Towards a better life: The fight against leukaemia (1985)

[Music] [Applause] Chin on chest. Shoulders nicely rounded. Go. Tracy is training to jump with those arerobatic superstars, the Red Devils. Stand by. Pen. Go. 101. 1 102. 103. Go. But she's jumping not for thrills or bravado, but to raise money for research into one of the world's most terrifying diseases. And look at those twists all the way throughout. Ready? Three years ago, Tracy became a victim of that disease. That's good. It's over there. As soon as it was her mother who first realized something was wrong. Tracy became desperately ill over the period of two weeks. She was finally taken into the hospital. She was in there for a week where they were doing tests and we knew that there was something desperately wrong with her but we weren't sure what. The result was um leukemia but unconfirmed. Got both shoulders in there just like a rocket. Lift it up. Four weeks later leukemia was confirmed. Right. Firmly in. How does that feel? She was only 14 when her parents were told she might have less than two years to live. We're almost ready to go. How can you tell a child she has a disease where she could possibly die? [Music] Over the next year, a great battle was fought. A battle for Tracy's life. Stand by. Tracy was referred to the Royal Marsden Hospital near London, a world center for the treatment of cancer. She was told her only hope was to have a bone marrow transplant using a new kind of treatment pioneered by Dr. Ray Poles, head of the leukemia unit. Hello, John. Hello, Ray. How are you? Oh, well, well. Every patient here has acute leukemia, a cancer of the blood. Mhm. With normal people, the bone marrow is a factory and it produces cells that we need for our every moment's existence. It produces red cells that carries our oxygen. We're dead in 3 minutes without that. It carries white cells that we use for fighting infection. And it uh produces platelets uh which we use for clotting, for stopping bleeding. Now with leukemia, the problem that occurs is one of those cells goes wrong. It becomes cancerous and it's a useless cell. It has no function whatsoever and it's also a greedy cell. It crowds out the whole of that bone marrow's face. It uh so what happened for instance in Tracy's case uh we were able to treat her with drugs to get rid of most of the cancer in her marrow and to make her marrow come back to normal function. If we had left her at that stage, inevitably the disease would have recurred and the only option we had with her was to completely destroy her bone marrow and rescue her with a bone marrow transplant. The Royal Marsden carries out a bone marrow transplant every week of the year, the highest number in Europe and for younger patients, the highest survival rate in the world. Leukemia can strike without warning. Either sex at any time of life. The most severe kinds need transplant. But a successful transplant depends on matching the tissue of patient and donor. If one takes a piece of tissue from any person and puts it into anybody else, there is a defense mechanism that attacks that tissue. And very few people in the outside population would be perfect matches by chance alone. But within the family, particularly brothers and sisters, by chance, because you've inherited material from your mother and your father, you can have brothers and sisters who are perfect matches. A complete stranger could be a perfect match, but it's a 1 in40,000 chance. A unit was set up in 1974 to process and register blood samples from volunteers to find matching donors. But it's a long slow business. To screen 40,000 people to find a suitable donor took many months. And we were finding that our patients were relapsing and dying whilst waiting for us to find a suitable donor. And this was just the problem that Tracy faced. She does have three brothers. They help run the family pub. But not one of them was a perfect match. Ray Poles took a gamble. Rather than risk Tracy dying, why not try one of the family who was certain to be a half match? Tracy's father. It's called mismatching. It was not Ray Paul's first innovation. Now, in 1975, we took a major decision, and that was that we would take leukemia patients not when they were just about to die, but very early on in their disease when they'd had the drug treatment. We'd made them extremely well. They were back at work at this point. We knew inevitably left alone their disease would come back and but we took the patients at that moment and we came in with our transplant. This took a lot of courage because some of those patients were going to die very quickly indeed and we know that they would have lived for another 6 months or a year before the disease came back and they died. So this was not a step taken lightly. But having taken that step we were suddenly successful. The majority of his patients will now survive transplant. Yet only a few years ago, it was rare for anyone to survive at all. But once selected, patients face months of difficult, often dangerous treatment. To prepare for transplant, they must take massive amounts of drugs, as many as 20 different kinds a day. The risk of infection is very great. So all drugs are fed through this tube direct to the main bloodstream. It's drastic treatment and every patient is supported by intensive nursing 24 hours a day. To my mind is no other branch of medicine where such exacting medicine exists. And the reason for this is that leukemia cells of course have come from the normal counterpart. And our big problem is that the drugs we use to attack those cells inevitably attack normal tissues. What happens is we take the patient, we give them these drugs at the beginning, we give them further drug preparation just prior to the transplant and inevitably we're going to poison these patients with these highly toxic drugs. And the only way that we can possibly be successful and minimize these effects is by a very high standard of medicine, a very high standard of dedicated nursing and almost unique conditions in which these patients are managed. And this is the only possible way that we can hope to be successful. [Music] sterile rooms and equipment, specially filtered air, everything controlled to reduce the risk of infection. It's during this period that the first side effects of the toxic drugs will begin to