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Adult Acute Myeloid Leukemia Archive Questions

Below are Dr. Baer’s answers to Adult Acute Myeloid 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 23.

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Q : 1

My friend has AML and had a peripheral stem cell transplant 21 days ago. What is the danger for our friend if the transplant does not take? Can he try again or get another donor? Is it normal for the transplant to not have taken by now?

The time for production of blood cells derived from the donor, or "engraftment," is variable. Twenty-one days is on the long side of the range. It is important to look for correctable causes, such as medications or infection. More cells from the donor or, in the longer term, cells from another donor are possible options.

Q : 2

My mom was diagnosed with AML about a year ago. Recently she has been having shortness of breath (oxygen is at 78%) and aches in her abdomen. She went to the ER had and the results of here CBC were: WBC-6, HGB-9 and Platelets-24. What should we do?

You mom's counts are low and she should see her hematologist/oncologist. If she does not feel and is still having shortness of breath, you should take her back to the hospital.

Q : 3

Does preleukemia present with abnormally high platelets?

It can present with a high platelet count; however, bone marrow aspiration and biopsy should be done to confirm a diagnosis.

Q : 4

I am 70 years old and have AML, but it is in remission. How careful should I be around people with colds?

I would always recommend being extremely careful, particularly now that we have this new flu virus and you're 70 years old. Frequent hand washing and avoidance of direct exposure to sick people is recommended. Depending on how long you have been in remission, you may want to wear a mask to protect yourself from exposure. This is especially good if you have recently finished your chemotherapy. You should also check with your primary oncologist for further recommendations.

Q : 5

My ex-husband has been diagnosed with Acute Leukemia MLL5. Are his children likely to inherit the disease? If he needs a bone marrow transplant, would his kids be potential donors? If it is genetic, how do we find out if the kids have the gene?

Usually children are used as donors in a unique type of the transplant called haplo transplant. The preference is to type the patient's siblings or try to find an unrelated donor from a donor registry. Very few leukemias are inherited. If your husband has leukemia, it does not mean that your children are genetically predisposed to it.

Q : 6

My Mother is 70 years of age and was diagnosed with AML (monoblastic) 3 weeks ago. She received 3 days of Idarubicin and 7 days of AraC chemotherapy, but her AML did not go into remission. The doctor told us her cytogenetics revealed 12 chromosonal abnormalities and that she fell in the high risk phase. Do you have any suggestions or recommendations that would help us make the best choices for our mother at this point?

There is no standard treatment for elderly patients with refractory AML and complex chromosomal abnormalities. I would suggest considering participation in a clinical study aimed at this patient group, if available. You should check with her physician to see if there are any being conducted in your area.

Q : 7

My father is 68 years old and has AML (M4 with eos). His initial chemo was successful and it put him into remission. He is now undergoing consolidation chemo and other than this AML, he has no health problems. Even though he is over 60, does that help with his prognosis? Also, the oncologist says he is tolerating the chemo very well, so they are doing "full-force" chemo.

If your father has M4 with eos and classical chromosmal abnormality involving chromosome 16, then I think it is very reasonable to proceed with consolidation chemotherapy. Even in patients above age 60, this type of leukemia responds best to therapy.

Q : 8

I have had 4 blood transfusions since Nov 2007. My recent bone marrow biopsy and aspiration turned up 29% blasts. I had normal cytogenetics and have been diagnosed with AML. I'm 72 years old, but in excellent physical shape. What is my outlook? I am preparing to start on Vidaza.

I think that the Vidaza is a very reasonable choice for therapy since it appears that your leukemia may be coming after a period of myelodysplasia (pre-leukemia). It will be important to see how well you respond after 4-6 cycles of Vidaza. If you don't see any improvement, there may be other treatment options, including participation in clinical studies.

Q : 9

My 74-year-old mother was diagnosed with MDS 6 months ago, and 5 weeks ago, it suddenly turned into AML. She was diagnosed when she went into the hospital for diahhrea and a fever. She has had 2 rounds of mylotarg -- the 2nd round with very little side effect. We are hoping we can keep her away from any infections. I know her prognosis is not very good, but are we talking at least a couple of months? During her 5 weeks in the hospital, she has had numerous transfusions. I need a little more information than what the doctor is supplying.

From the information you provided, it appears that you mother has AML arising from the MDS, which is associated with a poorer prognosis and is unlikely to be cured. There are many factors that may affect patients' survival--age, other diseases, tolerability of chemo, development of toxicity, and so on. It is expected that these patients need numerous transfusions and may develop infections. For overall prognosis in terms of months, weeks or similar, I would advise you to speak with her primary oncologist who has more insight into her condition at this moment.

