Benzene Leukemia Law Blog : Benzene and Leukemia Lawyer & Attorney : Burke & Eisner Law Firm : Benzene Exposure, Non-Hodgkins Lymphoma

Myelodysplastic syndrome (MDS) is a cancer of the blood that can have a strong impact on the red blood cells, white blood cells and platelets. Research continues to be done on the illness and doctors are now better fine tuning the risk factors that are associated with myelodysplastic syndrome

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Among the most common risk factors that have been discovered are smoking, environmental exposures, cancer treatments and congenital diseases. In some cases, people have developed MDS with no apparent causes able to be linked; however, in the majority of cases, these risk factors have been associated with myelodysplastic syndrome.

A Detailed Look at Myelodysplastic Syndrome Risk Factors

Smoking- Researchers have concluded that the only lifestyle-related myelodysplastic syndrome risk factor is smoking. Although it’s old news that smoking is responsible for many types of cancer, including mouth, throat and lung cancer, not many realize that it can affect cells that don’t come into direct contact with smoke. 


Environmental Exposures: Environmental risk factors, most notably exposure to benzene, have been found to be the cause of MDS in many cases. When people are exposed over an extended period of time to benzene and other toxic chemicals, their chances of developing MDS and other life-altering diseases are increased.

Cancer Treatment: Cancer patients who have been treated with certain chemotherapy drugs have been found to be more likely to develop MDS. And combining these medications with radiation therapy only increases this risk further.

Congenital Diseases: Fanconi anemia is an inherited disorder that’s associated with an increased risk of developing leukemia or MDS as a child or young adult.


 

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A student from Charleston recently spent a somewhat frustrating and painful month indoors due to his severe aplastic anemia. Rob Willis is being treated at the Duke University Medical Center and can not so much as step outside or go into the sun due to his condition.

Willis is a senior at Capital High School and after two very intensive chemotherapy treatments is living day to day with severe aplastic anemia. Aplastic anemia is a group of diseases that effect the bone marrow and blood cells in the body. Although chemotherapy is a common treatment for the illness, in more severe cases, such as with Willis, the treatment doesn't always help.

However, after his time spent inside, doctors prepped Willis to receive a bone marrow transplant hoping that it would be the treatment that would return him to health. And they were right.  

Patient Receives Support from Friends and Family

Since his surgery, Willis has been on the road to recovery from his severe aplastic anemia and was recently crowned homecoming king by his peers.

"It was a great honor. It really showed how much everybody was supporting me," says Willis. "It made me feel a lot less distanced than I had to be. It's unimaginable how many people have taken notice of what has happened and been there."

Every year thousands of people are diagnosed with severe aplastic anemia and Willis is now devoted to educating people more about the illness and how they can lend a helping hand to those who are living with it.

What Caused His Severe Aplastic Anemia?

 In many cases, doctors are unsure as to what caused the patient to develop severe aplastic anemia. In Willis' case it was undetermined though his mother, Becky, says it was discovered when an ankle injury from soccer continued to plague Willis. Continuing infection and bleeding are two major signs of aplastic anemia since it effects the white and red blood cells.

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An article in the current issue of John Hopkins Magazine describes a clinical trial in which high doses of cyclophosphamide were used to relieve symptoms associated with multiple sclerosis(MS).  The treatment is also referred to as "HiCy."  Treatment with low doses over a long term had been used since the 1980s but the treatment came with some pretty serious side effects.  The inflammation of MS was reduced but patients became susceptible to infection and tumors.  

Doug Kerr, a neurologist at Johns Hopkins, and colleagues Richard Jones and Robert Brodsky had used high doses given over a few days to patients with immune diseases such as lupus and aplastic anemia.  The treatment had reversed disease progression with minimal toxicity. The idea behind the high-dose treatment for MS was to knock out the infection completely and hope that the immune system would rebound and behave better.

Their idea seems to have worked.  Of the first nine patients they treated this way, seven had reduction in disability after  two years.  Twenty-nine patients, including Chris Young, have been enrolled in a second trial with similar results and no adverse effects.

In 2004 Chris Young woke up barely able to move his body on the right side.  He was 29 when he was diagnosed with MS and his disease got worse over the next few years. It was October of 2007 when he found out about the Hopkins clinical trial, called and was accepted for the study.

His short term memory was awful.  Lists didn't really help because he would forget where he put the lists.  Five days after the treatment he woke up and everything was clear.  Within a week of treatment he could stand in the bathtub without holding on and three months later he was walking without a cane.

"In most therapies for MS, the goal is only to make the disease slow down a little bit. Here, people actually got better," says hematologist and oncologist Douglas Gladstone of Hematology Oncology Associates of Western Suffolk, in New York. Additional research by Gladstone, who served a fellowship at Hopkins in the late 1990s, has also shown the effectiveness of HiCy on 14 MS patients. "This potentially represents a new standard of care," he adds.

Kerr said that the next step is to have a blinded clinical trial at multiple centers.  While he is encouraged by the results, he emphasizes the need for further study.  His team is also working on combination drug therapies to be used for those whose MS did not go quiet with the HiCy therapy.

