Category Archives: Leukemia

Part 2: Understanding Medical Treatment Protocol for Childhood Leukemia

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This article comes in two parts: Part 1: The Tragic Story of An Eleven-Year-Old Boy With Leukemia

Understanding the Symptoms

In leukemia patients, the normal development of the blood cells is disrupted and they are being crowded out by abnormal, immature blood cells. The full blood picture (FBC) of such patient shows abnormal blood counts. The patient is anemic with low red blood cells, haemoglobin, and platelet counts. The white blood cell may be high or low but there is usually neutropenia (low number of neutrophils).  Lactic dehydrogenase (LDH) level is usually raised.

Since leukemia is a disseminated disease it also produces a wide variety of other symptoms such as:

  • Rheumatoid arthritis fever.
  • Hyperparathyroidism (overactivity of the parathyroid glands resulting in excess production of parathyroid hormone).
  • Bone pain which may result in a limp, refusal to walk or localized discomfort of the jaw, long bones, vertebral column, hip, scapula and ribs.
  • Swelling of the liver, spleen and lymph nodes. Hepato-splenomegaly occurs in approximately two thirds of patients with ALL. About fifty percent of patients showed asymptomatic lymphadenopathy.
  • Paratracheal or mediastinal adenopathy and thymus enlargement may result in mild to severe respiratory symptoms.
  • Nephritis (kidney inflammation). Renal involvement by ALL can result in hematuria (blood in urine), hypertension and renal failure associated with nephromegaly.
  • Meningitis (inflammation of the protective membranes covering the brain and spinal cord). Meningeal involvement can result in severe headache, emesis (vomiting) and papilledema (optic disc swelling caused by increased intracranial pressure).

Central Nervous System (CNS) Leukemia

  • Less than 5 percent of children have evidence of CNS 2 at diagnosis (CNS 2 means less than 5 WBCs/ul but blasts are present). Unless adequate CNS preventive therapy is administered the majority of patients will eventually develop CNS disease.
  • CNS leukemia is presumed to develop either from the spreading or seeding of the meninges (membranes enveloping the central nervous system) by circulating leukemic cells or by direct extension from involved cranial bone marrow.

Testicular Leukemia

  • Clinically evident testicular involvement is rare at initial diagnosis but overt disease occurs in approximately 10 to 15 percent of boys with ALL.
  • Clinically overt, testicular leukemia presents as painless testicular enlargement that is usually unilateral.
  • Although it is believed that the testes are a leukemic sanctuary site, protected from systemic chemotherapy by a blood-testes barrier, animal studies suggest this is not the case.

Lymph Nodes

Nodal involvement is a characteristic feature of ALL and is often responsible for bringing the patient to medical attention. Typically the lymphadenopathy is generalized and enlarged nodes are painless and freely moveable. Nodal enlargement is an indirect measure of tumour burden and has been associated with prognosis.

Evaluation of the Patient

The diagnostic evaluation of a patient with acute leukemia is a comprehensive process involving:

  • Detailed history.
  • Complete physical examination.
  • Morphologic and laboratory assessment of peripheral blood and bone marrow, blood chemisty, comprehensive clotting studies, a lumbar puncture and CSF (cerebrospinal fluid) examinations.

Diagnosis

  • The diagnosis of acute leukemia entails a stepwise approach. First in sequence and importance is the distinction of acute leukemia from other neoplastic diseases and reactive disorders. Second is differentiating acute myeloid (AML) and acute lymphoblastic (ALL) leukemia. The third facet is the classification of AML and ALL into categories that define treatment and prognostic groups.
  • Approximately 80% of cases of ALL have a B-cell precursor immunophenotype.
  • Approximately 15% of ALLs have an antigen profile of T-cell precursors (thymic T cells).
  • A small group of cases (<5%) of ALL have the immunophenotypic profile of more mature B cells, i.e., surface immunoglobulin.

Prognosis

The prognosis for ALL differs between individuals depending on a variety of factors:

  • Gender: females tend to fare better than males.
  • Ethnicity: Caucasians are more likely to develop acute leukemia than African-Americans, Asians or Hispanics. However, they also tend to have a better prognosis than non-Caucasians.
  • Age at diagnosis: children between 1–10 years of age are most likely to develop ALL and to be cured of it. Cases in older patients are more likely to result from chromosomal abnormalities (e.g., the Philadelphia chromosome) that make treatment more difficult and prognoses poorer.
  • White blood cell count at diagnosis of less than 50,000/µl
  • Cancer spread into the Central nervous system (brain or spinal cord) has worse outcomes.
  • Morphological, immunological, and genetic subtypes.
  • Patient’s response to initial treatment.
  • Genetic disorders such as Down’s Syndrome 

Cytogenetic, Molecular Studies and Immunonophenotyping

Robert McKenna (Multifaceted Approach to the Diagnosis and Classification of Acute Leukemias in Clinical Chemistry August 2000 vol. 46 no. 8 1252-1259) http://www.clinchem.org/content/46/8/1252.long, wrote:

  • Until recently, the diagnosis and classification of acute myeloid (AML) and acute lymphoblastic (ALL) leukemias was based almost exclusively on well-defined morphologic criteria and cytochemical stains. Although most cases can be diagnosed by these methods, there is only modest correlation between morphologic categories and treatment responsiveness and prognosis.
  • The expansion of therapeutic options and improvement in remission induction and disease-free survival for both AML and ALL have stimulated emphasis on defining good and poor treatment response groups. This is most effectively accomplished by a multifaceted approach to diagnosis and classification using immunophenotyping, cytogenetics, and molecular analysis in addition to the traditional methods.
  • Immunophenotyping is important in characterizing morphologically poorly differentiated acute leukemias and in defining prognostic categories of ALL.
  • Cytogenetic and molecular studies provide important prognostic information and are becoming vitally important in determining the appropriate treatment protocol. With optimal application of these techniques in the diagnosis of acute leukemias, treatment strategies can be more specifically directed and new therapeutic approaches can be evaluated more effectively.

Cytogentics is an important predictor of outcome. Some cytogenetic subtypes have a worse prognosis than others. These include:

  • A translocation between chromosomes 9 and 22, known as the Philadelphia chromosome, occurs in about 20% of adult and 5% in pediatric cases of ALL.
  • Not all translocations of chromosomes carry a poorer prognosis. Some translocations are relatively favorable. For example, Hyperdiploidy (>50 chromosomes) is a good prognostic factor.

Cytogenetic change

Risk category
Philadelphia chromosome Poor prognosis
t(4;11)(q21;q23) Poor prognosis
t(8;14)(q24.1;q32) Poor prognosis
Complex karyotype (more than four abnormalities) Poor prognosis
Low hypodiploidy or near triploidy Poor prognosis
High hyperdiploidy (specifically, trisomy 4, 10, 17) Good prognosis
del(9p) Good prognosis

Source: http://en.wikipedia.org/wiki/Acute_lymphoblastic_leukemia

Immunonophenotyping

The importance of defining the immunophenotype in ALL lies in its correlation with response to treatment and prognosis  In childhood ALL, immunophenotype is a major factor in determining the chemotherapy protocol. The immunophenotypic prognostic groups of ALL are shown in below:

Favorable B-cell precursor (CD10+) (Cytogenetic findings influence prognosis)
Less favorable B-cell precursor (CD10−)
B cell (Slg+; Burkitt cell leukemia)
T cell

B-cell precursor ALLs have a more favorable prognosis than the other groups; however, within the B-cell precursor category, there are subsets with a poor prognosis. Most of the favorable and unfavorable prognostic groups of B-cell precursor ALL can be identified by their cytogenetic karyotype or molecular features.

Treatment for Chilhood ALL

Nearly 30 years ago, Dr. Donald Pinkel developed the concept of total therapy and demonstrated that childhood leukemia could not only be cured but CURED in approximately half of the patients. But note that acute leukemia in children is very different from the adult version of the disease.

The cornerstones of this successful treatment were:

  • Multiple drug combination chemotherapy.
  • Administration of different sets of drugs for induction and continuation of remission.
  • Specific meningeal therapy.
  • Intensive antimetabolites and alkylating agent treatment immediately after remission induction.
  • Cessation of all therapy after 2 to 3 years of continuous complete remission.

One of the most remarkable occurrences in the history of ALL therapy is the fact that there have been NO new agents introduced in the front-line therapy of ALL for the past 25 years. The same eight types of agents have been used in newly diagnosed patients since the early 1970s.

  1. A vinca alkaloid (vincristine).
  2. A corticosteroid (prednisone, prednisolone or dexamethasone).
  3. Asparaginase (four types are currently available).
  4. An anthracycline (daunorubicin or doxorubicin)
  5. An antifoliate (methotrexate).
  6. An antipurine (6-mercaptopurin or 6-thioguanine).
  7. Antipyrimidine (cytarabine), and
  8. An alkylating agent (cyclophosphamide).

Four main treatment phase or blocks are adopted by various treatment centres or international co-operative groups in their treatment protocols for ALL.

