LIIGHTNIING STRIIKES TWIICE FOR 25--YEAR OLD MEDIICAL STUDENT
FROM IINDIIA
July 28, 2003, will forever be etched in Rajat Gorai’s memory. The 23-year old had been steadily
losing weight (7 kg) and passing black tarry stools. The bright medical student from Calcutta’s
Nilratan Sircar Medical College
thought he had ulcers. He could feel a mass in the left side of his abdomen and asked his doctor
friends whether his spleen was enlarged. This was confirmed by an ultrasound scan. However,
nothing prepared Rajat for the news given to him by his Hematology Professor- “Rajat, you have
chronic myeloid leukemia.” The room spun, dreams of being a pediatric specialist doctor shattered in
one blow and Rajat was so shocked and devastated that he cannot remember what happened in the
next few hours. Lightning hadstruck.
Helped by his close friend, he returned home to Tribeni, a suburb of Kolkata, to show his shocked
father his blood report. The report said Rajat’s white blood count was 154,000. Later, a bone
marrow biopsy would confirm chronic myeloid leukemia. When he saw his Dad, Rajat broke down
and cried for an hour. His devastated Dad went to see the doctor and did not reveal to his son until
later, that the dire prediction had been Rajat would have a 3-4 year life span. His Dad cried.
Buoyed up by his Dad’s steadfast belief that he would be all right and his five close friends’ advice to
seek medical attention at one of India’s top cancer centers, Rajat departed for Mumbai and thus,
started his CML
journey. Rajat consulted with one of India’s top oncologists, Dr. Tapan Saikia, who told Rajat his
options, a bone marrow transplant which is curative but carried mortality risks or a golden pill called
Gleevec, which,
though, new, was giving remarkable results in clinical trials worldwide. Unfortunately, the price of
Novartis’ Gleevec was out of Rajat’s family’s reach so Rajat was started on the generic version,
Veenat. Rajat’s bone marrow biopsy at diagnosis had shown the cancer marker of CML, the
Philadelphia chromosome to be at 100%Ph+ but to Rajat’s delight and
relief, his 6-month test on Veenat showed the cancer marker had reduced to 46%Ph+. Rajat started
to pick up the pieces of his life, began the process of becoming whole again. Although, some of his
friends and relatives
advised against it, Rajat Gorai bravely sat for his MBBS examination in February 2004 and passed
the exam with flying colors. Rajat began to rebuild his life. In March 2004, Novartis, Gleevec’s
manufacturer accepted him into its donation program so that Rajat obtained the drug that was saving
his life, free of cost. The side-effects from the drug were minimal, some fluid retention and loss of
skin pigmentation.
When, in October 2004, Rajat’s WBC climbed to 14,000, he was filled with trepidation that changed
to panic when in November, 2004, his report read WBC at 17,000. Rajat left Kolkata for Mumbai to
consult with Dr. Saikia. His tests at Mumbai revealed a WBC of 40,000 and a bone marrow biopsy
confirmed that the young man’s leukemia had relapsed, the cancer marker was at 90%Ph+. Rajat’s
dose of Gleevec was increased to 600mg but by February 2005, his disease was back with a
vengeance,
WBC at 55,000 whereupon his doctor introduced the chemotherapy drug Hydroxyurea to control the
white counts. Rajat’s doctor declared him Gleevec-resistant and strongly suggested a bone marrow
transplant. Rajat’s siblings were not a match. Lightning had struck twice in the young man’s life.
Diagnosed at the age of 23 with leukemia, in an era when 80% of patients were responding to the
promising drug, Gleevec, he was proven resistant. He constantly asked himself why life was mocking
him this way and received no answers. Gleevec, his only ray of hope, had disappeared, leaving him in
despair and if it were not for his medical friends
propping him up, Rajat would have given up on life. His parents took up religion in the hope that their
fervent prayers would reach the ears of a deaf God. Rajat’s Medical College started raising funds for
an impending bone marrow transplant that costs more than
Rs. 5 lacs in India and his Dad’s employers also agreed to pay for some of the transplant costs.
At this time, a Psychology Professor, himself a CML patient, Dr. Ranjit Basu, came into contact with
Rajat and told him about the new kinase inhibitor BMS-354825 or Dasatinib which was giving great
results for Gleevec-resistant patients worldwide and was in clinical trials in Singapore. Dr. Basu told
Rajat to contact Dr. Anjana Rai Chaudhuri, a patient caregiver living in Singapore who ran a CML
Support Group. For Rajat, bone marrow transplant was a last resort, he believed the procedure could
cripple him for life, had a high risk of GVHD and even if cured, he could relapse and be at risk for
lifelong infections. Therefore, Dasatinib was like a silver lining to a dark cloud and Rajat began to
tentatively hope again that his aggressive disease would be controlled with an oral pill. Dr. Saikia was
a close friend of Dr. Goh Yeow Tee, who was the principal investigator in charge of the Dasatinib
trials in Singapore but finances remained a problem. It was not an easy task to fly to Singapore and
be based there for the first 3 months of
the trial and pay for doctor consults. Encouraged by Dr. Basu and Anjana and after much e-mailing
with the clinical trial personnel
at Singapore, Rajat was finally accepted into the Phase III Dasatinib trial end of June 2005. Phase II
trials had closed and Rajat’s basophils had climbed to 30%, his disease was progressing and Anjana
told him to come to Singapore and stay with her until the new trials opened.
