Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Haematological malignancies in developing countries: is CML the commonest childhood leukaemia?

Leukemia volume 21, page 2194 (2007)Cite this article

We would like to commend the editors for highlighting the usually silent issue of treatment differences in affluent vs developing societies1 and stimulating discussion on such an important topic. We were, however, intrigued to read in the editorial that chronic myeloid leukaemia (CML) is the commonest childhood leukaemia in India rather than the ‘usual’ adult onset. The authors of this letter have worked in India, including one of the authors (CMP) for ∼35 years, and have never seen CML as the most common type of leukaemia in children, which they believe has always been acute lymphoblastic leukaemia. We agree that the epidemiological literature on the incidence of haematological malignancies in India is sparse, but even in the reported literature, CML is not seen in children and has an epidemiology that is similar to that seen in the West.2, 3, 4 We accept the fact that most government teaching hospitals come across numerous cases of chronic malignancies, where there is enough time for a patient to travel long distances, and a number of patients of acute leukaemia may be dying before receiving medical attention in rural areas. We are happy that the editors are optimistic on the treatment question but beg to differ that 80% of Indians cannot afford to pay for simple medicines, let alone an allogeneic transplant, which, even in the cost-constrained Indian scenario, would cost upwards of £3000, and further added costs of immunosuppression and treatment of infections. Busulphan and hydroxyurea still remain the treatment of choice for a majority of patients despite all the advances in CML. The Development of cheaper economic models of treatment, preferably ‘single-shot’ options, would be a major step forward.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Gajewski JL, Robinson P . Do affluent societies have the only options for the best therapy? Leukemia 2007; 21: 387–388.

    Article  CAS  Google Scholar 

  2. Chaudhuri K, Sinha A, Hati GC, Karmakar R, Banerjee A . Childhood malignancies at BS Medical College: a ten year study. Indian J Pathol Microbiol 2003; 46: 194–196.

    Google Scholar 

  3. D'Costa G, Siddiqui HM, Pradhan RM, Gupte SS . Pattern of leukemias: a ten-year incidence study of 242 cases. J Postgraduate Med 1989; 35: 191–195.

    CAS  Google Scholar 

  4. Kusumakumary P, Sankaranarayanan R, Padmakumary G, Varghese C, Kumar SR, Nair MK . Childhood cancer in Kerala, India. Lancet 1991; 338: 455–456.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, National Amyloidosis Centre, Royal Free and UCL Medical School, London, UK

    A D Wechalekar

  2. Department of Pathology, Lata Mangeshkar Institute of Medical Sciences, Nagpur, India. E-mail: a.wechalekar@medsch.ucl.ac.uk,

    C M Parande

Authors
  1. A D Wechalekar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C M Parande
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wechalekar, A., Parande, C. Haematological malignancies in developing countries: is CML the commonest childhood leukaemia?. Leukemia 21, 2194 (2007). https://doi.org/10.1038/sj.leu.2404880

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.leu.2404880

This article is cited by

Search

Advanced search

Quick links