  1. Remission Induction phase
  2. CNS Preventive / Sanctuary Therapy
  3. Consolidation or  intensification phase
  4. Maintenance phase

REMISSION INDUCTION PHASE: The goal of this phase is to kill the leukemia cells in the blood and bone marrow. The treatment comprises a backbone of three systemic agents: a glucocorticoid, vincristine and L-asparaginase for standard-risk cases. Many treatment protocols add a fourth agent such as an anthracycline for high-risk cases.

The treatment is delivered over 4 to 5 weeks with the goal of achieving complete remission – meaning that leukemia cells are no longer found in bone marrow samples and the blood counts become normal. A bone marrow test is taken at the end of induction treatment to confirm whether or not there is still has leukemia. The bone marrow sample is looked at under a microscope. But take note that a remission is not the same as a cure.

More than 95% of children with ALL will go into remission after one month of treatment. A rapid early response to treatment, measured by the clearance of blasts from either the bone marrow or peripheral blood, has been shown to predict better treatment outcome.

CENTRAL NERVOUS SYSTEM (CNS) SANCTUARY THERAPY: Intrathecal Chemotherapy / Radiotherapy

Anticancer drugs given by mouth or injected into a vein to kill leukemia cells may not reach leukemia cells in the CNS (brain and spinal cord). The leukemia cells are believed to have the ability to find sanctuary (hide) in the CNS. CNS sanctuary therapy is also called CNS prophylaxis because it is given to stop leukemia cells from growing in the CNS.

All children with ALL receive CNS sanctuary therapy as part of their treatment and may start simultaneously with the remission induction therapy phase.

CNS treatment involves injecting a drug, usually methotrexate, directly into the spinal fluid. This procedure is referred to as intrathecal chemotherapy and is done during a lumbar puncture.

Some patients who have a relapse in which leukemia cells are found in one part of the body (such as the cerebrospinal fluid or the testicles) but are not found in the bone marrow. These children may have intense chemotherapy, sometimes along with radiation treatment to the affected area.  Radiotherapy to their brain (cranial radiotherapy) is not done if the patient is younger than two years old.

Those with T-cell leukemia or cancer cells in the CSF, may need radiation to the head, too.  But recent studies have found that many children even with high-risk ALL may not need radiation therapy if they are given more intense chemo. Doctors try to avoid radiation because, no matter how low the dose, it may cause some problems in thinking and growth.

CONSOLIDATION or INTENSIFICATION PHASE:  Studies from the German BFM (Berline-Frankfurt-Munster) group have shown that the use of drugs such as cyclosphamide, cytarabine, and thioguanine in combination may further reduce the levels of sub-microscopic residual ALL cells. However, this treatment may lead to substantial toxicities and complications, but the cure rate increase far outweighs these risks.

These treatments may be given immediately after remission has been achieved or they may be given later such as between 4 to 6 months after remission – this phase is known delayed intensification.

In high-risk patients, repeated delivery of intensive blocks of chemotherapy courses interspersed by relatively non-myeloablative interim maintenance chemotherapy has improved cure rate substantially.

The epipodophyllotoxins, such as VP-16, are potent anti-leukemia agents, but its use is often restricted in childhood ALL because of is potential for contributing to the secondary development of AML.  But in high-risk patients, its use is currently justified.

The goal of this intensification phase is to get rid of any remaining leukemia cells that may not be active but could begin to regrow and cause a relapse.  This phase lasts about one to two months. Several drugs are used, depending on the child’s risk category. Some children may benefit from a stem cell transplant at this time.

MAINTENANCE PHASE:  If the leukemia stays in remission after the first two phases of treatment, this last phase, maintenance chemotherapy begins. The total length of therapy for all third phases is two to three years for most children with ALL.  The purpose of this third phase of treatment is to kill any remaining leukemia cells that may regrow and cause a relapse. Often the cancer treatments in this phase are given in lower doses than those used for induction and consolidation phases.

In this phase of treatment, a majority of the medications are taken orally with few side effects. This consist of:

  • Daily oral doses of 6-mercaptopurine, best given at night on an empty stomach, combined with
  • Weekly oral doses of methotrexate.
  • Every four weeks,  pulses of intravenous vincristine  combined with 5 days of oral glucocorticoid.

Patients will be able to take part in their normal daily activities for as long as they feel able to. Most children return to school before beginning maintenance treatment.

This phase of treatment lasts for up to two years from diagnosis for girls and up to three years for boys. This is because boys are at higher risk for relapse than girls. The few attempts to reduce the duration of treatment protocols to less than 2 years from remission have been associated with increased risk of relapse. Likewise, there appears to be little benefit to extending the duration of maintenance therapy beyond 3 years.

Testicular radiotherapy

In some situations it may be necessary for boys to have radiotherapy to their testicles. This is because leukemia cells can survive in the testicles despite chemotherapy.

Bone Marrow  (BMT) / Peripheral Blood Stem Cell Transplantation (PBSCT)

Bone marrow contains immature cells known as hematopoietic  stem cells which divide to form more blood-forming stem cells, or they mature into one of three types of blood cells: white blood cells, red blood cells and platelets.  Most hematopoietic stem cells are found in the bone marrow, but some cells, called peripheral blood stem cells (PBSCs), are found in the bloodstream. Blood in the umbilical cord also contains hematopoietic stem cells. Cells from any of these sources can be used in transplants.

Chemotherapy and radiation therapy severely damage or destroy the patient’s bone marrow. Without healthy bone marrow, the patient is no longer able to make the needed blood cells. BMT and PBSCT replace stem cells destroyed by treatment. There are three types of transplants:

  1. In autologous transplantation, patients receive their own stem cells.
  2. In syngeneic transplantation , patients receive stem cells from their identical twin.
  3. In allogeneic transplantation, patients receive stem cells from their brother, sister, or parent. A person who is not related to the patient (an unrelated donor) also may be used.

Stem Cells Matching

To minimize potential side effects, the stem cells must match the patient’s own stem cells as closely as possible. A special blood test is done comparing the human leukocyte-associated (HLA) antigens on the surface of the cells. In general, patients are less likely to develop a complication known as graft-versus-host disease (GVHD) if the stem cells of the donor and patient are closely matched.

Transplantation Procedure

High-dose chemotherapy is given before stem cell transplantation, i.e.  giving high doses of anti-cancer drugs to kill cancer cells. This treatment often causes the bone marrow to stop making blood cells and can cause other serious side effects.

After being treated with high-dose anticancer drugs and/or radiation, the patient receives the stem cells through an intravenous (IV) line just like a blood transfusion. This procedure takes one to five hours.

After entering the bloodstream, the stem cells travel to the bone marrow, where they begin to produce new white blood cells, red blood cells, and platelets in a process known as “engraftment.” Engraftment usually occurs within about 2 to 4 weeks after transplantation.

Doctors monitor it by checking blood counts on a frequent basis. Complete recovery of immune function takes much longer, however—up to several months for autologous transplant recipients and one to two years for patients receiving allogeneic transplants.

Doctors evaluate the results of various blood tests to confirm that new blood cells are being produced and that the cancer has not returned. Bone marrow aspiration (the removal of a small sample of bone marrow through a needle for examination under a microscope) can also help doctors determine how well the new marrow is working.

In the initial 2 to 4 weeks after transplantation, the patient’s immune system is not effective and is easily susceptible to infections. Hence, utmost care is required to maintain a sterile environment. The patient is put on antibiotics and other medications to protect against viral and fungal infections.

After this period, the graft begins to settle in the new bone marrow, produces blood cells and gradually improves the host’s condition. Drugs to suppress immunity may be withdrawn once the graft has taken hold in the recipient. Most patients may need re-immunization with vaccines at this stage.

Note:  Besides leukemia,  stem cell transplantation is used to treat lymphoma, multiple myeloma and myelodysplasia.

Possible Side Effects of BMT and PBSCT

  • The major risk is an increased susceptibility to infection and bleeding as a result of the high-dose cancer treatment. Doctors may give the patient antibiotics to prevent or treat infection. They may also give the patient transfusions of platelets to prevent bleeding and red blood cells to treat anemia.
  • Patients who undergo BMT and PBSCT may experience short-term side effects such as nausea, vomiting, fatigue, loss of appetite, mouth sores, hair loss, and skin reactions.
  • Potential long-term risks include infertility (the inability to produce children), cataracts , secondary (new) cancers,  and damage to the liver, kidneys, lungs, and/or heart. These arise due to the effects of  the heavy doses of chemotherapy and radiation therapy received before transplantation.
  • With allogeneic transplants, graft-versus-host disease (GVHD) sometimes develops when white blood cells from the donor (the graft) identify cells in the patient’s body (the host) as foreign and attack them. The most commonly damaged organs are the skin, liver, and intestines. This complication can develop within a few weeks of the transplant (acute GVHD) or much later (chronic GVHD). To prevent this complication, the patient may receive medications that suppress the immune system.

