Hi everyone :) I'm new here, and am wondering if anyone has experience with multiple rounds of induction chemo? My fiancée is currently undergoing his 2nd induction cycle, and I'm just having trouble understanding the progression...how many times can they possibly repeat the induction therapy? While the doctors and nurses are amazing and very helpful, no conversations involve future plans, everything is very "one day at a time." Has anyone had good experiences after multiple inductions?
Hello and welcome!
My 3-year-old son had 2 inductions (which seems to be standard for pediatric AML, but not for adult AML). I am guessing they are repeating your fiance's induction because he didn't go into remission after round 1? My son didn't either, he had 20% blasts left after Induction I but went into remission after Induction II. For the second round of induction the docs tweaked his meds and transferred him to a high-risk protocol.
I was able to do a lot of searching online which gave me the future directions for my son's treatment, maybe they have something out there for adults?
Hope you can find some answers...ask the oncologist next time you see him/her.
Multiple inductions are quite common with this disease, unfortunately. They're often needed.
Now, I figure your fiancee either relapsed or didn't quite make remission after the first round. The circumstances might have something to do with their one day at a time outlook. If there's a question of if they might want to focus on getting there. I'm sure they have plans to follow up on once they've assured remission.
Anyway, a person can theoretically receive induction so long as the disease hasn't become refractory and the patients vital organs remain free from serious damage. I think the most I've heard of is four but that's through a foggy chemo brain. There might've been more. I do know that the most I've heard of in succession was three.
I had induction, got into remission and, then, relapsed. So I went through induction twice, the second followed immediately by a transplant. It can be done.
Thanks for the replies so far! A couple of weeks after the first induction blasts were found inhis peripheral blood, so they knew right away induction wasn't successful. Re-induction has gone well, but a longer process waiting for the counts to come up (everything stayed very low for quite a while). So it's a waiting game now...he does have a 10/10 unrelated match but they won't attempt a transplant unless they achieve remission. Both inductions have gone relatively smoothly (I'm knocking on wood here!) but of course it's a long run for everyone and full of stress. It's at least nice to read that multiple induction doesn't have to mean failure...
Annie - I know a few people who went through two inductions. It's quite common. I believe the statistics are something like 30-ish percent who fail first induction.
The people I know were all able to achieve remission.
In my case they had doubts at some point about whether the induction was successful, but it ended up being ok (they agreed my blast count to be 5%, although at first some people saw a higher count.)
A little late input. I'm in the middle of my 3rd induction. First two (for AML M1, FLT3+) in December and January were cytarabine and idarubicin. Blasts cleared up at first in December but returned later at 8% and 13%.
This time they tried two new drugs: etoposide and mitotranxone. Just going neutropenic right now, and the next BMB will be a week from now. (Have had 5 of those and 60 days of hospitalization since Thanksgiving when I got the dx.) Like many others, I'm just going through this one day at a time, one BMB at a time.
Be strong, be kind, and be sure you get all of your questions answered.
My one year old had three inductions because she failed to go into remission after the first two. Remission was achieved after induction 3 and she went straight to transplant (MUD). I am happy to say she is still in remission a year post transplant.
Best wishes on this hellish journey.....we'll be thinking of you both.
Thanks again for all the replies. The second induction was unsuccessful as well, blasts are at 40% which is what they were before the first induction :( The oncologist wants to enroll him in a clinical trial with a yet-to-be named drug from Roche. It's effects are apparently as bad or worse that the chemo and he will most likely be hospitalized again. I've been looking for discussions about clinical trials...is it me or does it just sound scary?
I'm very sorry to hear the 2nd induction was not successful. There was a LLS presentation a couple of years ago (I cannot locate it any more on the LLS website, sadly); in it, Dr. Estey, the featured physician and a respected AML authority from the Hutch in Seattle, talked about when clinical trials become the most appropriate form of treatment to pursue. In a nutshell, he said that in cases where the standard treatment proved inadequate, a clinical trial would be the next best step. I hope a suitable trial can be found that will knock those blasts out of the ballpark.
The concept of clinical trials may sound scary, but if the conventional treatment isn't working, it may well be his best chance. And the trial may offer a treatment that hasn't hit the mainstream yet but could be the treatment we've all been waiting for. There had to be a first patient to try Gleevec, the drug that has taken CML from being one of the most deadly leukemias into a disease that can be managed, in the majority of cases, as a chronic disease for many years. There had to be the first APL patient to try the Arsenic protocol that has turned APL into one of the acute leukemias with the best statistics for long-term survival. With a clinical trial, he should be monitored more closely that he might be if he remained in treatment with the local oncologist. None of the treatments for this disease are fun or easy, but we do what we have to do.
