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    How is Leukaemia treated?

    2 December 2019

    We lost a great wit and writer last week when Clive James died at the age of 80 from leukaemia – bone marrow cancer. What surprised many was not the fact that he had died, but that it was almost a decade after he was told he had the condition in 2010, coming shortly after another life-threatening diagnosis of the lung condition emphysema, caused by decades of smoking up to four packs of cigarettes a day. In 2012 he said he was getting near the end of his life, and that he was ‘approaching his terminus’. In 2016 he then said he was ‘highly embarrassed’ to still be alive and revealed the reason – a somewhat experimental drug called ibrutinib that he had started taking the previous year, almost as a last resort when his disease relapsed.

    There are a number of variations of leukaemia, and James had the chronic lymphocytic type (CLL), which has 10 new cases and three fatalities every day in the UK. As a chronic condition it typically develops more slowly than an acute type – which are usually much more aggressive – but the underlying disease remains the same where huge numbers of abnormal white blood cells are produced, impacting on the production of normal blood cells. As a result of low numbers of red blood cells in the body, typical symptoms include looking pale, shortness of breath (which is also the usual symptom of emphysema), marked fatigue, easy bruising and weight loss. There may also be significant sweating at night and repeated infections. The emphysema that James suffered from made him more prone to chest infections (and ultimately prevented him flying back to his native Australia in his final months). That – and his deteriorating kidney health – would also have impacted on his ability to tolerate the often severe side effects of conventional chemotherapy, and lead to his being offered ibrutinib.

    Although the drug had been available on the NHS for almost two years, it was not in common use and was still viewed as somewhat experimental when James started taking it, almost as a last-chance roll of the treatment dice, working by inhibiting a specific cancer cell communications pathway and so slowing their growth. In 2019 it is now used more widely in NHS cancer specialist centres but remains a second-line treatment option after conventional chemotherapy has failed. This differs from other centres in Europe where it can be given as first-line treatment on diagnosis.
    It is not without potential significant side effects however, as James himself talked about. He was admitted to hospital with a severe allergic reaction and also suffered leg problems that affected his ability to walk. Despite this, in 2017 he wrote of the drug as having been a ‘cluster-bomb of goodness’ to him. Since then it has been used in treating other forms of blood cancer but ultimately was unable to prevent him succumbing to his disease. It is difficult to be precise about survival statistics of CLL in the UK, but in his age group, 60 per cent of men can still now expect to be living 5 years after diagnosis.

    The unholy trinity of leukaemia, emphysema and kidney failure would have seen off many far younger men than James. It is something of a tribute to his sheer force of will, as well as modern cancer drug therapy that he was able to keep going for so long. James said: “You have to have lived for a long time and be approaching the end of your life before you can see the world as I see it now, so I’m quite pleased with that even though I’m a bit terrified because it really is the mark of the end, isn’t it? One’s hoping to make a good exit.”