Some Notes on T-cell ALL

  • The presence of massive lymphadenopathy or a large mediastinal mass, a particular feature of patients with T-cell disease, has been associated with a poor prognosis.
  • T-cell ALL may release a cytokine osteoclast-activating factor that results in symptomatic hypercalcemia (elevated levels of calcium in the blood) and diffuse osteopenia (mild decrease in bone mineralization, not as severe as osteoporosis.).
  • Facial palsy due to nerve root infiltration may also be an early sign of T-cell ALL.
  • B-cell ALL has a more rapid growth rate and relapses within 6 months, while B-precursor ALL relapses after considerably longer intervals.
  • The growth rate of T-cell ALL tends to be intermediate between B-precursor and B-cell ALL and the duration of risk of relapse is greater than for B-cell but less than for B-precursor ALL.

Overall Outcome of Medical Treatment of Childhood ALL

Conter V et al. of Italy wrote in Acute Lymphoblastic Leukemia:

  • Although the treatment of childhood ALL has been gradually intensified during the last 30 to 40 years, leading to a significant improvement of outcome, still roughly 25 percent of patients suffer from a relapse of the disease.
  • The management of relapse remains controversial but increasingly involves the use of high-dose chemo/radiotherapy and stem cell infusion. Despite recent improvements the overall results remain unsatisfactory worldwide. Relapsed ALL  continues to make a major contribution to the morbidity and mortality of childhood cancer.

(https://www.orpha.net/data/patho/Pro/en/AcuteLymphoblasticLeukemia-FRenPro3732.pdf )

Nita Seibel (Treatment of acute lymphoblastic leukemia in children and adolescents: peaks and pitfalls, Amer. Soc. Hematology Education Prog. Book, 2008) wrote:

  • Survival of children with acute lymphoblastic leukemia (ALL) is often described as the success story for oncology.  In the 1996-2204 SEER data the 5-year survival for patients will ALL was 84 percent for children and young adults less than 19 years of age and 88 percent for children and teens less than 15 years of age. This is in comparison to 3 percent reported in the 1960s. The outlook for children and adolescents diagnosed with ALL today is much better than even before.
  • However, as we all know, cure in not assured and is not obtained without sequelae (Note: sequelae means any abnormal condition that follows and is the result of a disease, treatment, or injury. E.g. deafness after treatment with an ototoxic drug, or scar formation after a laceration).

Martin Schrappe and Matin Stanulla of Germany (in International Society of Paediatric Oncology) wrote:

  • Nowadays … childhood ALL can be successfully treated in about 80 percent of patients by the applications of intensive combination chemotherapy regimens, which in specific patient subgroups may need to be supplemented with radiation therapy and /or hematopoietic stem cell transplantation.
  • However, although the goal of developing effective therapy for the majority of children with ALL has been achieved, significant numbers of patients still die due to recurrent disease or the toxicity of treatment applied.

Muller J et al. (Treatment results with ALL-BFM-95 protocol in children with acute lymphoblastic leukemia in Hungary. Article in Hungarian: Orv Hetil. 2005 Jan 9;146(2):75-80) reported that  the treatment outcome of Hungarian children with acute lymphoblastic leukemia improved remarkably over the last decades. Seventy-eight percent of children suffering from ALL could be cured with the ALL-BFM-95 protocol.

Kocak et al. (ALL-BFM 95 treatment in Turkish children with acute lymphoblastic leukemia-experience of a single center, Pediatr Hematol Oncol. 2012 Mar;29(2):130-40) reported that their 13 years’ experience treating 140 Turkish  children with ALL with original ALL-BFM (Berlin-Franfurt-Münster) 95 protocol.

  • Complete remission rate was 97.7% with a relapse rate of 12.9% and death rate 17.9% during a median follow-up of 69 months.
  • The event-free survival (EFS), disease-free survival (DFS), and overall survival (OS) in these patients at 12 years were 75.0%, 87.1%, and 80.6%, respectively.

In the article, Hope for children with leukemia (http://sg.theasianparent.com/hope-for-children-with-leukemia/#), Eeleen Lee reported on the experiences of childhood leukemia treatment in Singapore.

  • It is a highly curable disease with intensive chemotherapy. The current cure rates in the developed world surpass 80%.
  • Associate Professor Allen Yeoh, Principal Investigator of the study and Senior Consultant, Division of Paediatrics Haematology-Oncology, National University of Singapore Hospital said: Leukemia treatment creates a conundrum. On one hand, leukaemia is a rapidly fatal cancer if not treated correctly. On the other hand, chemotherapy drugs cause significant side effects that worry both doctors and parents
  • One of the significant side effects of the treatment is damage to organs like the heart, skin and brain, which may lead to long-term complications, including secondary cancers. In fact, the costs related to treating the side effects of chemotherapy often exceed those of treating leukemia.
  • The increased complications put the young patients at a high risk of long-term side effects, which can be life threatening and significantly reduce quality of life.

G. Gustafsson and S. O. Lie (Acute leukaemias in Cancer in children – clinical management) wrote:

  • One hope for the future is that the therapy of the acute leukaemias in children should be more globally available to children. Probably not more than 20 percent of the children on this planet with leukaemias are offered a therapy that gives any chance of cure.
  • Modern, high-intensity protocols are expensive and carry a high risk of morbidity and even mortality.  Therapy-related death or complications are of great concern, between 3 and 5 percent die from therapy-related complications.
  • Long-term late effects are also of increasing concern, especially when it comes to the commonly used anthracyclines and the development of heart failure. Clearly, the risk of heart failure is very significant in children. (Note; Examples of anthracyclines are Andriamycin, Doxorubicin, Epirubicin, Indarubicin, Mitoxoanthrone).

Points to Ponder

  • Treatment of childhood leukemia represents the most outstanding achievement of oncology. In spite of such success story, still 30 percent of patients die – either of the disease or from the treatment itself.
  • Other cancers such as sarcomas, ovarian cancer, breast cancer, small cell lung cancer, myeloma, follicular lymphoma are described low cure rate cancers. What do you think of the chance of success then?
  • Do you ever wonder why, Allen Rose, worldwide vice-president of Glaxo-SmithKline said (Daily Express, 8 Dec. 2003): Drugs for cancer are only effective in 25 percent of the patients?  Perhaps that is the most and the best that chemo-drugs can do for most of our common cancers!
  • Treatment of Leukemia is not cheap and comes with drastic side effects. And according to Professor Yeoh (above), the costs related to treating the side effects of chemotherapy often exceed those of treating leukemia.
  • Do you wonder if that is all scientific medical science can offer this world?
  • Has anyone ever attempted to find a better and effective alternative? No, that cannot happen because that will threaten the status quo.

Materials for this article are taken from:

http://emedicine.medscape.com/article/990113-treatment

http://www.cancer.org/cancer/leukemiainchildren/overviewguide/childhood-leukemia-overview-treating-children-with-all

http://www.cancer.umn.edu/cancerinfo/NCI/CDR258001.html

http://www.cancer.gov/cancertopics/factsheet/Therapy/bone-marrow-transplant

Acute Lymphoblatic Leukemia: https://www.orpha.net/data/patho/Pro/en/AcuteLymphoblasticLeukemia-FRenPro3732.pdf

Multifaceted Approach to the Diagnosis and Classification of Acute Leukemias http://www.clinchem.org/content/46/8/1252.full.pdf+html

An excellent article on Childhood Leukemia was written by Theodore Zipt et al (in Chapter 81: Clinical Oncology, 2nd Ed. Harcout Publishers, 2000).

Part 1: The Tragic Story of An Eleven-Year-Old Boy With Leukemia

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This article comes in two parts: Part 2: Understanding Medical Treatment Protocol for Childhood Leukemia

At CA Care we do not get to see many leukemia cases. If we have the option, we would rather ask you to go for medical treatment. This is because, according to medical literature, modern-day chemotherapy achieve good cure rate with leukemia. However, of late, we get to see more leukemia patients – especially children and young adults. One case that triggered me to write this article is that of Matt (not real name),  an eleven-year-old boy who came to our centre on 21 January 2013. Matt had undergone all the necessary medical treatments but his leukemia did not go away. Eventually the doctors told Matt’s parents to just bring him home. There was nothing else that the doctors could do for him. Under such circumstance, Matt’s parents brought him to see us. We could not refuse this case, since this is probably the last hope for Matt and his parents.  However, we cautioned Matt’s parents that they still need the doctor’s help – for blood transfusion or other life-threatening problems that may crop up.

I brought Matt’s file home to study his case in more detail – what he had gone through. Then I decided to do more reading. Let me share with you what we know about leukemia as of today.

What is leukemia?

It is cancer of the blood that develops in the bone marrow. When a patient has leukemia, the bone marrow, for an unknown reason, begins to make white blood cells that do not mature correctly. They continue to reproduce themselves very quickly and do not function as healthy white blood cells. Then the immature white blood cells, called blasts, begin to crowd out other healthy cells in the bone marrow. The patient experiences many symptoms such as infections, anemia, bleeding, etc.

