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Nine-month-old Afeefa was suffering from acute lymphoblastic leukemia and was required to undergo a bone marrow transplant. After a successful surgery and a nearly six-month stay in the hospital, she has overcome all odds.
The fourth child born to a Pakistani couple in March 2022, Afeefa was just three months old when she started experiencing prolonged fever and looking pale.
Her father Muhammad Iqbal and and mother Batool Zahra, residing in the UAE for the last ten years, took her to a hospital near their home in Ajman. An abnormal blood test prompted them to bring her to Burjeel Medical City.
Further testing revealed the baby was suffering from acute lymphoblastic leukaemia, a type of cancer of the blood and bone marrow that can progress quickly without treatment.
"Acute lymphoblastic leukemia is one of the common cancers in children, but it needs to be treated aggressively. Once we confirmed the disease, we further evaluated the little one's bone marrow. The advanced genetic test revealed that a high risk of a genetic mutation was driving this leukaemia. As per the international protocol, the only chance to cure her disease was through bone marrow transplantation," said Dr Zainul Aabideen, HoD pediatric haematology, oncology & BMT, Burjeel Medical City.
In allogeneic bone marrow transplantations, a donor replaces the patient's bone marrow with healthy blood stem cells. The ideal donor is a complete match according to HLA antigens to ensure immunological compatibility. The medical team led by Dr Aabideen conducted HLA typing of Afeefa's family and found that her eight-year-old sister Nazia Zahra was a full match.
Despite her young age, Nazia was happy to help out her baby sister. "I was sad when the doctors told me my little sister was very sick. I felt happy when my parents told me I could help her improve. I was a brave girl and was not afraid. Afeefa is like my twin sister now," said the third grader.
Meanwhile, based on the UK CCLG protocol, the medical team continued chemotherapy to stabilise Afeefa's condition and prepare her for the procedure. The bone marrow transplantation was conducted at Burjeel Medical City on December 1, after which Afeefa was under strict medical attention to monitor her body's response to the new cells. In the days after the procedure, she experienced complications like seizures and infections in her bloodstream that were successfully managed by the medical team looking after her. Soon, the little one's health and prognosis improved steadily.
On December 19, the neutrophil engraftment showed promising results. A chimerism test, a genetic-based specialized test to understand the procedure's success, was conducted one month after the transplant. The medical team was thrilled to learn that baby Afeefa had 100 percent donor chimerism (indicating all her bone marrow cells are from her sister).
Prof Humaid Al Shamsi, consultant and director, oncology services, Burjeel, said, "The entire team at Burjeel Medical City is thrilled baby Afeefa has overcome all odds and is now finally discharged home. The success of the bone marrow procedure in a patient so young offers hope to more children in need of such care. The procedure demonstrates our capabilities and expertise in bone marrow transplant. We are proud of this new milestone and thank the authorities for their encouragement."
Baby Afeefa's parents are feeling incredibly relieved. "After taking our baby to the hospital for the first time in June, the family's entire life changed in a matter of hours. Everything was disturbed, from the kids' education to our work. We now feel like a huge struggle has been over after months of suffering and pain,” said Iqbal.
According to Dr Mansi Sachdev, consultant, paediatric haematology, oncology, and bone marrow transplant, Burjeel Medical City, the timing of paediatric bone marrow transplants depends on the diagnosis.
"The indications for bone marrow transplants in paediatric patients are varied. The procedure can be performed in paediatric patients from one month and above. Every transplant comes with its challenges, and the indications are different. Afeefa's situation has been challenging due to her young age, but we overcame the odds together. She will continue to follow up with us in the outpatient clinic for the next year to ensure she is doing well," said Dr Sachdev.
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