show. Just so happens it didn't affect me that much and it wasn't too bad. Really, the worst bit of that, you know, upset me more than anything was losing my hair. But then, you know, I think my parents were more upset than me, so I wasn't too bad. We'd kept a lock of her hair and we took this into Cud and we got her a wig which in fact was a perfect match as far as the colors concerned. And when she had the wig on, she looked quite lovely again, like her old Tracy. And in fact, we cried. I'm not quite sure whether to relieve or what, but perhaps we felt it boosted her morale again, looking somewhere near normal, you might say. Looks more Anna is 14, the same age as Tracy when she had hair transplant. She too lost most of her hair. Dad. Oh, that's quite good. Look. Quite nice. Very nice. You try the other one. It's a bit different color. Just a minute. Let's just have this one. Oh my goodness. That one change. It's beautiful. And Valerie is 27. She and her husband Ian have two children. They were one and two when her leukemia was discovered a year ago. I phoned the other evening far and things were gone. And he did mention that uh Leah said is mommy coming out with another baby cuz she hasn't had it for a long time. So you better find something to take home a bit quick. Yeah. Take her home with the treatment has to be Valerie's transplant is still a week away. But today is a kind of rehearsal for a crucial part of treatment that has to happen before transplant. In 6 days time, her whole body will be irdiated for many hours to kill off the diseased bone marrow. But that huge dose of radiation must be carefully calculated in advance. So capsules that absorb radiation are placed all over the body to measure the rays as they go into the body and out the other side. From this they can calculate exactly how much radiation each particular part of the body can absorb. Every person is different and the dose must be tailored to suit each individual. How long you need to everyone's clear, the cobalt beam is switched on. A short burst of radiation and in 10 minutes the test will be over. After the test, the radiation absorbent capsules are removed for measuring. Total body radiation could kill healthy as well as diseased tissue. So the radiation released will be measured and recorded on computer and Valer's exact dose worked out accordingly. Even a tiny error could be fatal. So accuracy is essential. It's also essential for Valerie's donor, her brother Michael, to be at Marsden a few days before the final radiation begins. Without his healthy marrow, she would die. I know you've been down to the department already. The day of radiation itself and the last briefing before Valerie is taken down. Also her last chance to change her mind about transplant. Once radiation happens and her own bone marrow is destroyed, there's no turning back. She left the ward at 9 in the morning. Ahead of her, possibly the most drastic and dangerous part of the whole transplant program. Don't know. Depends whether a last check with the capsules to make sure Valerie's dose is correct. Those windows are terribly transparent to just move her down, please. A few minutes to position her accurately in line with the beam. From the control room, radiation a million times more powerful than an ordinary X-ray is switched on. She's exposed to that beam not just for an instant, but for long periods. A whole day of almost total isolation. Her only contact by two-way radio to the control room where every stage of her treatment is monitored. For husband Ian, a day of waiting. Radiation this intense causes sickness and depression. It's something no patient or relative can ever forget. Didn't think the radiation was going to be as bad as it was, but I was violently sick all the way through and it's very, very lonely. Although people do come in to check you from time to time to turn you over. You're heavily sedated. You're crying out for someone to come and just be near you. And I I was so distressed at the time. I was thinking, God, why am I here? You know, why are they doing this to me? It was really that bad. I went along just to see if there was if they needed me and they said that Tracy was rather distressed. So I asked if I should speak to her over the microphone and they said that they rather I didn't because uh it could upset her even more. So at that point I just left. [Music] 8 hours later, Valerie is back on the ward. Like Tracy, she was very sick. That radiation sickness and other after effects will continue for many months. Thank you. While Valerie was recovering on the ward, her brother is being briefed for his operation on the following day. No, please do yourself comfortable. I'm one of the anists here and I just wondered if I could have. It won't be a major operation. It will probably last less than an hour, but giving bone marrow isn't that simple either. It's much more than volunteering to give a pint of blood. And any operation that involves having a general anesthetic carries with it a certain element of risk. I'm a little bit um apprehensive about having an anesthetic for the first time, but uh compared with what Val is experiencing, it's uh it's nothing. It's quite a feature actually. Thank you. 16 stone. A hollow needle is pushed deep into the bone. In this case, Michael's pelvis. And the dark red marrow drawn off. It looks like ordinary blood, but it comes from the honeycomb of the bone itself. On average, the doctors need about a liter, sufficient to contain an ample supply of the vital stem cells that help manufacture new blood. Michael's own bone marrow will have recovered in about 2 weeks, but most owners are home and back at work in 48 hours or so. Michael's marrow proved to be very rich in stem cells, so they needed less than usual, and the operation was over in half an hour. Michael, nice deep breath now. That's it. Operation's over now. It's all gone very well. The transplant itself is almost an anticlimax. It's like a blood transfusion by the special introvenous line straight into the bloodstream. From there, it will gradually find its own way into the bones. But it will take from two to three weeks to start making new blood. And during this time, with hardly any white blood cells, the body has lost all its normal defense against infection and is especially vulnerable. Blood samples must