Childhood leukemia

Leukemia is the most common form of cancer in children. It accounts for about 30 percent of children cancers in American children.  According to Conter V.  et al. (Acute lymphoblastic leukemia. Orphanet Encyclopedia, Dec. 2004) about 3,000 children in the United States and 5,000 children in Europe are diagnosed with ALL (acute lymphoblastic leukemia )each year. The peak incidence of ALL occurs between age two and five years.

The 2003 – 2005 report  of Cancer Incidence in Peninsular Malaysia indicated that leukemia was the most frequent type of cancer among male and female Malaysian children from birth up to 14 years old.

Almost all cases of childhood leukemia are acute, meaning they develop rapidly and get worse quickly if not treated properly. ALL  is the most common type of leukemia in children. It   accounts for three out of every four cases of childhood leukemia in the US, making it the most common type of cancer in children.

Acute myelogenous leukemia (AML) is the next most common type of childhood leukemia.

In Malaysia, about 85 per cent of childhood leukemia cases are due to ALL. The remaining cases are mostly acute myeloid leukemia (AML).  In Singapore three out of every 10 youngsters are diagnosed with ALL annually. Note: Chronic lymphoblastic leukemia (CLL) does not occur in children and chronic myeloid leukemia (CML) is very rarely seen in children. AML is the most common type of acute leukemia in adults.

Symptoms of Childhood Leukemia

Common symptoms are: fatigue or weakness, infection and fever, easy bleeding or bruising, shortness of breath and coughing. Other symptoms may include: bone or joint pains, swelling of the abdomen, face, arms, sides of neck or groin, swelling above the collarbone, loss of appetite, headaches, seizures, balance problems, or abnormal vision, vomiting, rashes and gum problems.

According to Conter V. et al. of Italy, the first symptoms of children with ALL are usually non-specific and include anorexia, irritability and lethargy.  Fever is the most common symptom – found in 60 percent of patients. Progressive bone marrow failure leading to pallor (or anemia), bleeding (thrombocytopenia – low platelets) and susceptibility to infections (due to neutropenia  – low white blood cells). Over one third of patients may present with a limp, and pains in the bone and joints.  Less common signs and symptoms include headaches, vomiting, respiratory distress, oliguria (small amount of urine) and anuria (absence of urine).  At initial diagnosis, 60 to 70 percent of children have enlarged liver or spleen. Lymphadenopathy  (enlargement of lymph nodes, usually painless) is also frequent (Acute Lymphoblastic Leukemia:  https://www.orpha.net/data/patho/Pro/en/AcuteLymphoblasticLeukemia-FRenPro3732.pdf )

The Story of Matt

Mat was 10 years old when he had fevers, gum bleeding and both his lower limbs had bruises and petechiae (tiny red spots) rashes for four days. According to his mother, before this he was breathless and lethargic for about a month. They consulted a doctor in a government hospital in their hometown. On further examination, there were bruises at his lower lip and both lower limbs. There were petechiea rashes over the abdomen. The cervical and inguinal nodes were palpable and measured 0.5 to 1 cm in size. His liver and spleen were swollen.

Blood test showed hyperleucocytosis (abnormally excessive numbers of leukocytes in the blood) and thrombocytopenia (lower than normal platelets). Further test showed 89 percent blast cells, suggestive of acute leukemia.

Due to persistent oozing from a wound at the lower lips, Matt received platelet transfusion for three times. He was also given antibiotics, IV Cefuroxime.

Matt was referred to the General Hospital in Penang.  His blast cells were positive for CD2, CD3, CD7, CD8, cyTdT and weak for CD13 which was consistent with T-ALL.

Matt was started on ALL BFM 95 protocol on 27 December 2011.

  • IV Dexamethasone
  • Oral Prednisolone
  • IT methotrexate
  • IM Asparaginase

In addition Matt was given: Bactrim, Morphine, Ranitidine, Ceftazidime, Amikacin, Cloxacillin, Neupogen, Pyridoxine and Dexamethasone eyedrops.

After eight days, his blood showed 58 percent blast, 6786 cells – down from 89 percent.

On 21 January 2012 blood test showed 2 percent blast.

On 25 January 2012 PBF (peripheral blood film) showed no blasts.

On 27 February 2012 Matt received:

  • Dexamethasone
  • IV Vincristine
  • IV Methotrexate
  • IV Folinic acid
  • IV Ifoshpamide
  • IV Daunorubicin
  • IV Asparaginase
  • IV Kytril

However, the chemotherapy protocol was upgraded from moderate risk to HR (high risk) on 30 January 2012 due the day 8 PBF which showed blast more than 1,000.  Matt completed the following chemotherapy:

  • 1st HR1 protocol on 30 Janruary 2012
  • 1st HR 2 protocol on 27 February 2012
  • 1st HR 3 protocol on 19 March 2012
  • 2nd HR 1 protocol on 14 April 2012
  • 2nd HR 2 protocol on 25 May 2012

Among the drugs Matt received were:

  • Ara-C, Etoposide
  • Triple IT (Methotrexate + Cytarabine + Hydrocortisone)
  •  IV Asparaginase

Matt was started on chemotherapy Protocol IIa on 27 June 2012. He received:

  • Dexamehtasone
  • IV vincristine
  • IV Doxorubicin
  • Erwinsa Asparginase

In and Out of Hospital

Matt had been in and out of the hospital for quite a while. For examples:

He was admitted on 26 February 2012 and was discharged on 16 March 2012 due to the following problems:

  • Neutropenic fever: Despite being treated with IV Vancomycin, Matt developed multiple temperature spike. Despite starting on Cefepime, Matt still had persistent temperature spike.
  • Infection over chemoport.
  • Raised ALT. Chemotherapy completed on 16 March 2012 but his ALT = 144 on 16 March 2012.
  • Persistent abdominal pain.
  • Hypokalemia (lower-than-normal amount of potassium in the blood).

Matt was again admitted on 19 March 2012 and was discharged on 5 April 2012. His problems were:

  • Anaphylactic shock (sudden, severe allergic reaction characterized by a sharp drop in blood pressure, urticaria, and breathing difficulties).  Matt present with generalized skin itchness, epigastric pain, vomiting, chills and rigors. BP was lowish and pulse weak. This problem according to the medical report was a problem due to Asparginase.
  • Neutropenic fever.
  • Asymptomatic thrombocytopenia. Platelet count = 7.
  • Anemia.
  • Hypokalemia.
  • Raised ALT.  On 19 March 2012, ALT = 181; 23 March 2012 = 252; 24 March 2012 = 279; 25 March 2012 = 230.

Matt was admitted on 20 July 2012 due to:

  • Rhinorrhoea (persistent watery mucus discharge from the nose)
  • Neutropenic sepsis

For these he was covered with IV ceftazidime and amikacin. He had persistent temperature spike and had toothache on Day 3 admission and was reviewed by dental with impression of pericoronitis (infection causing swelling or inflammation of gums and surrounding soft tissues ).

Bone Marrow Transplantation (BMT) 

According to Mattt’s mother, they were in Kuala Lumpur for about a month. Matt underwent an allogenic  BMT on 14 August 2012. The donor was his brother.

Post-BMT Matt was on:

  • monthly IT Methotrexate (last done on 19 December 2012)
  • Cyclosporin
  • Bactrim

Relapse

Matt was admitted on 2 January 2013. This is what the doctor wrote (reproduced per report dated 3 January 2013):

  • Admission for poor oral intake for two days associated with lethargy and bilateral knee pain. On examination, he was noted to splenomegaly with hepatomegaly. An urgent Full Blood Picture was taken and verbally reported by our hematologist as 75 percent blast cell seen.
  • Both mother and father were explained regarding the patient’s condition and progress. Explained that patient’s FBC is such that TW is increasing trend and other parameters are reducing trend. PBF showed blast cells suggestive of relapse.  Also explained that chemotherapy is not an ideal option in view of his condition.
  • Parents were advised regarding palliative care.
  • The life expectancy is probable for another 6 months. Explained that prognosis is grave. Parents were also counseled regarding HOSPICE (only available in Penang).
  • Parents understood.

Following are excerpts of our conversation:

Chris: (After a year of chemotherapy and BMT, he suffered a relapse). After this, what did the doctor say?

Mother: Doctor said: Go home. The doctor could not do anything more for him. He could undergo more intensive chemotherapy   –  following the adult protocol – but he might not be able to take it.

C: So, after that you were left doing nothing?

Father: We went around the village and started taking herbs and some roots of plants.

M: The doctor told us that if there is any bleeding, then we should bring him back. If there is a need for blood transfusion, we need to do that. That is all that they can do for us.

C: Okay, that is good. We need the doctor – if there is not enough blood, go quickly and have a blood transfusion while we are not doing anything, you can try the herbs. But I cannot guarantee that I can help in this case. Anyway, we can try if you like.   Over the years, I did help some patients. But don’t expect that by taking the herbs for one or two months the problem will go away.

C: (To patient) Did you suffer while undergoing chemotherapy?

Patient: Shaking his head.

F:  They put a chemo-port for him.

M: It was very difficult.

F: But he is a person who can endure pain.

