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Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 193-194

Effect of sorcery on myeloid blasts


Department of Clinical Hematology and Stem Cell Transplantation, Dayanand Medical College and Hospital, Ludhiana, India

Date of Submission18-Feb-2021
Date of Decision04-Mar-2021
Date of Acceptance07-Mar-2021
Date of Web Publication30-Jun-2021

Correspondence Address:
Suvir Singh
Dayanand Medical College and Hospital, Ludhiana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_43_21

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How to cite this article:
Singh S. Effect of sorcery on myeloid blasts. Cancer Res Stat Treat 2021;4:193-4

How to cite this URL:
Singh S. Effect of sorcery on myeloid blasts. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Oct 22];4:193-4. Available from: https://www.crstonline.com/text.asp?2021/4/2/193/320068



It is the beginning of winter, and a chill is just settling over the Northern Indian plains. The sun is bright, and patches of blue skies and white fluffy clouds are visible everywhere – the two most pleasant months of the year. Slowly, from the West, you see a cloud of black smoke materialize, likely caused by a person of callous disposition who is setting their trash on fire. Pungent, upsetting, and sharply disruptive, it pushes you inside the room to escape, much like the lady in front of you.

She is unmarried, in her 30s, and accompanied by her brothers. One year ago, she experienced abdominal pain and fever, and her white blood cell count went up to 200,000/μl. Her spleen was confirmed to be intrepidly trying to cross the midline. A painful bone marrow examination was performed, and a real-time quantitative polymerase chain reaction (RQPCR) confirmed the presence of a BCR/ABL fusion transcript. The family hears the words “chronic,” “good,” and “>80% survival” being emphasized ad nauseam by their oncologist. Influenced by their extended family of uncles and aunts, they take a second opinion, and the same adverbs are stressed upon. The patient is prescribed imatinib, with the advice to follow-up every month.

As the patent period for imatinib ended a long time ago, it is available at throwaway prices in India, for as low as US$ 28 per month in places. That combined with the superlatives used by the oncologist should have ensured a relatively positive follow-up to this story. Chronic myeloid leukemia (CML) being the malignancy with the most dramatic turnaround over the past decade, you are confident as a physician.

Somehow, that logic does not penetrate the walls of the preformed notions and an overbearing culture. The proverbial cloud of black smoke creeps in, making them stop imatinib and seek other therapies. They are told about a healer who lives in a nearby hill town, well known for his ability to diagnose cancer by simply feeling the patient's pulse, treating it at the “origin,” and uprooting it forever. Somehow, they are impressed with the queue outside his hut. There are more than 150 patients in the queue, all diagnosed with some form of deadly cancer. Fittingly, their medical records and reports are well hidden out of sight inside their luggage.

She is prescribed a combination of drugs in different plastic bags. The patients are asked about their treatment history and advised to stop all chemotherapy medications, as they may interfere with the functioning of the drugs. RQPCR, bone marrow, and “chronic phase” take a backseat with this newfound spectacle, and she spends the next 6 months grinding the drugs, mixing them with a juice, and ingesting them as per instructions.

However, the pungent, repellent puff of black smoke rears its ugly head once more. While brushing her teeth one day, she sees a spot of blood on the gums. She ignores it and moves on. In 2 days, fever and body aches have truly set in, and she is unable to walk without support. The herbs do not seem to be having any effect. The family must now decide. To escape the cloud of black smoke, they must move through it to the clear air beyond. Paradoxically, they return to the same oncologist who was not able to break down the barrier of obliviousness that the family was forced to live within.

This time, the superlatives are far and few. It is now “acute,” “very bad,” and “<20%.” The haze lifts, and talk of chemotherapy, human leukocyte antigens (HLA) matching, and transplantation now takes the center stage. The cost of induction followed by transplantation is going to be at least US $28,000, and all of it will have to be paid out of pocket. Even if she goes through all this, the outcomes are grim. She still has no say in it. She silently accompanies her brothers and cousins as they make arrangements for her treatment. The most worried member in the family is her elder brother. Her wedding is 7 days away, and the invites have been sent out. How will he call everyone and tell them the wedding has been canceled?

Between diagnosis, treatment planning, and follow-up, there are myriad factors that decide whether a patient will benefit at all. Despite rapid scientific advances, there are a number of factors including social, cultural, and economic that might hinder the treatment. Even for a disease like CML, we are cautious when discussing the prognosis and outcomes with the patients and their caregivers. You admit the patient, start the chemotherapy, and get back to the clinic to tend to the growing line of patients with hematologic cancers. How many will accept the rhetoric of disease aggressiveness and prognosis given by you remains to be seen. Maybe the next few years will be different.

Meanwhile, the healer is comfortable in his hut, with a long queue having formed once more in the freezing cold. As you admit the patient and the bright red daunorubicin makes its way into her veins, the black puff of smoke makes its appearance, pungent, and disruptive.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.






 

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