Baby Afeefa was suffering from acute lymphoblastic leukaemia.

Gulf Today Report

In a noteworthy achievement, a nine-month-old baby girl has successfully undergone a bone marrow transplant for acute lymphoblastic leukaemia at an Abu Dhabi hospital. Afeefa Zahra Muhammad Iqbal, the fourth child born to a Pakistani couple in March 2022, was only three months old when she started experiencing prolonged fever and looking pale. Muhammad Iqbal and Batool Zahra, who have been residing in the UAE for the last 10 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 baby Afeefa was suffering from acute lymphoblastic leukaemia, a type of cancer of the blood and bone marrow that can progress quickly without treatment.

"Acute lymphoblastic leukaemia 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 Paediatric Haematology, Oncology & BMT, Burjeel Medical City.

In allogeneic bone marrow transplantations, the patient's bone marrow is replaced with healthy blood stem cells from a donor. The ideal donor is a full match according to HLA antigens to ensure immunological compatibility. The medical team led by Dr. Aabideen conducted HLA typing of baby Afeefa's family and found that her eight-year-old sister Nazia Zahra was a full match.

Baby Afeefa is now headed home after a hospital stay of around six months. 

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 get better. I was a brave girl, and was not afraid. Afeefa is like my twin sister now," said the third grader.

The treatment plan

Meanwhile, based on the UK CCLG protocol, the medical team continued chemotherapy to stabilise Afeefa's condition and prepare her for the procedure. The highly advanced bone marrow transplantation was conducted at Burjeel Medical City on 1st December, 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 19th December, the neutrophil engraftment showed promising results. A chimerism test, a genetic-based specialised 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% donor chimerism (indicating all her bone marrow cells are from her sister).

Prof. Humaid Al Shamsi, Consultant & 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."

‘Feeling Relieved’

Baby Afeefa's parents are feeling incredibly relieved. "After taking our baby to the hospital for the first time in June, the entire life of the family 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. The treatment was excellent, and the entire medical team at Burjeel Medical City was supportive. We felt at home at the hospital. I also want to mention my wife, who observed our child round-the-clock and alerted the medical team even if there was the slightest change in her. Her commitment to Afeefa has also played a part in the healing process," said Iqbal.

According to Dr. Mansi Sachdev, Consultant, Paediatric Haematology, Oncology & 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 1 month and above. Every transplant comes with its challenges, and the indications are different. Afeefa's situation has been challenging due to her very 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.