M: Oh, when undergoing BMT it was worse. He had pains in the bones – throughout the whole body. He received six times of intensive radiation – twice a day for three days. Then they gave him chemo. I forget how many cycles. But it lasted only about half an hour each time.

C: Let me have a look at his medical records. He had chemo for about a year? Do you see much success while in the hospital?

Father: Many failures.

M: It was just an experiment hoping to help the children.

Comments

In short, after a year of all possible medical treatments, Matt was back to the same condition he was as in early December 2012.  And he was given six months to live. It was at this point that Matt and his parents came to seek our help on 21 January 2013.

We have learned early that chemotherapy is said to be most effective – high complete response and high cure rate – for five types of cancer: Hodgkin’s disease, testicular cancer, choriocarcinoma, lymphoblastic leukemia and childhood cancers.  So, treating ALL is supposed to be one of chemotherapy’s success stories. Unfortunately for Matt, chemotherapy had failed to help him.

Sverre Lie, President of the International Society of Paediatric Oncology (in Cancer in children – clinical management) wrote:

  • The progress which has been achieved in the treatment of childhood cancer is in many ways a remarkable success story. From being an almost lethal disease 20 – 30 years ago, more than 70 percent of children with cancer can now be offered treatment with cure as most likely outcome.
  • However, this progress has its dark side …. The diagnostic process is complicated, the therapy very demanding or even life-threatening, and the possibility of relapse a constant threat.
  • The problems of long-term sequelae are a matter of concern. (Note:  Sequelae is any abnormal condition that follows and is the result of a disease, treatment, or injury. E.g. deafness after treatment with an ototoxic drug, or scar formation after a laceration).
  • Furthermore, it remains a sad fact that in spite of all the progress made, childhood cancer is still the leading cause of death from disease in children. The remaining third that we are still unable to cure with present strategies remains a tremendous challenge.
  • We have three important challenges: first we need to find effective therapy for the third whom we cannot cure with current strategies; secondly we want to get rid of long-term sequelae in the patients were are able to cure today; and thirdly we would like to spread the knowledge of effective treatment of childhood cancer to areas and countries where no such service is available.

Let me close by quoting Conter V. et al. of Italy (cited earlier):

  • Treatment has thus become increasingly complex and high levels of organization, expertise and knowledge are nowadays required to achieve optimal results.
  • For these reasons children with ALL should be treated in centers which can offer specialized personnel and provide up-to-date diagnostic tools and treatment strategies.

Our Herbs Did Not Cure His Mother of Her Terminal Leukemia Within Two Weeks

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H-733 was a 65-year-old lady. She came to see us on 6 November 2011. She had leukemia and was treated in the hospital in Sungai Petani, Kedah for eight days. Then she was in a Penang hospital receiving treatment from 3 October 2011 to 4 November 2011.

She received one cycle of chemotherapy consisting of seven injections. She was scheduled for four cycles but refused to undergo further chemotherapy. The only thing I could remember of this case was the patient telling me that her days in the hospital undergoing chemo were a real “hell”.

In this patient’s file are only two pieces of paper – the Disclaimer and Release of Liability form (signed by her son) and a short note about her case. There was no medical report of any kind. Understandable! She went to the government hospitals and if you are not “persuasive enough” or don’t know “your way” enough they don’t give you your medical reports.

Based on the patient’s story, I prescribed herbs for her leukemia.  Listen to my conversation with this lady after she took   our herbs for a week.

In this video conversation it was clear that the patient felt better after taking the herbs for one week.  I have told this patient (and many more  before her) that,  If after you have taken the herbs for two or three weeks and still do not seem to benefit from the herbs – i.e., do not benefit in any way, my advice is: Stop taking the herb. Go and find someone else. Do not waste your precious time.

Take note of what she said after taking our herbs for a week, I am happy now. One month in the hospital (doing chemo) was hell but now I am in heaven. Unfortunately we never get to see this patient again after this. Why did she not come back to see us again? Did she think that she was already cured after being well? Or could it be that someone had told her to stop taking our herbs and go for something else “better”? I can’t understand.  Definitely it is beyond me to comprehend why!

But as far as we are concern, her file was set aside and left forgotten. We know that a majority (70 percent) of patients who came to us were just shopping for a magic bullet. So this case is nothing unusual.

Nearly a year later, I received an email from the patient’s son. Let me reproduce the email exchanges we had. Perhaps we all can learn from this episode. The emails from Mr. Chin (that is what he called himself) are reproduced here as they are, without any editing.

Oct 16, 2012 Hello Dr Chris,

My Name is Mr Chin..I not sure you still remember last year December you have a Accute Myleoid Leukemia

Patient From Sungai Petani, Her name is Miss Ong. She was my Mother, she pass away this year March. The reason I write this letter to you, Just want to Inform you.. your medicine did not work at all for my Mother Case.. and I hope you can keep this Information for your own record. maybe Next time got the Some cancer patient, you can let them know my mother end result. Maybe 2 week also is a vey important time frame to the other Patient.

Thank you Chirs.. Regards, Mr Chin.

Reply: Yes…thank you. Is she the one who was in the hospital and she told me that she went through hell in the hospital? How long did you take the herbs? Only for two weeks? …two months or what? I cannot remember the case. Can you give me the file number? Chris.

Oct 17, 2012

Sorry I don’t have the File number with me anymore, yes My mother does mention she went through hell in hospital. But Chris to be frank, Me as a outsider, my Mother judgement on that time is not right anymore. Penang Hospital do the thing they suppose to do.. So nothing wrong with them. Just that time my mother is in pain and worries, and make such comment, and that time I just want her release her stress, so did not make a correction on that spot… My Mother took your herb for 2 week… Mr Chin.

Reply: You mean she only took herbs for 2 weeks … and you expect the herbs to cure her? I now remember, she came once to see me and never come back again. And you expect taking herbs for two weeks you can get a cure?

 Oct 17, 2012

Mr Chris.. In the first Place you mention to us, let my mother try 2 week, If this medicine is not work, then this medicine is not effective to her. please move on and try another remedy… I guess you are too busy till you did not remember your word.

The reason i make a afford to write a letter to you, just want to share information to you… and hope this info will benefit to another patient. You will do a Job with Love and Caring , and please don’t fall to the trap of hate and criticism..” May God Bless you” have a strange to care to another cancer patient….Thank you. Mr Chin.

Reply:  Yes… you are right. I have her file H 733 — your mother is 65 years old ..Ong WK ..is that correct? She had chemo  once when she came and it was after 7 injections … she suffered the following side effects…a) rashes b) arms and legs swelling  c) fevers on and off and  d) skin peeled off.

She took herbs on 6 Nov 2011. That is the record I have. Yes, very correct …if you take herbs for 2 weeks and don’t benefit, go elsewhere. Yes, you are correct. I am here to help people but I cannot remember all the cases …I have people coming to see me everyday ….. especially if they come to see me only one time, I cannot remember them. How to remember? You are also correct that I need to know and keep my record so that I can learn and tell others. Yes, I am happy to tell others about your mother’s case. I also want to learn from your mother’s case.  So to make my record complete …Can I ask you the following questions so that I can help others understand what is going on:

a) Did your mother go for more chemo in the GH?
b) Or did she go to someone else for help?
c) She died in March 2012 — can you tell me what happened between this time? If she took the herbs for 2 weeks …it means that by December 2011 she has finished taking my herbs …. but you only wrote me this email two days ago — almost one years after this? I wonder why you only write me only now? Why wait for so long? I am not trying to blame you, I am just curious to understand what is going on.

I also want to tell you that I am not angry …. I am just curious to know what happen and how people think. I see all kinds of people and they all write different things. So this is my learning experience. Thank you for writing and if you have the time, please let me have your answers. Regards and God bless you too. Chris

Oct 18, 2012  Mr Chris. Below is the answer you wanted..

a) No my Mother just go for 1st round chemo, and GH already said she are not fit to go for 2nd round of Chemo..

b)  Yes.. we look for the China chinese doctor for help. http://yanqiang.net/ 

c)  Her Body condition is getting weak, and putting palette and blood into her body.. also didn’t work for her anymore.

c)  Chris as i mention to you at the first place, Just share this info so that you can use it for your reference.. I am not here try to Blame anyone…In Fact In this world there is no 100% way can cure cancer. So instead wasting the time condemn people medicine did work and how harmful to people, why not take this precious time study how to solve this cancer problem. But I know this is very Challenging… Thank you! 

Reply: Thank you very much for replying. It is good for you to reply and complete the story of your mother. I would like to write this story.  I have just written a book and the last chapter is called My Patients My Teacher ….. I am sending this copy to you. May be you want to read it.

Over 16 years I have helped thousands and thousands of patients …and there is NO cure for any cancer. Everyone should know that. Everyone who has cancer all die. Even without cancer, we all also die.

If you have time, it is good if you can answer the question I asked you earlier but understand that no one is trying to blame anybody. We understand that.

What I would like to know is this —- your mother only took my herbs for 2 weeks and she died some months later….the question is: Why did you write to tell me about this only NOW … many months after she died or almost one year after coming to see me once? Why not write earlier? I may have helped better.