In August 2005, Rajat took his first Dasatinib pill and within two weeks, his blood counts had
normalized. In October 2005, his cancer marker had decreased to 40%Ph+ on 140mg dose of the
drug and he had no side-effects. Rajat’s disease was being controlled yet again by a new drug in
clinical trials. Rajat felt he was being given a second chance. After reading US CML patient Jerry
Mayfield’s Diary, Rajat had felt that Dasatinib was giving patients a good QOL and he had nothing to
lose by joining the trials. Rajat’s second bone marrow biopsy at the end of 6 months on Dasatinib
shows his cancer marker to be 30%Ph+, he had a major chromosomal response to the drug.
Mutations test done at Singapore General
Hospital had revealed that Rajat had an ABL point mutation that had rendered him Gleevec resistant.
The oncoprotein had distorted
preventing Gleevec from binding.
Today, Rajat is not only in complete chromosomal response on Dasatinib, but he is also in a
major molecular remission. He has been on Dasatinib for nearly 3 years now and his only major side-
effect has been pleural effusion two times which was resolved by thoracentesis. Rajat feels the
pleural effusion is a small price to pay for the great response to Sprycel. Today, Rajat is studying to
enter the MD program in India, a Sprycel success story.
Rajat’s hobbies are playing cricket and table tennis. He likes listening to music and his favorite singer
is Kishore Kumar. All Rajat wants is to be a normal, loving son to his parents, an affectionate older
brother and have fun with his five close friends. And realize his dream of medically treating children.
He wants to end his story with the refrain from this song of Kishore
Kumar:
“Chalte chalte mere yeh geet yaad rakhna
Kabhi alvida na kahena, kabhi alvida na kahena.”
Translated: “While I go on my way, remember this song of mine
Never say goodbye, never say goodbye.”
FROM IINDIIA
July 28, 2003, will forever be etched in Rajat Gorai’s memory. The 23-year old had been steadily
losing weight (7 kg) and passing black tarry stools. The bright medical student from Calcutta’s
Nilratan Sircar Medical College
thought he had ulcers. He could feel a mass in the left side of his abdomen and asked his doctor
friends whether his spleen was enlarged. This was confirmed by an ultrasound scan. However,
nothing prepared Rajat for the news given to him by his Hematology Professor- “Rajat, you have
chronic myeloid leukemia.” The room spun, dreams of being a pediatric specialist doctor shattered in
one blow and Rajat was so shocked and devastated that he cannot remember what happened in the
next few hours. Lightning hadstruck.
Helped by his close friend, he returned home to Tribeni, a suburb of Kolkata, to show his shocked
father his blood report. The report said Rajat’s white blood count was 154,000. Later, a bone
marrow biopsy would confirm chronic myeloid leukemia. When he saw his Dad, Rajat broke down
and cried for an hour. His devastated Dad went to see the doctor and did not reveal to his son until
later, that the dire prediction had been Rajat would have a 3-4 year life span. His Dad cried.
Buoyed up by his Dad’s steadfast belief that he would be all right and his five close friends’ advice to
seek medical attention at one of India’s top cancer centers, Rajat departed for Mumbai and thus,
started his CML
journey. Rajat consulted with one of India’s top oncologists, Dr. Tapan Saikia, who told Rajat his
options, a bone marrow transplant which is curative but carried mortality risks or a golden pill called
Gleevec, which,
though, new, was giving remarkable results in clinical trials worldwide. Unfortunately, the price of
Novartis’ Gleevec was out of Rajat’s family’s reach so Rajat was started on the generic version,
Veenat. Rajat’s bone marrow biopsy at diagnosis had shown the cancer marker of CML, the
Philadelphia chromosome to be at 100%Ph+ but to Rajat’s delight and
relief, his 6-month test on Veenat showed the cancer marker had reduced to 46%Ph+. Rajat started
to pick up the pieces of his life, began the process of becoming whole again. Although, some of his
friends and relatives
advised against it, Rajat Gorai bravely sat for his MBBS examination in February 2004 and passed
the exam with flying colors. Rajat began to rebuild his life. In March 2004, Novartis, Gleevec’s
manufacturer accepted him into its donation program so that Rajat obtained the drug that was saving
his life, free of cost. The side-effects from the drug were minimal, some fluid retention and loss of
skin pigmentation.
