Treatment of B-Cell Acute Lymphoblastic Leukemia in children

Treatment of B-Cell Acute Lymphoblastic Leukemia in children – Sample Opinion for Medical Case Received // Case Number – OD/2025/2778 // 2nd-Half-Year-Old // Kenya

Case Summary – Baby NM is a case of 2nd half year old girl child from Kenya who was diagnosed with B-cell acute lymphoblastic leukemia (B-ALL).  B-cell Acute Lymphoblastic Leukemia (B-ALL) is a fast-growing blood cancer in children where too many immature B-cells (a type of white blood cell) crowd out healthy cells. It mainly affects children, but can occur in adults. Symptoms include fatigue, infections and easy bruising.

Investigations needed-  To confirm the line of treatment, baby NM will need to go through detailed physical and clinical investigations which will include: NGS-based karyotyping, cytogenetics, molecular study, bone marrow aspiration and biopsy,etc, along with other routine tests. If the biopsy has been done and slides are available, it is advised that the family bring the slides for review. The investigative outcomes will enable us to be in a definitive position to suggest a possible line of treatment.

Possible Line of Treatment / Plan: Once the diagnosis of B-cell Acute Lymphoblastic Leukemia is confirmed, baby NM will begin the treatment with induction chemotherapy with to achieve remission of the disease. The initial induction chemotherapy will be followed by consolidation chemotherapy aiming to eliminate any remaining cancer cells and prevent relapse.

If the response to chemotherapy is good, the baby will continue with consolidation chemotherapy. If the response to chemotherapy is limited, then the baby may require to go for Allogenic Bone Marrow Transplant with a matching sibling donor.

Induction chemotherapy- is the first and strong dose of chemo given to quickly shrink or kill cancer cells. It’s used in aggressive cancers like leukemia or high-risk tumors. The goal is to achieve remission (reduce cancer signs) before further treatments like consolidation or stem cell transplant. This will be aggressive chemotherapy and the treatment may take 3-6 months.

Consolidation chemotherapy- is extra treatment given after the main therapy (like surgery or initial chemo) to kill any remaining cancer cells. It helps lower the chance of the cancer coming back. Usually given for a short period it’s like a “clean-up” step to ensure the best results. These will be through oral medications and the treatment may take 6-18 months.

Allogenic Bone Marrow / Stem Cell Transplant uses healthy blood stem cells from a matching donor’s body to replace bone marrow that’s not working properly. For this, a Healthy and matching donor is needed. This is usually a DNA-matched sibling. If a matching donor is not available, then we may take a donation from a half-match donor, such as either of the parents or less matched siblings. This is called Haplo Identical BMT.

Kindly Note: The advised plan was solely based on the reports shared with us. The final line of treatment was to be decided post the physical and clinical evaluations of the patient on arrival only. 

We’d recommend the following hospitals having acclaimed Bone Marrow Transplantation doctors as below:

1. Sanar International Hospital  – Gurgaon, Delhi NCR.

Dr. Satyendra Katewa will be the treating doctor.

2. Sharda University Hospital, – Noida, Delhi NCR.

Dr. Anil Thakwani will be the treating doctor.

3. KIMS Hospitals, Hyderabad, India

Dr. Narender Kumar Thota will be the treating doctor.

4. Amrita Hospitals – Fardabad, Delhi NCR.

Dr. Pravas Chandra Mishra will be the treating doctor.

5. BLK-MAX Super Specialty Hospital – New Delhi, India

Estimated costs:

Estimated cost of Initial Evaluations will be approx. USD 1500-2000 on OPD basis

Estimated cost of Induction Chemotherapy at various hospital will be approx.:-

For consolidation Chemotherapy the cost may vary from $15000 to $20000 over 18 months.

OR,

Estimated cost of Allogenic Bone Marrow Transplant will be approx.:-

In case a matching donor is not available and we have to do a Haplo identical BMT, the cost will go up by $6000-$8000.

Kindly Note: The above rates are on approximate basis; actual charges will depend upon the final plan confirmed on the basis of medical evaluation at the hospital.


Stay in India:For induction chemo- The patient may require 3 months on day care basis. She will need to stay in India for this period.

For Consolidation Chemo – The patient may go back home after the first cycle and continue the treatment at home.
OR,
For BMT – The transplant will take 25-27 days stay in hospital. Post-Transplant he will still take another 4-5 weeks of follow up before he can fly back. She will need to stay in India for this.

Total Stay In India– 4- 6 months.

Inclusions of BMT Package: –
1.  Pre transplant work up includes confirmation of disease with staging, hematological and biochemical work up, virological screening, echocardiogram, pulmonary function test and other investigations
2.  Hospitalization for the patient for 3 weeks in HEPA filter room
3. Hickman catheter insertion
4. Immunosuppressive drugs
5.  Growth factors (G CSF), Antibiotics, Antifungal and Antiviral drugs
6. Blood products (PRBCs, Platelets, FFP).
7.  Laboratory investigations during transplant (Hematological, biochemistry, blood culture, drug assay for cyclosporine).
8.  Radiological investigations
9. Doctor’s fees & Nursing charges

Exclusions:

1.      Any consultation other than in discussion
2.       Extended stay.
3.       Treatment for any other illness.
4.       Covid Tests
 
On Arrival: Patient will be received at the airport by our Representative. Apart from the medical and nursing team, one Case Manager will take care of all the needs. We shall also assist the family with the reasonably charged accommodation near the hospital. They may prepare USD 30-50 per day towards accommodation in the guest house after discharge from the hospital.

Disclaimer – This is a sample opinion for better understanding of non-medicals and patients. The above is an opinion which has been accumulated from the many good but different opinions received from multiple doctors. The treating doctor is the best person to give you accurate information.  The actual Treatment Plan may vary from case to case.