Adult Acute Lymphocytic Leukemia Archive Questions

Below are Dr. Gojo’s answers to Adult Acute Lymphocytic Leukemia questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.



Now displaying records 1 to 15 of 15.

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Q : 1 12/15/2009	I am a 64-year-old ALL Ph+ patient currently undergoing the M.D. Anderson Hyper C-Vad protocol. During the therapy I was given Gleevec (400mg) daily then jumped up to 800mg when it was determined through bone marrow biopsy that Gleevec was not driving the ALL into remission. I was then put on dasatinib which seems to be working towards getting me into remission. My WBC was 52,000 when I had my primary care MD look at me and two days later I was in the hospital. Now it is suggested that I receive a bone marrow transplant. I've read up on success/failure of transplants for older recipients and it almost seems better to skip it. What are your thoughts? I think that your doctor is recommending transplant because you did not responded well to the treatment initially and you have Ph+ ALL. This suggests that your chances to be cured by chemotherapy alone are not that good. If you have a perfect match we usually recommend allogeneic BMT for patients like you. There are side effects associated with the transplant and you should talk in detail with your transplant doctor about them. However, your age by itself should not be a factor if you do not have any other significant health issues.
Q : 2 07/31/2009	If a patient (32 years old) is receiving maintenance care after completing chemotherapy and radiation treatment and then has a relapse of ALL, should they begin treatment again? In the maintenance stage, is stopping Vincristine and giving Vinblastine the correct thing to do? Yes, if ALL relapses we recommend reinduction chemotherapy particularly in patients of younger age.
Q : 3 06/20/2009	Can you tell me more about dose modification in 6MP during continuation therapy? Are there certain guidelines that are followed? If you are referring to the maintenance phase of ALL therapy, then it is usually protocol dependent. It is important to monitor AST/ALT/bilirubin counts. If there is an evidence of elevated AST/ALT > 5 x normal or bilirubin >3 we usually withhold therapy until there is a return to the baseline and we restart at 50% of the original dose. Depending on the degree of myelosuppression, we also withhold the medication or dose reduction. Again, that depends on the protocol and the dosage used.
Q : 4 11/12/2008	In your opinion, what is the "standard of care" for a patient with relapsed (after three years) adult lymphoblastic lymphoma (T-cell) (when the initial treatment was hyper-CVAD with 2 years of maintenance methotraxate, 6-MP, dexamthasone, and vincristine)? I do not think that there is standard of care. Depending on the age, cytogenetics, and performance status, we usually treat patient with re-induction chemo to achieve CR followed by allogeneic transplant. The options are: similar regimens used in the therapy of lymphoblastic lymphoma such as Larson/CALGB regimen, BFM type of regimen (both include some agents that are not given with hyperCVAD), or other regimens or clinical study or repeating HyperCVAD. BUT, the goal is to get the patient into remission to move ahead with alloBMT. I think that the most important determinants which regimen to choose are whether the patient can tolerate agressive chemo or not, whether the pt is a candidate for alloBMT. Any of proposed regimens should be fine if the answer is positive. I think that the physician who provided the initial therapy should be able to discuss these details with you.
Q : 5 07/07/2008	Is it common practice to treat an adult patient with leukemia with chemotherapy everyday for three weeks? I have never heard of anyone getting that much chemo in such a short period of time. Acute leukemias require intensive treatment. There are different treatment protocols for the treatment of acute myeloid and lymphoid leukemia. You should check with the treating physician which protocol/treatment she/he is using and for what disease. That may help explain why the treatment seems to be too intense.
Q : 6 05/07/2008	My brother was diagnosed with ALL-L2 6 weeks ago. He went through the induction treatment with little trouble. In fact, now he is in remission; no leukemia was found in the blood or in the bone marrow. He was in the hospital for 32 days. Now at his home until April 15, to then go back to the hospital for another treatment. Are there any biological treatments instead of chemotherapy? He is 40 years old. All your insight will be greatly appreciated. The chemotherapy, repeat courses is a standard of care for patients with ALL. If a person has a special type of ALL, associated with Philadelphia chromosome, we add biologic agents to the chemotherapy and consider bone marrow transplant. I suggest you talk with his physicians about his prognostic factors.