What about the Chinese doctor — he also cannot help her? How long did she take herbs from the Chinese doctor? Did you also write to the Chinese doctor and tell him that your mother died?

It would be good if you give your answers so that we all can understand the real story. And I also can write a good story about this so that all patients understand what is going on. Thank you again for writing me. Chris.

Oct 18, 2012

Thank you for Sharing Your Book… hope this book will be benefit for the cancer patients and theirs family.

Chris Hope You can understand , with Lose a family member is not a easy thing… and we need time to calm down ourself and get refresh to think what we suppose to do , to help another cancer victim..

If the Chinese Doctor can help, My mother will not be died…My mother take 2 month for this chinese doctor herb… Yup I  do wrote the letter to this chinese doctor, The answer from them is simple. thanks For Sharing, They will keep my mother as their study record. and thanks me for Informing them.

Chris  i Just hope you just can share my mother Case to another AML Cancer Patient, Your Medicine is not work For AML Patient Before and at least let them aware about it. If They Still want to try your method then is their choice….and I also think maybe for some Patient 2 week try period also is a very important time frame for them.. I believe some Patient Family did not report the result to you, and make you can not judge your method is workable for which type of cancer..

Reply: Chin
1. Did your mother go to China for treatment?

2. How long was your mother on this Chinese treatment? … also 2 weeks like mine?

3. Is she on any treatment when she died? Was she on the Chinese treatment or no treatment at all.

When I share this story, I need to have as much information as possible, otherwise I cannot understand and explain why.

Oct 18, 2012

1. Did your mother go to China for treatment? No her Condition is not fit to fly over there, and the Chinese doctor also mention no need her to go over there because of my mother condition.

2. How long was your mother on this Chinese treatment? …also 2 weeks like mine?  2 month

3. Is she on any treatment when she died? Was she on the Chinese treatment or no treatment at all.  No treatment at all when she died..

My mother also gave up for the Chinese Medicine after 2 month taking it… her condition is not improve at all, and at the last when i am on the mid of planning send her to try the DC-CIK treament is was too late. so I hope with Sharing this the next cancer Patient If have choice.. don’t waste the time to try the Medicine which is not work.. then with saving the time they maybe can find a better alternative way to treat this AML cancer.. Chin

Reply: You are right …don’t waste time on medicine that do not work …you tried the chemo …  it did not work, you came to CA Care and took my herbs for 2 weeks and it did not work…then you tried 2 months of herbs from Chinese hospital in Shandong and it did not work … so where do you think you can find medicine that can work?

Do you think that DC-CIK you mentioned can work? If so, how do you know that it will work? … my patient had this treatment in Singapore and then went to Japan for the same treatment and for many months …to do this treatment and he died. It did not work either.

It only means, nobody in this world can cure cancer  …. click this link and see what patients wrote me about their leukemia…. http://adaywithchristeo.wordpress.com/category/leukemia-2/

You can see they all need help…BUT who can cure leukemia????? Have you read anything about leukemia?

When I write your mother’s story, I shall explain that there is no one on earth who can cure leukemia. If and when you think you know where to find cure for cancer, please let me know. I too want to know.

And if you read the chapter of the book that I sent you…. I tell everyone who come to see me … there is no cure for cancer ….I have no magic bullet for cancer….that is why I tell you…take my herbs for 2 weeks and go elsewhere if you don’t think it helps you… simple as that.

It is good that you write me. I shall write some articles to let patients know more about cancer. It is not an easy problem. Chris.

Oct 19, 2012

Chris I know your frustration… Seeing people In front of you who’s seek for help and you can not do anything about it. Maybe Is good too, let me Paint my picture more clearly… as a Patient of the Family who do hope too Reduce the ” NOISE” during company our family member for the last journey… ” NOISE” mean’s the fault hope.. the hope that think this cancer can be fix, the hope thats make us didn’t prepare our family member will be gone.

I think if we were know this cancer can not be cure at all in the first place , then we will do a necessary preparation for it.

so please pardon me if i said it unclear…I believe my mother just a single small dot in your journey to help the cancer patient.. so with my mother result I telling you, maybe you can use it as a data. within of how many Leukemia person who come to seek for your help.. is benefit it form your medicine…and you can come out a percentage chart of a effectiveness of your herb toward Leukemia.

If the answer is only 1% then, you can tell the patient are they welling to try it or not, But If 0% then I guess you can cloose down your herb section for Leukimia.. This Happen Is GH Penang too , Doctor Goh do mention to us, with my mother condition, the 2nd Chemo will have a 15% success rate only. She Ask us to think cafully… so we decide not to go for it.. In my First Letter to you I already wrote in this world still don’t have a 100% effective way to cure the cancer.. we all know that…Chin. 

Reply: Thank you for your reply. After reading and replying to your emails, I think I need to send you the complete book that I wrote free-of-charge: Cancer – Is there another option. Take it, read it and try to understand it. It is definitely too late to save your mother, but perhaps it may be able to help others.  That is if read and understand it.

(Available at http://bookoncancer.com/productDetail.php?P_Id=56)

Let me tell what you need to know that may help you in the future.

1. In the first two pages of the book, I talk about ignorance.

  • Over the past many years, many (thousands!) cancer patients had come to seek our help and advice. They wanted to know what else they could do, generally after modern medicine had failed them. Most of these patients were totally ignorant of what they were up against. Many think that they could easily find a cure for their cancers. They come seeking for that non-existent magic bullet for their cancer. Alas! Many failed to find a cure. At CA Care we don’t talk about cure, because we do not see a cure for any cancer.
  • Many patients come to us – not wanting to see the left or right – they have only one aim, expecting and wanting us to cure their cancer. No, we cannot cure you! Don’t ever expect that after you have taken our herbs the cancer will go away the next day or a few weeks or months later. Such expectation is ridiculous. The situation becomes even more ridiculous when patients who come had already undergone all the medical treatments and failed. Yet when they come to us they expect a miracle – to be cured!  When I think of this – and it happens very often – I am flabbergasted. Simple common sense tells you that it is not possible and unreasonable.
  • In cancer, it is worth noting that ignorance kills. To be able to find healing, patients should realise that they must do something for themselves, not to rely entirely on others to help them.

 2.  You are right – your mother is  just a single small dot in your journey to help the cancer patient. Yes, your mother died but it does not mean that other patients should follow her to the graves as well. Read Chapter 7 of my book:  Chronic Leukemia: Blood Improved While On CA Care’s Herbs. This lady works in the Hospital in Hong Kong and she has been taking my herbs for two years (not two weeks like your mother) and she is doing fine.

After you have read that story, click this link: http://cacare.com/index.php?option=com_content&task=view&id=243&Itemid=57

This is the story of Pak Jam’s wife (teacher) who had leukemia and was in worse condition than your mother. But she survived and could go back to resume teaching again. She came to see me beginning of this year (2012). And she was taking herbs for more than 2 years, not two weeks like your mother.

Then you want to know what? She died after she came to Penang (in 2012) – because she went to the hospital in Aceh and they put in the wrong blood for her!

3.  Same medicine, different patients

  • One lesson anybody need to learn is that you may give the same medicine but patients are different. If the medicine fails it is not because the medicine is not good – it may be the patients are not good. Human beings are not the same. They carry different baggages.
  • After helping thousands of patients over the years, I have learned that almost 70 percent of them are here to find a magic bullet or wanting to find cure on their own terms. Our therapy is not easy to follow. You need to heal yourself – and it is you and you alone who can heal you. Others can only help but you decide you own fate.
  •  No two persons taking the same path would end up at exactly the same destination. Cancer is about you as a person. If you are not able to change your mental attitude, your diet, your lifestyle, etc. no one else can help you. You are a goner if you come and tell me: If I cannot eat meat life is not worth living; I have no time to cook the herbs; The herbs taste awful, etc.

4. Accept Reality

One thing we all must do is to accept reality. If the cancer is already serious, there is nothing in this world that can cure it.  Read Chapter 12 of my book:  Mayo Clinic Gave Him Only One More Week to Live. The Doctor Is Not Convinced That Chemo Can Kill the Cancer This Time. Do you know what Mayo Clinic is? This is one of the best hospitals in the world. Kings and rich men all over the world go there for treatment. Yes, after Mayo this young man wrote asking me to help his father. Let us face reality! I understand – he wanted to do the best for his father. Like you wanted to do the best for your mother – and you thought buying herbs from China can cure your mother. 

Read also Chapter 13:  Salivary Gland (Parotid) Cancer: The Doctor Said: It Would Be Useless to Keep Him Alive. Do you know that the wife of this patient is a dental specialist?  She is medically trained. She too could not find a cure. She too wanted to do the best for her husband. But there is a limit to what anybody can do to help.

The same is true for you. Your mother went to the hospital and had chemo. When she came to me she was suffering side effects like rashes, swelling of legs and arm, she had fevers and her skin peeled. It was lucky that she did not die of the chemo. She was on my herbs for two weeks and then went for herbs from a hospital in China for two months. And you expect a cure for her leukemia when even the doctor in GH had told you the second round of chemo will only give you 15% success rate only. And you did not think 15% was good enough. What you don’t understand is success rate — success rate does NOT equal to cure. What is success rate? Nothing – it is not cure.

