The life of the thalassemic in today's world is far different than it was just a few years ago and one can expect that this trend will continue at a rapid pace in the coming years. Sixteen years ago, when I was first beginning to learn about thalassemia, I asked Lisa Cammilleri, the founder of thalpal, how long a thalassemic could expect to live. She told me that the mid-thirties was a good life expectancy and she really had little faith she could live beyond that age. She passed away shortly after her 34th birthday. And what I saw in those years only reaffirmed that this was typical, even though some thals had somehow managed to live beyond that age and were well on their way to age 40 and even 50! This was remarkable, but for the most part, I continued to see patients living only into their 30's at most and often only into their mid to late 20's. Incredibly, during the past 15 years there has been a major change in this projection of life expectancy.
I often hear parents and patients say "we have waited so long for such and such and it seems like it never happens." Yes, it took ages for an oral chelator (Exjade) to be marketed in the US, but another oral chelator (Kelfer) has been used in India for close to 30 years and has kept many people alive. I will be very happy to see a dear friend in India turn 50 this year and I know another is rapidly approaching that landmark. Things have not been equal for those in Asia, so these are true inspirations for all. And yes, a cure other than bone marrow transplant, gene therapy, is still in trials, even though things do look promising in that direction in the future. But, is a cure really as important if treatment reaches the stage where thalassemics can expect to live full and fairly normal lives if they fully comply with their treatment programs? What I have discovered over the past few years and I know Dr Vichinsky has confirmed this with patients, we really don't know how long thals can live because we don't really see any obstacles to having a normal lifespan if patients do fully comply. As understanding about the various aspects of thalassemia becomes clearer, we will see that a normal life is the expectation and not the exception, and that this progress will rapidly change the standard of care throughout the entire world.
What are the basics of staying alive? We can break this down into the three basics; maintaining hemoglobin level, iron chelation and protecting the body from the damaging effects of free iron. Of course, there is much else involved with maintaining and monitoring the health, but these are the basic issues that must be addressed if a thalassemic expects the body to function normally for a lifetime. One of the biggest changes in the approach to thal treatment over the past two decades is the recognition that maintaining as close to normal an Hb level as possible is key to normal growth and development and the old theory of keeping the Hb as low as possible to minimize iron intake, has fallen along the wayside. Because of advances in chelation, it is now believed to be far better to take adequate blood and enjoy the benefits of having a sufficient oxygen supply to the organs and all of the body. Not only does this enhance physical development but is also has the added benefit of allowing thals to feel much better, which allows them to carry on with their daily lives. Secondly, not only has chelation advanced but the understanding of what needs to be done for proper chelation and which combination of chelators work best, has been expanded. Patients who were once thought to be beyond help are now being helped with aggressive chelation programs and medical intervention where necessary, but even patients with congestive heart failure can now be saved if it is caught early enough and the damage that has been done to their heart by iron, is now known to be reversible. Even the approach to when to start chelation is changing and I predict that chelation will be starting along with the first transfusions in the future, as it has been observed that this can help prevent free iron from destroying red blood cells. In addition to new chelators, and several more are currently in various stages of development, methods to make chelators work better and faster are also in development. When will all this be available? Sooner than you may think. If you think about it, you will realize how much is different today than it was a few years ago and advancements in treatment are coming very fast. We are seeing patients literally turn their lives around by aggressively attacking their problems in a serious manner, with the realization that their efforts will be rewarded with good health. Thirdly, the body and its glands and organs need to be protected from the dangerous effects of iron oxidation in the body. We all know iron oxidation when we see it on a car. It's called rust and as Neil Young wrote, "rust never sleeps", and in the body, this is also the case. Oxidation from iron and other radicals is a constant and preventing the damage that this oxidation can cause is becoming a new focus of treatment in thalassemia and this group has been a leader in spreading the word about the many benefits of taking antioxidants and various other supplements that are necessary to supply the high amount of nutrients required by the thalassemic. We talk in depth about this topic elsewhere on the thalpal.com website so I will not repeat all that here.
What we have been seeing over the past couple years is nothing short of amazing. We are seeing patients, who 5 years ago would have been told they had little chance of surviving, completely turn things around and put themselves back on the road to good health. I now realize that there really is no reason that anyone should tell a thal to have negative expectations as far as quality and length of life. We really don't know because so much is new, but if these basics are complied with from birth to death, we will be seeing many more thals celebrate the births of their grandchildren. Stop waiting for when will something happen. It's already happening and it's only going to get better.
I have devoted much of the past sixteen years to furthering my own understanding of thalassemia and its treatments, and sharing this knowledge with as wide an audience as possible through this website, through social media and in person, and helping to guide others to expand this effort with their own, and these selfless efforts by all involved, our moderators and all contributing members, have been quite effective, and I think I can say for all with full confidence that there is nothing more rewarding than hearing the reports of those who have followed what they have learned here and have totally changed their lives. Our work and our efforts to reach out to all the thalassemia community have made and are making a big difference in the lives of many and this work will continue as more people embrace the concept of being a thalpal, sharing a positive message about the lives of those who live with thalassemia. Let's be the leaders in creating awareness of this new reality where thalassemics do intend to stay alive.
Updated 2/20/18
Andy Battaglia
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