Q : 7 12/06/2007	My mother passed away after a sudden onset of AML. She was only 63 and the first person in our family to have the disease. Some people have mentioned that AML is hereditary and my sister and I should be tested. Is AML really hereditary? No, the majority of AMLs are non-hereditary. Taking into account that your mother is the only family member ever affected by AML and that she had it at the age of 63, I do not think that you or your sister are at a greater risk for developing AML. There are very few hereditary AMLs, but they effect multiple family members and are diagnosed at a much younger age.
Q : 8 06/21/2007	My mom was diagnosed with AML three weeks ago. She has had one transfusion. Blasts currently are 5*, myelocyte 2*,meta 9*, seg 18*, band 14*, plat 56*, wbc 3.3*, hgb 8.8, hct 25.8, rbc morph few t, wbc few t. Her prognosis is 2 weeks to 2 months. Is this accurate? She is 78 and has chosen to go untreated. Unfortunately, if acute myeloid leukemia is not treated, then the outcome is poor and usually measured in weeks or months. However, the administration of blood products such as platelets and red blood cells sometimes can improve the quality of life.
Q : 9 01/21/2007	My uncle was just diagnosed with Adult ALL; he has T-cell, with mediastinal mass as well. Apparently this is one of the more rare forms. He has started treatment with the Larson Regimen. Is this what you would recommend? The Larson protocol is appropriate for the treatment as long as all instructions are followed.
Q : 10 10/25/2006	My mother was diagnosed with adult acute lymphocytic leukemia and passed away in January 2006. Initially she had breast cancer and was in remission for one month when she started feeling sick. She went to the ER with a severe headache and was diagnosed with acute leukemia. Someone told me that 1% of women follow breast cancer with acute leukemia. Is this true? I have not been able to find anything online to verify this. Patients with breast cancer who receive treatment with certain chemotherapy and radiotherapy are at slightly higher risk of developing secondary leukemias than the average population, but it is usually acute myeloid leukemia and not acute lymphocytic leukemia. Furthermore, these secondary leukemias usually develop after some time and not immediately after the treatment.
Q : 11 01/09/2006	I have been suffering with several symptoms for over 4 months now, and I have had an abnormal blood result that indicated high protein, high calcium and low white blood cells, with possible urinary tract infection. I have read alot and my dermatologist gave me the results recently and said possible leukemia. My doctor is not aggressive and seems to be taking a route which doesn't seem right. How do I get my GP to take it seriously? He seems to think that as long as I look OK, I am just one of those people who do not feel well. I think the best approach would be that you ask your dermatologist to speak to your doctor or vice versa, and that you express your concerns to your doctor. You should share with him/her the results that your dermatologist gave to you.
Q : 12 11/14/2005	Last week my wife was diagnosed with ALL. Other than chemotherapy and radiation, do you know of any naturopathic, non-chemical treatments that could be considered? We are afraid that chemo itself will be fatal if administered. Unfortunately, I am not aware of any naturopathic treatments. Although chemotherapy may have side effects, it is still the only approach that can help a patient.
Q : 13 10/18/2005	I am a survivor of ALL (now 47 yrs. old). I had a bone marrow transplant, was part of a clinical trial in 1996, and I have been in remission 9 yrs. I have little resources with other survivors. I do suffer from chronic pain and have episodes of just not feeling well, although my blood work has been good. Is this is what I should consider normal for a transplant survivor? I think that it is important that you follow up with your physicians and that you are properly evaluated for your symptoms. However, some of the symptoms could be related to anxiety that sometimes occurs in patients who have survived and are cured from the cancer. The Leukemia and Lymphoma Society sponsors support groups in each state (including one here at UMGCC). You should probably try to join one, as it may be helpful to share your experience.
Q : 14 10/14/2005	My sister, aged 37 years, has been diagnosed with acute myeloid leukaemia and is taking treatment in India. On completion of treatment, what is her life expectancy? Life expectancy depends on the type of leukemia, prognostic factors such as leukemia chromosomes, response to initial treatment etc. You should speak with her physician about it.
Q : 15 10/13/2005	I was recently admitted to the hospital for severe anemia (hgb 7.0). My white blood cells are low as well as my red blood cells. My Iron is VERY high. My platelttes are low and "clumping." I have had a bone marrow biopsy and am awaiting the results. Do these counts sound like a possible leukemia situation to you, and if so, what kind? Low blood count may be a consequence of infection, or disease such as myelodysplasia (pre-leukemia), leukemia, vitamin defficiency and others. Without a bone marrow evaluation, I cannot tell you what is the answer in your situation.

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