Why a child and an adult with leukemia aren’t fighting the same cancer

Leukemia is cancer of the blood and bone marrow. Instead of making healthy blood cells on a steady schedule, the marrow starts pumping out abnormal white cells that don’t work right. They crowd out the good stuff. So people get tired, sick more often, bruise easily, and feel off in ways that are hard to pin down at first. It’s scary because it doesn’t always show up as a single lump you can point to. It’s everywhere the blood goes. And that’s pretty much everywhere.As per reports, Leukemia is the sixth most prevalent malignancy between 1990 and 2019 in India. Leukemia is more frequent in men (7.17%) than in women (6.39%). It ranked ninth in terms of deaths among all cancers from 1990 to 2019, accounting for approximately 4.6% of all cancers. Here’s the part that trips people up. We talk about leukemia like it’s one thing. It isn’t. In kids, the most common type is acute lymphoblastic leukemia. In adults, it’s often acute myeloid leukemia or chronic forms that behave slower but are tougher to treat. The genetic mistakes inside them are different too. So the disease follows different rules.“The basic dissimilarity that we can observe between children and adults, is the actual type of leukemia, which is acute lymphoblastic leukemia (ALL) and occurs in almost 80% of all leukemia in childhood. In adults we mostly see acute myeloid leukemia (AML), as well as chronic lymphocytic (CLL) leukemia (or chronic myeloid leukemia (CML).This already shows the manner in which the results are going to work since the treatment and biology of these leukaemia’s does not work the same way,” Dr. Ashish Bakshi , Director- Medical Oncology and Haematology, Dr L H Hiranandani Hospital Powai, Mumbai.“The genetic nature of leukemia is also age specific. The most typical case of good-quality changes are observed in children’s patients, such as the ETV6-RUNX1 fusion, which is likely to be cured. The poor-risk changes such as the Philadelphia chromosome are however more probable to be found in the adults of the same disease therefore complicating treatment. In AML children tend to have massive changes of chromosomes whereas in adults the mutations are small and maladaptive changes acquired throughout a lifetime. The fact that the cases of paediatrics are more liable to respond to the intensive treatment, than the adult cases, the guilt falls on them,” he adds. The expert then explains why it is important to know about the difference.The response to treatment is very eliciting from this dichotomy. The majority of the top hospitals have almost 98 per cent of them remitting after the initial treatment and more than 90 per cent survive in the long run. Only slightly above three-quarters of the cases can be remitted and achieve successful survival in adults, which is much less in cases of an average of 40-60 percent depending on the conditions and type of subtype used on the patients. The same is true of AML where survival rate among the children was never less than 70-75 percent and for adults it was still not less than 35-55 percent. They are not all the examples that demonstrate how the same diagnosis can be so varied in relation to a child or adult patient.One of the aspects that contribute to such a gap is the treatment tolerance. The aggressiveness means that children can better cope with a higher dose of chemotherapy. The drugs used in the treatment of the disease like asparaginase which are used as the pillars of treatment are highly acceptable among children compared to the adult population. Adults are more toxic, have more side effects, and treatment disruptions and particularly have other health conditions of diabetes, high blood pressure, or heart disease. This not only kills the intensity of treatment but also it reduces its performance. Physicians usually have an opportunity to decide either safety or effectiveness and it is far easier to make such a choice in younger patients, whose organs are fine.One of the reasons for this disparity is tolerance to treatment. Children can resist stricter regimen of chemotherapy at increased dosage. Asparaginase is one of the agents that are tolerated by children with a first-line treatment of paediatric ALL compared to adults. Adults, especially other disease conditions, including diabetes, high blood pressure, or heart disease, are more toxic, have more side effects and are more interrupted with their therapy. This not only decreases the strength of treatment, but also decreases the efficiency. Physicians always have to balance between safety and effectiveness, and when other organs of the younger patients are healthy, it is much easier.The schooling, play and normal development are disrupted to victimize the children, yet the family molding is very far-reaching to tame this kind of influence and ensure that the children remain resilient in the whole process. The adults, in turn, are overburdened with the question whether they will be able to lose their jobs, how the finances impact them, and the family, which may make the treatment process more complicated. In the two cases aid is needed to be emotional but it varies so much in nature.Medical experts consulted This article includes expert inputs shared with TOI Health by: Dr. Ashish Bakshi , Director- Medical Oncology and Haematology, Dr L H Hiranandani Hospital Powai, MumbaiInputs were used to explain why leukemia is not same in a child and an adult.