The decision of whether or not to pursue aggressive therapy is always a difficult one. It is especially difficult for patients who are in your father’s age range – because there is much higher risk involved with the therapy.
For AML, there are several risk factors that are important in determining the likely outcome of the disease. These can include age, functional capacity (how active a patient is at baseline), cytogenetic abnormalities (chromosome abnormalities found in the leukemia cells), and whether or not a patient had an underlying bone marrow problem from which the leukemia progressed. Age in and of itself would not be factor for determining treatment.
You mentioned that your father has a history of diabetes. Does he have any other medical problems (complications from his diabetes, high blood pressure, heart disease)? Does he exercise regularly? Is he active and fit for his age? For patients who are in his age range and are medically fit, aggressive therapy can be a reasonable treatment option.
“Aggressive therapy” typically implies intensive chemotherapy with a long hospitalization (anywhere from 4-6 weeks). Many complications can occur during this hospitalization (infection, bleeding, organ dysfunction). Your father would be monitored closely. You must know going into it that the risks are there and they are not small – there is a risk of dying during the hospitalization. You must also know that aggressive therapy does not guarantee a complete remission or that your father will be able to remain in a complete remission. But it is the treatment option most likely to result in a complete remission and improved supportive care measures (better anti-nausea medications, better antibiotic therapy, etc) have made it more tolerable for all patients.
Other treatment options include “intermediate therapy” which is outpatient therapy, and “best supportive care” which entails measures that are based on providing comfort to the patient.
Many centers also have clinical trials available for older patients with AML and I would advise you to ask your father’s leukemia doctor about this as well.
I cannot tell you what would be the best decision for your father. It is a discussion that he and your family would need to have together. It is a decision based on your father’s wishes and his goals for the care. You should discuss further with his leukemia doctor.
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