STI: Infection after chemotherapy led to death

April 12, 2009

Infection after chemotherapy led to death

By Nur Dianah Suhaimi 

 

How do you deal with a cancer that attacks blood?

 

Early diagnosis and treatment improve the odds of beating this fast-spreading blood cancer, or acute myelogenous leukaemia (AML).

 

But it was an infection, soon after his latest round of chemotherapy, that led to the sudden death of DBS chief Richard Stanley yesterday.

 

In fact, doctors had felt that Mr Stanley's AML was treatable when it was diagnosed in late January. Mr Stanley, 48, went to see a doctor when he had flu-like symptoms, including fever and a cough, over the Chinese New Year holidays.

 

Tests over the next three days confirmed he had AML.

 

The bad news came just nine months after he became chief executive of Singapore's biggest bank. He took leave, for up to six months, and began chemotherapy treatment at once.

 

In a staff memo then, DBS chairman Koh Boon Hwee said doctors felt Mr Stanley's condition was treatable and full remission was possible.

 

Haematologists who spoke to The Sunday Times yesterday explained that AML is a type of cancer in which the bone marrow makes abnormal white blood cells. These leukaemia cells build up in the bone marrow and blood, so there is less room for healthy cells. The causes of AML are mostly unknown.

 

It is a very serious illness and the cancer can worsen very quickly if not treated. Dr Benjamin Mow, consultant haematologist at Mount Elizabeth Hospital, said: 'If it is not treated, the person can die within three months.'

 

Patients have even died within two to three weeks of diagnosis due to complications from the disease or during treatment, said Dr Koh Liang Piu, senior consultant at the National University Cancer Institute.

 

Even with treatment, chances of recovering fully come with caveats. A normal, healthy person might have a 40 per cent to 50 per cent chance of recovery. But the elderly or sickly will have less than a 10 per cent chance, said DrKoh.

 

A relapse is common, occurring in three or four out of every 10 'cured' AML patients, he said.

 

In the less serious cases, the patient will have to go through four cycles of chemotherapy as treatment. The more serious and risky cases will need both chemotherapy and a bone marrow transplant, said doctors.

 

Because AML patients lack white blood cells needed to fight infection and disease, they have to be isolated during treatment to minimise the risk of infection.

 

Their single-bed isolation wards are specially cleaned. The few visitors who see them have to wash their hands and wear a face mask before entering the room. Such care is needed because, often, it is infections which lead to death among AML patients - especially after chemotherapy treatment.

 

Said Dr Koh: 'After chemotherapy, the patient's immunity is very low for the next two to three weeks. This is when the risk of infection is very high. Usually, death happens during this period.'

 

In a statement yesterday, DBS said Mr Stanley contracted an infection after chemotherapy, after which his condition 'deteriorated rapidly' in the last 48 hours.

 

Mr Stanley was treated at Mount Elizabeth Hospital. His doctor, consultant haematologist Dr Freddy Teo Cheng Peng, could not be contacted yesterday.

 

Infections can come from anywhere - from airborne bacteria to the pre-existing bacteria carried by the patients themselves. In very serious infections, such as blood or lung infection, the patient can die within hours, said Dr Koh.

 

Internal bleeding is also a common cause of death among AML patients, the worst being bleeding in the brain. This can happen suddenly and results from a lack of healthy platelets which help to form blood clots.

 

Said Dr Mow: 'Usually when the patient no longer responds to chemotherapy or becomes very sick, it might be too late to do anything else.'