full member of the Global Register, stipulates donors must not have had malaria in the last 12 months rather than the stricter criteria of, for example, the UK register of not having been in a malarial area.