What are his cytogenetics? Is he FLT3+? The FLT3 anomaly can create a chemo-resistant leukemia, but there are some medications out there that sometimes can be added to the protocol and allow the patient to achieve a remission so a stem cell transplant can be done.
With a tricky case, it will be important to seek treatment from the experts who have more experience. I don't know where he's being treated, but I don't think he would be out of line at all if he sought a second opinion from one of the major treatment centers.
I wish you both the best. Please let us know how he's doing, and how you're doing as well.
Well I must say that the last reply cast a little sunshine on an otherwise horrible evening :). My fiancée is being treated at Princess Margaret in Toronto, Ontario. I haven't heard anything about FLT but they did say he had changes in chromosomes 1 & 3 I believe? We will know more about the plan next week...thanks for the best wishes :)
I'm sorry that the second induction didn't work all that well. It must've worked a little, I think. Otherwise, the blasts would've increased over the time he was being treated. Kind of like swimming against the current of a river. Your making headway by simply not getting swept downstream.
It all sounds scary, not being able to achieve remission and the clinical trial both. However, to me, the scariest thing was losing the years I had ahead of me with my wife and family. That always helped put things in perspective and I was determined to do anything and everything I could to keep those years.
Things went pretty smoothly for me. I wish they were for you two, as well. But put everything into this you can and hope for the best.
I just finished my 3rd induction chemo and am in remission for the 4th time. I have been actively trying for a BMT since the 2nd remission but have run into brick walls eventhough my brother is a complete match for the transplant. I went to Baylor in Dallas first for BMT and they wouldn't do it claiming that I had too much damage to my lungs and kidneys (1st chemo was given to me incorrectly that put me on life support in a coma and obviously caused damage). I wasn't going to accept that so traveled to MDA in Houston. They ran all the pre-test but when it came time to talk about setting up the BMT they wouldn't accept my insurance. But the BMB they performed showed that I was in remission. I then traveled to Memorial Sloan-Kettering in New York. They repeated all the test and unfortunately by that time the Luekemia was back. Sloan doc also said that the liver counts were way off. She instructed me to go back to Tulsa to see my doc and have my liver checked, etc. I traveled back to Tulsa and had a liver biopsy. That night or the next night (I have no memory of this) my mom took me to the emergency room because I was having a bad headache and was talking delerium. Ended up that the cancer has spread to the fluid around my brain. Docs in Tulsa said they couldn't care for me and I was air lifted to MDA in Houston. I spent 50 days in the hospital receiving lumbar punctures (with chemo inserted) for the cancer around the brain twice a week and my 3rd induction of chemo for the AML. I have reached remission again but we ended up in Houston for 3 months! We just got home to Tulsa 4 days ago (so good to be home!) MDA will work with my insurance for chemo and medical care but once again when it came time to talk BMT they refused to take my insurance. I talked and complained and fought with everyone....bosses, of the boss of the boss. They wouldn't budge. Doc says I am in a critical time frame and need the BMT like now! So...once again I am going back to New York, leaving this Saturday to do all the testing all over again at Sloan and see if they will do the transplant now that I'm in remission. The only problem is that I have not been able to pass any of the pulmonary tests and that is one of the test they will be doing. We will see what happens. FYI- I was diagnosed July 2010.
I hope they find something that works for your boyfriend and he doesn't have to suffer through another induction chemo regiman.
Oh Hope, what a story! I hope you manage to pass the pulmonary tests so you can do the transplant at MSK. I just went there for a consult yesterday. (I'm not in remission, so a transplant isn't an immediate concern, although I do know I have 3 12/12 MUDs out there.) I'm also a PT and have worked at MSK, so I know a lot of the people there. Let me know if you need anything. My friend, Holly, is a music therapist on the transplant unit. Anything you need - just let me know. "Friend" me on this site, and I think that gives you access to my email address. I'm also on FB as well.
That just completely sucks, Hope. I'm sorry you're having such a tough time getting your ducks in a row...or for some of them to even get on the same plot of land with you.
If you keep running into road blocks, try the Hutch in Seattle. They seem to be pretty good at finding a way forward. No guarantees, of course. But it can't hurt to ask, if it becomes necessary.
I replied above during my 3rd induction (AML with FLT3/ITD). It failed. Then a 4th attempt -- with a combination of high-dose Cytarabine, Idarubicin and Nexavar -- finally knocked my blasts down to 3%. If your fiancee is still fighting to get into remission, there is always room for hope.
I'm so sorry to hear about this.... yes. My mother failed induction 2 times and was allergic to 2 other chemos. She was accepted to the u of mn for the nk transplant which killed her leukemia! She is in limbo now, still needing bmt. Check out her case. Caringbridge.org. visit. Theresabeissel (all together). Check out the u of mn. Dr. Warlick is her dr. It can help!