CA Care is the last one stop – we are people’s door mat

I jokingly tell patients – CA Care is your last one stop. The cases that come to us are usually beyond us to cure. Make no mistake, we are under no illusion. Over the years we always call a spade a spade and we face reality without any pretence. Death is a reality – it can happen to you or me, anytime – irrespective of whether you have cancer or not. Perhaps with cancer, the journey to the grave seems more certain and somewhat shorter!

I said this again and again, we at CA Care can only help you. Your healing is yours to seek and achieve. To those who truly need our help, we say this: Live and don’t give up hope. There is an option. There is hope. But if you want healing on your own terms and refuse to learn and change, then there is nothing much anyone can do to help you.

Okay, with this, I think I have written enough. I thank you again for writing. I would like to end this discussion and let me move on to help others who need my help. I hope you have time to read this book that I send you. Take your time to read and understand. It may help you or others one day. Chris.

Oct 20, 2012  Chris

Really appreciate your thoughtful and meaningful write back..Chris Please don’t miss understanding I am here judging what are you doing….In fact I don’t have a right and qualified to do this at all.I just hope I can provide my mother result as a data, so that maybe you can use it in the future..My mother AML Cancer is just a single case of so many different type of cancer. Me, by hoping provide you this info, you roughly may know your herb is more effective to which type of cancer…Lastly You mention to us just let my mother try 2 week your herb. but that time if you were tell us to try 2 years ( like a Hong kong Ladies) and follow your diet guide…then we will follow you…. That time is not we want to give up, we done that because you tell us 2 week is the limit.

Chris Really Thank you for Your Time ,and I think I took too much time from you.Please move on with GOD faith.. and continued your meaningful journey. ” God Bless You” Chris… Chin. 

Comments:  I have asked myself – why do I have to waste time replying to such emails? Let me tell you why.

  1. I realize that it is not only the sick person who needs help. At times, the caregivers and family members or even friends too need help. If you view it from this perspective, it makes sense.
  2. The message that Mr. Chin wants you to know is this: Coming to see us and taking our herbs for two weeks did not cure her mother of her leukemia.  I fully agree with him. In fact I want to add a bit more to this message.  If you come to us hoping to find an instant magic bullet for your cancer, then I am telling you plain and clear – you have come to the wrong place. Perhaps you have better luck going somewhere else. Go and find someone else who can promise to cure you.
  3. Some weeks ago, one lady came to see me. She had cervical cancer. After surgery, she took Sabah Snake grass every day. A year later, her cancer came back. She came to seek our help. I told her to go for chemo but she refused. She told me she understood the serious risk that she was taking in wanting me to help her with our herbs. She did not come to see me hoping to find a cure! I was impressed by her attitude and plan to write a full story of this case. Then there is another case of a man from Jakarta, Indonesia. He had pancreatic cancer. I told him I am not able to cure his cancer.  He told me he understood that very well and he wanted me to help him as best as I can. He knew that nobody can cure his cancer. I plan to write his story too.
  4. Do you see that Mr. Chin’s case came at an “appropriate” time indeed? Mr. Chin’s case adds another perspective to my two other stories. Here, Mr. Chin came to CA Care expecting to find a cure. And my herbs cannot cure his mother’s leukemia within two weeks.

Let me end this article by quoting my favourite author, Harold Kushner, a Jewish rabbi. This what he said, When all you’ve ever wanted isn’t enough. This is what he wrote,… the irony of the phase “the best and the brightest”… The best and the brightest was the way we described the government officials who got us into Vietnam to begin with then kept getting in deeper and deeper. They were undeniably brilliant men, honor graduates of the finest universities, armed with mountains of information from the most sophisticated computers, and still they kept making the wrong decision. They had intelligence. They had information. But they lacked wisdom… smart enough to lead, but not wise enough to know where they should be going.

It there is one lesson which I think you can learn regarding this case. Use your common sense (or be wise!) when gathering information – especially from the internet. They are a lot of “junk” information in the cyberspace. We can find all kinds of claims – this and that stuff can cure cancer. Evaluate these claims critically. Mr. Chin’s mother underwent chemo for about a month. This did not work. After one cycle she gave it up. She came to CA Care and took our herbs for two week and decided that our herbs did not cure her. The son “hunted” for more herbs – this time from China and his mother took them for two months. It did not cure her either.  Mr.  Chin was in the midst of wanting to “send her to try the DC-CIK treatment” – also in China. But it was too late – his mother died! How long can you go on trying – hopping from one treatment to another? Leukemia does not wait for anyone. You don’t have the luxury of experimenting anymore when you have cancer.  What many of us fail to realize is that healing starts from our own self first!  The real good doctor who can heal us resides within us.

Let me quote Kushner again, indeed many of us believe are smart but only … smart enough to lead, but not wise enough to know where they should be going. 

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Thanks for writing! For the time ever, I received some responses after posting this article: Our Herbs Did Not Cure His Mother of Her Terminal Leukemia Within Two Weeks

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Dear Dr. Chris,

Thank you for the sharing H733 story. In one if your book: “We also learned that for those who want to believe, there is no need for too much explanation or proof. But for those who do not wish to believe, no matter what evidence is provided, it is never enough. There is always something not right about it and there is always a reason to reject it.”

It was such a long time I didn’t visit you in Penang. But I never stop taking your herbs since Dec-2009 till now. BTW my recording is H237. God is good, He sent me to your place, I always remember “Our hands but God heals”. I just want to let you know I am very good now. I have been sharing my testimonial to those cancer patient but it is not easy to let people to believe especially Chinese medicine (Herbs). As usual they ask me how many cycle of herbs I need to take, my answer to them is that when is the last day God calls me home.

I have stopped my work and become a house maker for one year already. Life is great and I look healthy and young after taking your herbs for the past 3 years. I believe God will make a way for me. I want to Thank you again. Send my regards to Beng Im. God Bless you and your family. Jessie

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Hi Chris,

Simple mind uses simple interpretation. Simple minded read your sentence and put a fool-stop. Well, I think about 30 to 40% of people think this way.

I observe that many church members sway in the direction by one speaker and then in another by another. This leads to a temporal understanding of Bible. Reality of the world today. With kind regards, Siew

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Dear Dr Chris,

Thank you very much for sending me articles and updates regarding the good work  CA Care is doing.

I only have one of your books entitled Understanding Cancer War and Cure. i have read it many times over and i am grateful that you have devoted your time and life to help people ‘manage’ their cancer. i hope to purchase more of your books soon.

We all know you have emphasised time and again that you have no magic bullet to cure cancer but you are here to offer another option; the herb and holistic approach to life. To me, only God can heal and people like you, Dr Chris, are willing instruments for God and i thank God for that. In fact, i understand very well the frustrations you face when patients and loved ones expect miraculous healing (which can only come from our God Almighty). i remember now the video where you said, ‘if you can eat and sleep, what more do you want?’

i would like to encourage you to keep up your good work because many people are helped by you. To God be the glory! Blessings, Grace

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Hi  there! Your reply to that Mr. Chin was awesome. Take care! GG

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Hi Chris,

Thank you for sharing this. I admire your patience with this Mr. Chin. The way I interpret his reason for emailing you after such a long time after the death of his mother would have to be he is still grieving and has not fully come to terms with the loss of his mother just yet. It is unfortunate there’s no grief counselors or support groups available for him to help him stop raving on like a ‘lunatic’.

On a brighter side, Chris, I had my yearly follow up with my oncologist last week and told her I had stopped taking Tamoxifen since March due to the side effects and guess what ? She agreed that I don’t really have much benefits at all taking Tamoxifen because my excised DCIS tumour was only 7mm so it is ok to stop it. This blew me away! I thought to myself then why did she prescribe Tamoxifen in the first place? Anyway, I didn’t want to waste my time disputing the issue. I just thank GOD for guiding me to seek you.

Thank you and God Bless, LC

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Hi Chris and Im,

I have recently read the article you wrote re. the lady with leaukemia who tried your herbs for 2 weeks followed by 2 months of chinese herbs. All of this after receiving heavy doses of chemo prior to seeing you.

When I was diagnosed with stomach cancer over 20 yrs ago I was advised to try a new treatment called Chemo.  20yrs ago very few people contracted cancer and even the specialist whom I saw had difficulty explaining what Cancer is.   After I read many books on the subject I formed a basis of why I contracted this disease. I was very impressed with Dr Binzel’s work, Dr Hans Nepier and the Oasis of hope clinic in Mexico. I devoured these books in a few short weeks as I was told that i must act instantly if i wanted to live.  What i learned was that it is imperitive to take time and understand what was happening to my body and why.   I called dr Hans Nepier in germany and asked if I should come to his clinic. He asked me what treatment i have had and when I replied none, he asked what do i intend to do. I told him I was taking herbs and changed my diet and also letting go of much sadness in my life.  He seemed very impressed as he said I was on the right track and to continue with the herbs and my changed attitude to good food and letting go of emotional baggage.   He said to have more tests in 6 months and if all is well continue what I was doing for the rest of my liife.