When, in October 2004, Rajat’s WBC climbed to 14,000, he was filled with trepidation that changed
to panic when in November, 2004, his report read WBC at 17,000. Rajat left Kolkata for Mumbai to
consult with Dr. Saikia. His tests at Mumbai revealed a WBC of 40,000 and a bone marrow biopsy
confirmed that the young man’s leukemia had relapsed, the cancer marker was at 90%Ph+. Rajat’s
dose of Gleevec was increased to 600mg but by February 2005, his disease was back with a
vengeance,
WBC at 55,000 whereupon his doctor introduced the chemotherapy drug Hydroxyurea to control the
white counts. Rajat’s doctor declared him Gleevec-resistant and strongly suggested a bone marrow
transplant. Rajat’s siblings were not a match. Lightning had struck twice in the young man’s life.
Diagnosed at the age of 23 with leukemia, in an era when 80% of patients were responding to the
promising drug, Gleevec, he was proven resistant. He constantly asked himself why life was mocking
him this way and received no answers. Gleevec, his only ray of hope, had disappeared, leaving him in
despair and if it were not for his medical friends
propping him up, Rajat would have given up on life. His parents took up religion in the hope that their
fervent prayers would reach the ears of a deaf God. Rajat’s Medical College started raising funds for
an impending bone marrow transplant that costs more than
Rs. 5 lacs in India and his Dad’s employers also agreed to pay for some of the transplant costs.
At this time, a Psychology Professor, himself a CML patient, Dr. Ranjit Basu, came into contact with
Rajat and told him about the new kinase inhibitor BMS-354825 or Dasatinib which was giving great
results for Gleevec-resistant patients worldwide and was in clinical trials in Singapore. Dr. Basu told
Rajat to contact Dr. Anjana Rai Chaudhuri, a patient caregiver living in Singapore who ran a CML
Support Group. For Rajat, bone marrow transplant was a last resort, he believed the procedure could
cripple him for life, had a high risk of GVHD and even if cured, he could relapse and be at risk for
lifelong infections. Therefore, Dasatinib was like a silver lining to a dark cloud and Rajat began to
tentatively hope again that his aggressive disease would be controlled with an oral pill. Dr. Saikia was
a close friend of Dr. Goh Yeow Tee, who was the principal investigator in charge of the Dasatinib
trials in Singapore but finances remained a problem. It was not an easy task to fly to Singapore and
be based there for the first 3 months of
the trial and pay for doctor consults. Encouraged by Dr. Basu and Anjana and after much e-mailing
with the clinical trial personnel
at Singapore, Rajat was finally accepted into the Phase III Dasatinib trial end of June 2005. Phase II
trials had closed and Rajat’s basophils had climbed to 30%, his disease was progressing and Anjana
told him to come to Singapore and stay with her until the new trials opened.
In August 2005, Rajat took his first Dasatinib pill and within two weeks, his blood counts had
normalized. In October 2005, his cancer marker had decreased to 40%Ph+ on 140mg dose of the
drug and he had no side-effects. Rajat’s disease was being controlled yet again by a new drug in
clinical trials. Rajat felt he was being given a second chance. After reading US CML patient Jerry
Mayfield’s Diary, Rajat had felt that Dasatinib was giving patients a good QOL and he had nothing to
lose by joining the trials. Rajat’s second bone marrow biopsy at the end of 6 months on Dasatinib
shows his cancer marker to be 30%Ph+, he had a major chromosomal response to the drug.
Mutations test done at Singapore General
Hospital had revealed that Rajat had an ABL point mutation that had rendered him Gleevec resistant.
The oncoprotein had distorted
preventing Gleevec from binding.
Today, Rajat is not only in complete chromosomal response on Dasatinib, but he is also in a
major molecular remission. He has been on Dasatinib for nearly 3 years now and his only major side-
effect has been pleural effusion two times which was resolved by thoracentesis. Rajat feels the
pleural effusion is a small price to pay for the great response to Sprycel. Today, Rajat is studying to
enter the MD program in India, a Sprycel success story.
Rajat’s hobbies are playing cricket and table tennis. He likes listening to music and his favorite singer
is Kishore Kumar. All Rajat wants is to be a normal, loving son to his parents, an affectionate older
brother and have fun with his five close friends. And realize his dream of medically treating children.
He wants to end his story with the refrain from this song of Kishore
Kumar:
“Chalte chalte mere yeh geet yaad rakhna
Kabhi alvida na kahena, kabhi alvida na kahena.”
Translated: “While I go on my way, remember this song of mine
Never say goodbye, never say goodbye.”
