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Adult Acute Lymphocytic Leukemia Archive Questions

Below are Dr. Baer’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 19.

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Q : 1

For a person who has been in remission for more than 10 years, what is the likelihood of ALL recurrence?

The chance of recurrence at this stage is extremely unlikely.

Q : 2

I know that one symptoms of leukemia is petechiae, are they commonly misdiagnosed as cherry hemangiomas? I have small, flat, pin prick red dots along my inner arms, thighs, chest and shoulders and I was recently told by my doctor that they were cherry hemangiomas. However, they appear to resemble the description of petechiae to me. How can you distinguish between the two and does petechiae occur in the absence of leukemia or another serious blood disease?

The petechiae is a sign of a low platelet count and can occur for a variety of reasons, not only leukemia. If you are concerned, you should discuss it with your doctor and get your platelet count checked.

Q : 3

Our daughter is in remission from ALL after being diagnosed in July 2009. She is in the maintenance phase of her treatment and has remained disease free. Currently we are trying to find out whether or not she has TPMT enzymes to assimilate the 6-Mp/MTX therapy. In your experience, if a patient has such problems, is a low WBC count usually due to the medications or relapse?

Low blood counts in patients with ALL can certainly be due to the drug toxicity. However, a decrease in counts can occur if a patient has relapsed disease. This is the reason why patients have periodic bone marrow aspiration and biopsy. Concerning maintenance therapy, patients with ALL usually are treated according to the specific protocol. Other drugs that are frequently used in addition to 6-Mp and MTX are vincristine and steroids.

Q : 4

A friend of mine was diagnosed with ALL approximately 3 months ago. He is 62 years old and recently underwent induction chemotherapy treatments. Last week, he was admitted to a local hospital with breathing difficulties, extreme weakness and a very pallid complexion. His blood pressure dropped to dangerous levels during the past week and doctors found bleeding in his stomach. His muscle mass is so atrophied that he can no longer walk and requires physical therapy. Can you tell me if the aforementioned issues are typical side effects from the disease/treatment?

Because ALL is an aggressive disease, the treatment for ALL is very intense. The side effects you have described are not unusual.

Q : 5

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 respond 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 : 6

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 : 7

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 : 8

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 a 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 of which regimen to choose are whether the patient can tolerate agressive chemo or not and 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 : 9

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 : 10

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. He is 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 : 11

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 : 12

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 : 13

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 : 14

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 : 15

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 a lot 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.

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