The specialist was amazed to find no cancer and even feebly said that perhaps I did not have cancer in the first place. Boy, was i angry at this response as If I had done what he instructed I may not be alive today.

Very few then, if any survived according to the Australian statistics.  Chemo was not seen as a cure back then and many good doctors would advise their patients to have the surgery, if necessary, then follow a clean and healthy eating plan. I know a few people whom were given this advice and are still alive today.  No side effects and in fact feel the best they have ever felt.

When I contracted Uterine cancer stage 3, 4 yrs ago, I knew why and I was one of the lucky ones as I knew what I needed to do to heal my body.  You are spot on Chris when you say we are our own best doctors and with knowledge, understanding and assistance from caring people as you we can and do heal our bodies as I have long believed that the body can cure anything but first we need to know how. Mother nature is very powerful and I believe that god put on this earth everything to heal man’s ill.  You in your wisdom and training in the use of herbs and your unstoppable desire to help your fellow man should be the first port of call when told one has cancer.   I, like you see so many when they have exhausted all medical help and told “There is nothing more we can do”. I have seen so many times what this can do to the soul, when you put your trust in an establishment whom should be seeking the best treatment, whether orthodox or natural therapies. Sadly the medical system will not allow their doctors, oncologists etc., to administer any natural therapy as in their words “Where is the science behind such treatment”.   I say to them , “Show me the INDEPENDENT research undertaken to prove Chemo and radiation cures cancer. They cannot as all research undertaken is Kill the cancer.

In the turn of the 1900 century Professor John Beard from Edinburgh University found that cancer cells were trophoblast cells, which now have no pancreatic enzyme termination agents to curtail them.   When the people realise that instead of trying to kill the cancer it is best to heal the body and the best way to heal is to develop an action plan which I promote as E.K.A. Education, Knowledge, Action.   How can one fight an unknown if we do not know what we are dealing with.  Learn from the people who have had great successes, gain the know how of feeding the body good clean food, no animal, dairy, sugar etc. Raw is best and I love the new me and the energy and health I now have.

I was meant to find you Chris as I was guided to finding and reading your books.  I devoured 3 books in one evening as it made complete sense to me what you had written.   Modern societies, especially the west, is in the grip of an epidemic as cancer affects 1in2 of us.   I call it the rich men’s illness as the poor countries do not have anywhere near our shocking numbers.   Herbs have been used long before the introduction of modern medicine. They are the base of most drugs today, but sadly man made concoctions are added with terrible side effects. All in the name of medicine.   I have read many books and spoken to hundreds of medical, herbalists and scientists whom seek the truth above all else and honour the Hippocratical Oath “DO NO HARM’

They, as you have Chris, assisted many in their quest to optimal good health. I am so glad I found you and I am living proof that if one opens their mind and not give in to the fear tactics thrown at them , can and do go on to lead a long and happy life.   My surgeon is in awe that I am so well as I was told that without treatment, Chemo, I would not live any longer than perhaps 3 months.  I believe in knowing all there is to know about ones illness so as we can make an informed choice based on this information.

Most people are only too happy to give their permission to someone else to cure them, they take no active roll in their healing.  The brewing and taking of herbs, organic foods, clean water, being in control of your own happiness, deal with past traumas are all essential.  the cancer is a symptom of the disease. Rid the body of the cause and the symptom disappears. It worked for me and many whom I have assisted. They are alive and well today.

You and Im have dedicated your life to assisting others in their time of need and for that you are blessed with the knowledge that you have reached out to your fellow man and this is rare in our societies today.   Thank you both from the bottom of my heart for giving me your knowledge and wisdom of how I can heal my body of cancer.   Take heart that your time on earth was spent wisely and for the betterment of its people.

May you both live long and healthy, happy lives surrounded by those whom you love and marvel as I do at this wonderful world we live in.    I am sure I speak for many of your patients in saying, God Bless You Both and thank you for your guiding hands, caring for the many whom seek your help.

One day, Orthodox medicine will see the benefits of natural medicine and this will be the basis of treatment as the people will demand it.

Love to you both and keep up the good work, the world needs more Chris Teo’s.   xxx

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On Tue, Oct 30, 2012 at 5:22

H-733 was a 65-year-old lady. Our Herbs Did Not Cure His Mother of Her Terminal Leukemia Within Two Weeks

Dear Chris,

I wrote after seeing the above posting. My wife SJ.57 also passed away on the 24 October 2012 at 8.15am, with cancer started from her colon, ovarian, liver and lungs.

After her ops on her colon and ovarian on 22 May, 12, she declined chemo and we supported her wishes and my daughter took her to see your Subang branch and took the prepare boiled herbs for 2 months, then we went back to Sabah to attend her father’s 10 years death anniversary for 7 days. I asked her to bring all the herbs back but she said she can take the capsule type as not convenient to cook in others’ home. Told her we get a gas tank to compensate. She said too troublesome.

While there her feet swell and subside. On return my daughter saw her swelling feet and told her to go to Sunway Medical Centre but she declined. Saying there is no cure. I told them we go to Penang to see you but she declined as she said even Dato Punch Gunalan with a Doctor son also died. My daughter had to respect her wishes. She told me no cure for mum. Two weeks later her stomach bloated.

I told her that she might as well take holy water from her church if she declined chemo and Dr. Chris herbs. Then I gave Sabah Snake Grass for 2 weeks and nothing happens but her stomach kept growing every week at the rate like a pregnant woman baby growing per month. She blamed me and the Sabah Snake Grass but told her I only administrate it after her bloating stomach.

My daughter said no cure, her liver motas and discharged liquid. Her eyes showed jaundice.  We requested the Govt. Hospital to tap the liquid. The Dr. said the motas had attacked her liver and ultrasound showed no liquid. We knew it’s a matter of time before her body system will shut down completely, yet I bullied her to fight on, until she chased me away. Saying I’m killing her faster.

Finally she agreed to go to Sunway Med. for tapping, the Dr. said there is no hope and he would not give chemo to his relatives AT THIS STAGE , but do pain management. Warded to monitor for tapping and this cost about RM10K a week to stay there. Her body was shutting down, she lost about 3 kilos fast every week. Eating 4-5 spoonful mee sauh every 3 hours. Tapping done twice. She died 5 days after the 2nd. Tap.

We thank GOD and Drs. She died peacefully with very little pain and we know we have done the best for her but we lost the battle.

I wrote to let Mr. Chin, the son of the above mentioned lady that I lost my wife, I blamed nobody but fate.
Let their souls RIP. Amen.

Ng Thian Yew

Reply: Thank you for writing. Do you mind if I share this email with others. I shall cut off your name if you want me to do so, but it is good if the name remains but with no phone number, otherwise people think I am cooking up this email. Thanks. Chris.

Dear Dr. Chris,

Please do with my name too for I wish to tell the truth. You did what you can to help others. My wife made the mistake to stop taking your herbs which help during the 2 months but she wanted a cure fast which is not possible as it was too late.

We wish to thank you, please continue to help us, as Dr. Amir wrote in the STAR saying
chemo may not be the solution (barking at the wrong tree) and the specialists should heed his warnings.

It is painful to lose a dear one and it is frustrating when no cure is found, but others were cured.

Thank you Dr. I admire what you do to fight cancer. May the GOD guide your hands.

Best regards,
Ng Thian Yew

31 October 2012

Chronic Leukemia: Doing Well on CA Care’s Herbs

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Sometime in August 2010, I received an e-mail from a lady from a neighboring country.  She works in the radiology department of a hospital. That means her work involves taking X-rays, CT scans, etc., for patients.  She was down with chronic lymphocytic leukemia (CLL, suspected).  She declined medical intervention and decided to seek our help.

In fact, she is not the only person who wrote us. Two others in the same department of the same hospital  are also CA Care’s patients.  They were also diagnosed with cancer and they too took our herbs.

This lady with leukemia has been faithfully taking our herbs: Capsule A, Leuk 3, Leuk 4 and LL-tea since August 2010 until now.

On March 2012, this patient wrote:

Dr. Teo,

Attached is my blood test result on 22 March 2012  for your reference. Thank you very much for your help. Regards.

Reply:  Thanks for sending me the blood results. Wonderful ! What did the doctor say? Also besides taking my herbs, did you take any other medications? How do you feel? Chris.

Dr. Teo,

My doctor does not know why I can improve as he did not give me any medication.  I told him yesterday that I receive your herbal treatment. His response is just asks what types of herbs I take.

I only take the Herbs you give me and follow the no animal meat diet. I also inhale oxygen few times a week for 10-15 minutes, if I have time.

Starting from middle of February, I have influenza and upper respiratory infections and took   medications including antibiotics few times for these but stop a week ago before my blood test. However my flu is not completely recovered until now.  Anyway, everything is quite OK apart from the flu. Thank you very much for your help again. I will continue to keep the treatment and diet.

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