Accute Megakaryoblastic leukemia with 33% blasts

Hi,

My dad is 65 year old with diabetic history of 20 years.

He is diagnosed with AML (Accute Myleoid Leukemia) M-7 (Accute Megakaryoblastic leukemia) with 33% blasts in blood smear.

Doctor suggested aggressive chemotherapy on him.

Kindly suggest if it's right to follow doctors suggestion ? I'm worried about the stage of the disease and also the trauma that he has to go through with this kind of therapy.

Please advise.

Thanks,
Cbabum

[Hien K Duong, MD]

Dear Cbabum,

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.  

Good luck.

[cbabum]

Hi,

Thanks for your advise!

I forgot to mention background of the disease.

He was diagnosed with "Essential thrombocytosis" 4 years back and was prescribed hydroxyurea (also known as hydroxycarbamide) for reduction of the platelet count to the normal range.

Frequency of hydroxyurea (500 mg) usage - one tablet on one day and two tablet on next day.

Doctor said he got above transferred onto Leukemia.

About his health condition - he had no complications from Diabetes. He follows strict low glucose diet. He has now become weak and lost weight from past 2 months.

Can you suggest more on Intermediate / Palliative therapy ?

Regards,
Cbabum