What science has learned from treating leukemia patients like Jim Stewart gives Alex Myers a better chance

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Republished online as originally printed in the Post-Gazette Dec. 23, 1997.

"Never did I think that in my lifetime I'd be able to say to a parent: 'Your child will survive,' " said Dr. Vincent C. Albo, pediatric oncologist at Children's Hospital.

"When I had to tell parents that their child had leukemia, the next sentence always was: 'He is going to die.' "

Carol Stewart remembers those chilling words, spoken on Nov. 15, 1976. Her son Jim, who was 7, had been treated for more than two months for unexplained broken bones. He was pale, and the already skinny second-grader had lost weight.

"I got down on my knees to beg doctors to tell me my son's problem," she said.

Because diagnoses ranged from anemia to juvenile rheumatoid arthritis, Stewart did not immediately take Jim to Children's in Oakland. But a pediatrician from Children's insisted on certain tests, and Jim was admitted.

The results: acute lymphoblastic leukemia - the overproduction of abnormal white blood cells.

"(Doctors) said Jimmy would go into remission, but the longest it would last was 18 months," said Deloris Farley, 78, Jim's grandmother.

Between vicious cycles of chemotherapy and radiation, Jim was tutored at the family's Brighton Heights home.

"His first tutor said 'let's have fun' because he wasn't going to live," Farley said.

Increasing survival rates

To his mother and grandmother, Jim, 28, is a medical miracle.

To doctors, he is a man who was diagnosed with the most common form of childhood leukemia at a time of research advances.

"By 1977, we had moved into the modern age," said Dr. Marshall Lichtman, executive vice president of research and medical programs for the Leukemia Society of America.

From 1965 to 1970, 90 percent of the children diagnosed with leukemia died, and from 1965 through 1989, the survival rate rose to 50 percent, said Albo, 64, Jim's former doctor.

"The kids living with leukemia for only three months are now living forever," he said.

Alex Myers, 6, of Oakmont is one of the 1,750 children diagnosed with acute lymphoblastic leukemia this year who are realizing the benefits from the treatment Jim and other patients received 20 years ago.

Alex has a 92 percent chance for survival, Dr. Jeffrey Hord, Alex's pediatric oncologist at Children's.

In his fifth month of treatment, the first-grader now is in an intense period of chemotherapy to find undetected leukemia cells.

The learning curve

The first major breakthrough in leukemia treatment was 50 years ago, when the chemotherapy drug methotrexate was discovered. The drug, injected into the spinal fluid, kills proliferating leukemic cells.

"Until that time, a child could not go into remission," Albo said. "With methotrexate, he went into remission for (several) months."

By 1955, doctors at pediatric hospitals across the country decided to work cooperatively to try to come up with a cure for childhood cancer.

There are now 115 pediatric hospitals, including Children's, in the United States, Canada and Australia that are part of the Children's Cancer Group. ?They continue to devise and refine treatments for the more than 15,000 children diagnosed each year with various kinds of cancer. The National Cancer Institute supports the programs.

Another group of 100 hospitals, called the Pediatric Oncology Group, also works together in the same way.

"That has been a big part of why survival has improved," Hord said. By the time Jim Stewart was diagnosed in late 1976, the cancer group had learned the importance of combining chemotherapy drugs and steroids in attacking leukemic cells.

They had also found that when they attacked leukemic cells in the spine with radiation treatments, children went into even longer periods of remission.

"With that, the relapse rate in the central nervous system went from 70 percent to 5 percent," Albo said.

But it took almost another 10 years, however, for the effects of radiation on children's delicate spinal columns to become apparent.

Like Jim Stewart, children who had this treatment would eventually have trouble grasping mathematical concepts. With that discovery, the radiation intensity was reduced, but the cognitive problems did not disappear.

Problems were exacerbated for Jim because just as his treatment was ending in 1979 leukemic cells appeared in his testicles. Doctors continued radiation for two more years.

During these procedures, many of Jim's veins had collapsed. It was harder and harder to find usable veins. Sometimes the drugs leaked, burning his hands.

"I remember I'd grab my grandma by the throat it hurt so much," Jim said.

While the arduous treatments Alex receives are unnerving - and the drugs' side effects can be fierce - advances made during treatments of children like Jim in the past two decades have made tremendous differences in long-term survival.

Consider:

• Doctors know to continue treatment in boys for three years, three months to prevent reoccurence of leukemic cells in the testicles. For girls, the treatment remains at two years.

• Doctors learned to provide different levels of treatment to low-, intermediate- and high-risk children. High-risk children may still receive radiation.

• Topical anesthetics can now be applied to prevent pain from injections, and the plastic device inserted in the child's chest for the duration of the treatment has eliminated the problems of finding open veins.

Jim Stewart's life

Jim is a large, quiet man who drives a truck for Goodwill Industries business division. He is more animated and enthusiastic when he describes his weekend and evening volunteer stints for the American Red Cross emergency services. Last week, he dressed up as Santa Claus for a local party.

In the midst of a divorce after five years of marriage, he has moved in with his mother and grandmother.

He is prone to bronchial infections and must take testosterone monthly because of the radiation damage to his testicles. He is sterile. He graduated with his Oliver High School classmates in 1987 after struggling through special classes.

In a medical world spinning with absolute numbers, percentages and predictions, he defied the slim odds given him 21 years ago.

In those early, scary years, Jim often sneaked into bed at night with his mother.

"He told me he knew he might not live," said Carol Stewart, 51. "I didn't want to die at night," Jim said.

Now, he often falls asleep with the television on.

The voices in the background remind him that he is very much alive.



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