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Annie Dauer was told by her oncologist that she would need a stem-cell transplant to cure her non-Hodgkins lymphoma.  Because of chemotherapy involved, Annie was more concerned about what would happen to her ability to have children than anything else.  Her oncologist was not concerned about it but Annie insisted and was referred to a fertility specialist.  Now she has a two-year-old daughter and another one coming.

Welcome to the burgeoning world of oncofertility. As cancer survival rates climb and patients focus on quality-of-life issues, especially fertility, Dauer and others like her are forcing two very different medical specialties—oncology and assisted reproduction—to come together. "The narrative of cancer is no longer that it's a death sentence; it's a bump in your medical history that you overcome and go back to what we hope is a healthy lifestyle," says Teresa Woodruff of Northwestern University's Feinberg School of Medicine, who last fall received a first-of-its-kind $21 million NIH grant to develop ways of protecting cancer patients' reproductive health.

Of all those under 45 who have some form of cancer, about half will undergo toxic chemotherapy that will also target growing, fragile cells such as sperm, eggs and hair follicles.  The good news is that more options are becoming available to those who want to have children - men can bank live sperm to be used in an in vitro fertilization process, women can freeze eggs or ovarian tissue and for those with partners the freezing of embryos.  Hopefully the future will bring about ways to protect eggs and sperm from chemotherapy damage and perhaps the chemotherapy agents will be less toxic.

Up to now, few oncologists passed this vital information to patients, either because they were not aware of fertility advances, or because they were understandably preoccupied with saving lives. As the field grows (at least 50 centers now provide oncofertility services), more cancer docs are tackling the issue, and even altering treatments to aid fertility. Advocacy groups like Fertile Hope, which educate cancer patients about assisted reproduction, deserve credit for spreading the word. "It's being talked about more," says Nancy Lin, an oncologist at Boston's Dana-Farber Cancer Institute. "There's a growing awareness among doctors, and patients are more proactive."

In Annie's situation her fertility specialist removed an ovary and froze it to be used after she recovered from the chemotherapy.  Two years after her treatment Annie had a one-inch strip of ovary implanted just under her skin below the belly button.  The plan was that her doctor, Kutluk Oktay, would then harvest mature eggs, fertilize with sperm from Annie's husband Greg and implant them into Annie's uterus.  That never happened because, for some unknown reason, Annie's other ovary began to produce eggs and she became pregnant with her daughter Sienna. 

Oktay is at a loss for an explanation. "The healthy ovary may contain signals or hormones that may enable the [dormant] ovary to regenerate eggs," says Oktay. "That's the theory, other than a miracle."

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In Kolkata, India, a thirty-seven year old engineer, Kuntal Chowdhury, died after receiving  his chemotherapy treatment in the wrong way.

He was an engineer working with a nationalized bank when he was diagnosed in February with Non-Hodgkins Lymphoma, stage 2.  He was treated at Mumbai's Tata Memorial Hospital.  A month later he went for a chemotherapy treatment in Kolkata at the New Allipore Hospital under the care of his oncologist, Dr. Rajesh Jindel.

On June 18th he went for another treatment.  Dr. Jindel was not present when the anaesthetist  injected the drug.  The injection was supposed to be intravenous but it was pushed into Kuntal's spinal column.   Kuntal realized that it was wrong but it was too late.  His condition worsened starting with fever, vomiting and urine retention.  Paralysis settled in and he began to slowly slip away.  He was referred back to Tata Memorial Hospital.

On June 20, Kuntal was admitted there but the doctors could do little. Oncologist Reena Nair at Tata Memorial observed that the patient had developed "truneal ataxia" caused by a neurological disorder. Doctors there counseled the patient's family members about the condition and the possible outcome. Four days later, they came back to Kolkata and Kuntal was admitted to another private hospital. He was there till Wednesday.

The family has lodged a complaint with the state health department and the West Bengal Medical Council.  The president of the medical council has said they will investigate this and as soon as they get a reply from the doctor the case hearing will start.

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A study published in the May issue of the Journal of Pain and Symptom Management  indicates that a walking exercise program can  reduce fatigue levels in those AML( acute myelogenous leukemia) patients  who are being treated with chemotherapy.

Dr. Yeur-Hur Lai of National Taiwan University in Taipei and colleagues randomly assigned 22 hospitalized AML patients  to either a walking group or a control group receiving standard ward care.  The walking group walked 12 minutes each day for 5 days a week for a period of 3 weeks.  All patients were evaluated before chemotherapy and on day 7,14 and 21 of the chemotherapy.

The investigation found that those in the walking had lower levels of fatigue intensity and interference than the control.   They also found that symptom distress, anxiety and depression were lower in the walking group.

"Taken together, our preliminary findings suggest that a brief exercise-driven program, such as the walking exercise program, should be started at the beginning of chemotherapy to decrease chemotherapy-related fatigue," Lai's team concluded. "Standardizing the walking exercise program as part of a chemotherapy-related care model should be feasible and encouraged to improve cancer-related fatigue experiences."

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