be taken every day. The few white cells left in the body will die off quickly and the white count will drop close to zero. As the new marrow grows, the count should climb slowly back to normal. But until this happens, the condition of the blood must be continuously monitored. It's this blood count that will ultimately show whether transplant has succeeded or failed. If infection were to develop, it may be necessary to take white cells from a blood donor to boost the patient's blood before the new marrow has grown. Are they all they all the same? Anna's count has been fluctuating. Under her apparent calm, there's great tension and her one wish is to escape from this room. Goodness. That's wrong begins at church. You say that was done. Well, one of the things I came to especially tell you Valerie with still a long way to go will soon be experiencing the after effects of transplant and radiation bone now will be completely flattened. It's during that time that you can you're very prone to infections and worst of all your mouth because it's usually one of the first places it breaks down. Yes. And if you get mouth ulcers they are really nasty, really painful. So the best thing that you can do for yourself is to drink lots of fluids. I had a few side effects. For example, very dry and cracked sore skin. Um still violently sick. And I also had a very sore throat and mouth which I couldn't I couldn't even eat. Got to that stage. Um I remember on my birthday they cooked me a lovely chocolate birthday cake and I couldn't even eat my own birthday cake. Everybody has that tweet tip for me. One of the biggest problems that has dominated the whole program is that after the graft uh that is the new bone marrow uh has begun to grow because it carries with it its own immune system, it begins to attack the patient and this is a catastrophe. It attacks the skin, it attacks the intestine. It attacks the liver and about 50% of the patients were getting this problem and half of those patients were dying of it and dying in a most unpleasant and horrific way. We were very fortunate here at the mast because we were given the opportunity of testing a brand new imunosuppressive agent cycllosporin. This is an agent that suppresses immunity and we were able to test it in our patients after they'd received the transplant uh at a time when the marrow was growing and this immunity was developing and we have found and have been very encouraged by a drop in the death rate down to negligible amounts and over 97% of our patients now do not have this as a problem. when it was going to but there are other non-medical problems which still remain. You actually come through the doors and into isolation. It's only then that you realize, you know, all the things in life that you take for granted. You know, things like being able to touch people or just hold somebody's hand or been able to sort of hug your husband and your children, all those sort of things, you appreciate them that much more. For the families on the outside, giving strength and support night and day, waiting for that allimportant blood count to rise, sharing every moment of each other's ordeals, the strains they try so hard to conceal are immense. I think that those people are quite remarkable how they're able to stand the trauma and the strain of looking and seeing their loved ones, sometimes dying, but certainly suffering. And I think they're quite remarkable. Something like this draws you together, mother, father, and child, even the family really. And um I think it's, you know, it brings to you together in love and um you treasure tre treasure each moment. I mean, even the blossoms on the trees seem more beautiful because I think you wonder if it's how long your child has got to live and how much longer you're going to be together and share these experiences. 3 weeks after her transplant, Tracy's blood count was almost normal, and she was allowed out of isolation and back home to her family. Come on, son. Come on. But others were not so lucky. 12 days after her transplant, Margaret suffered serious complications. She died 4 days after these scenes were filmed. Four out of 10 of the patients in this unit may not survive. But 20 years ago, almost every single person with this kind of leukemia would have died without any hope at all. Every year, more lives are saved by advances in drugs, in patient care, and in this one unit, some of the world's leading cancer experts pooling their knowledge to defeat a terrifying disease. This unit costs the taxpayer a million pounds a year. A cost Ray Poles has no difficulty in justifying. A person who is 60 or 70 and who dies of cancer, that is very sad. a woman of 20 who dies of leukemia, who has two children and she leaves those two children and she leaves her husband. I find that a terrible thing to occur and I would I would think that this should be absolutely top priority for treating. 10 days after transplant, Valerie is still in isolation, but she's recovering well, and her blood count is just beginning to rise. Anna is still waiting to know what her future will be. Opening that door has broken isolation. Anna is free. Her transplant so far is a success. You've done it. Goodness, isn't it? Will you come see us on Monday? Yeah. Three years after transplant, Tracy is officially cured of what was once an incurable disease. As a child, she lived for sport. She seems to have a super abundance of energy and drive. Was it some of this that helped to pull her through? When I was in hospital, I knew I was very ill, but not once did I think about dying. I just wanted to get out, go back to normal, and be like everybody else. [Music] Surely the lovely views. I can see rivers and roads and lakes. And pull down on your left hand toggle. Pull down on your left hand toggle. I'm pulling down on my left hand toggle. It's quite scary. On the ground, her old school friends were there to cheer her on. Come on, keep coming this way. Head for the cross. Yeah, I'm landing and I'm coming down to the ground. I'm not going to look. Here we go. [Music] [Applause] [Music] [Music] Easy to see way down where everybody's standing. Because of research, because of all that's been learned about the treatment of leukemia, Tracy is alive. And in her lifetime, she may see the battle against this terrible disease won forever. [Music]