Q : 10

My father, who is 75 years old, was diagnosed with AML in July. He received chemotherapy and radiation treatments for 7 days and was released from the hospital to recover sufficiently for the next round of treatments. His oncologist did blood work recently for re-admission, and said that things "didn't look right." They consulted a specialist. This doctor and his current oncologist have decided that all they can do is "keep pushing it back" (referring to the AML). In your opinion, does this mean that it is refractory and never truly cleared up? And if so, what is the prognosis for refractory AML in a 75-year-old?

If your father really never achieved remission following initial treatment, we would call his leukemia refractory. However, even if he achieved remission and relapsed so quickly, I think that there is no big difference in regard to the prognosis of his AML. Unfortunately, patients of older age who have this type of leukemia cannot be cured, and frequently the goal of the treatment is to try to extend leukemia control and provide some quality of life. There are different ways to achieve it, from supportive type of care to clinical studies or some other treatment, to comfort care. You should discuss the best treatment option for your father with his oncologist.

Q : 11

I am a 38-year-old Indian male. In March 2006, I was diagnosed with Acute Myeloid Leukemia type 2 with maturation on a CBC report with 56% myeloblasts. My diagnosis was confirmed by bone marrow biopsy, immunophenotyping, and cytogenetics. First cycle chemotherapy was in March: Cytarabine 500 mg x7 days + daunorubicin 20 mg x3 days). Postchemotherapy bone marrow aspiration: AML in partial remission with 8% blasts. Second cycle chemotherapy in April: Cytarabine 5100 mg x3 days + mitoxantrone 17 mg x3 days). Postchemotherapy bone marrow aspiration: AML in complete remission. Third cycle chemotherapy in June: Cytarabine 4800 mg x3 days + mitoxantrone 13 mg x3 days). Postchemotherapy bone marrow aspiration: AML in complete remission. My 3rd cycle chemotherapy was rather complicated because of hypotension in 70/40 range, TLC remaining at 100 for about 30 days, gram-positive infection of my central line, and acute renal failure. I had a very slow recovery and it took almost 2 months before my CBC became normal in terms of RBC, TLC, and platelets. Because of this, my oncologist has been a bit reluctant to start the 4th cycle. My question is whether 4th cycle chemotherapy is warranted in my case or not. If the 4th cycle is given at this stage, will it be of benefit or not, since it has been already 90 days from my 3rd cycle.

Nobody can give you an exact answer to your question. However, since you required 2 cycles of chemo to enter into remission, I would probably consider further chemotherapy, in particular high-dose ara-c that has been proven benefitial in patients with your disease. Having said that, you must understand that I cannot assess your current organ function (kidneys) and also, complications you had. I think that the most proper thing would be to rediscuss all benefits and risks of the treatment with your primary oncologist so that both of you feel comfortable with the final decision.

Q : 12

My father-in-law is under 60 and just experienced a relapse of AML. It has been less than 1 year since his original diagnosis and treatment. Is his chance for survival decreased because the disease reoccurred, or is it the same as with the original diagnosis?

If AML relapses within 1 year of remission, usually, the chance for remission and cure is decreased. Therefore, in this setting, we seriously consider not only chemotherapy treatment but allogeneic stem cell transplant as well. However, the treatment plan is dependent on the performance status, presence of other medical problems, leukemia characteristics, and so on. All of these should be discussed with his primary leukemia doctor.

Q : 13

I am 54-years old, a painter and have worked with benzene and paint thinners for 30 years. I am healthy. Am I at risk to develop AML?

People exposed to chemicals/benzene have a higher risk of developing AML. However, it does not mean that all painters or workers exposed to these substances will develop AML. Most of them don't.

Q : 14

What type of success rate do you experience with the treatment of adult acute myeloid leukemia? My sister has recently been diagnoised. She suffered with ovarian cancer about four years ago. She has been cancer free for about 2 years. This recent diagnois has been earth-shattering. Could there be a connection between the two cancers?

I don't know if your sister received previous chemotherapy for her ovarian cancer, which sometimes may contribute to the development of acute leukemia. The success rate in the treatment of AML depends on a variety of prognostic factors such as patient age, cytogenetics, and white blood count. You should speak with her leukemia physician about these prognostic factors.

Q : 15

What are the chances of long term survival of relapsed refractory acute myeloid leukemia after non-related stem cell transplant did not last? What is the best treatment at this time?

Chances of long term survival of relapsed/refractory AML failing non-related stem cell transplant are extremely poor, if any. The treatment depends on the time of relapse from stem cell transplant, patient's performace status, and previous treatment, and may vary from no treatment at all, to supportive care and clinical studies. You should check with your physician about these options.

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