Can anyone describe what happens after a second induction for relapsed AML? My 73 year old mother was re-admitted two weeks ago after a little over a year in remission. She has now completed the same induction chemo (the 7+3 protocol) and so far has responded well to the chemo in the sense that her white cells have dropped as desired. The side effects have been bad though - clotting, difficulty breathing, etc. What happens now? I know that the options include bone marrow transplants, stem cell, clinical trials or palliative care. My mother has been considering stopping treatment at every step in this process, now more than ever. I am her health care power of attorney and want to support her - her primary desire is not to spend the rest of her life in the hospital.
Is she a candidate for stem cell, etc.? She is generally healthy although reacts very poorly to all of the chemo, antibiotics, etc. and seems to have a very sensitive system. Has had RA for many years, but no other health concerns. Is there a path that does not involve lengthy hospital stays or is that inevitable at this point? It is so confusing - no idea of what happens or when it might happen. To see her in pain is horrible and I feel like any path forward I am failing her. Is there any way at all to know prognosis or does that even matter at this point?
And advice is greatly appreciated. These discussions are tremendously helpful to me.
It's amazing that your mom, at 73, was given 7+3 induction once, let alone twice. Most folks in their 70s are given less toxic meds to try to keep the counts stable if not put them into regression.
Beyond the observation that she's a tough and, obviously, healthy lady, I can't say much though. This is really a question for her doc. Some folks in their 70s can get a transplant but that's not to say she'd be a candidate...again, the docs' call. Even so, there could be a very long hospital stay involved as no one can accurately predict how long anyone will be in the hospital post-transplant.
It's good that the WBC are down. That bodes well for the induction but the BMB will be what tells how it went.
I'm sorry that you are both in this situation and I wish I had answers. But there's no way for us to do anything other than to say there are surely options for her in the future.
Thanks, Tex. Just thought I would post an update. Mom has completed her second round of induction chemo. Took a while to respond this time and she is wiped out - basically stopped all activity for about a week, eating, talking included. But just in the last two days her WBC are up from 0.3 to 1.8 and 60% neutrophils and finally platelet counts started to rebound. Her doctors are even using the term "going home soon."
Not sure what comes next - other than the BMB. Her doctor has been unwilling to discuss any options at all, which makes sense - wants her to focus on what needs to happen now, rebounding from the chemo.
Assuming that she is in remission - how does the next step work? How long would stem cell, if even an option at her age, take in terms of hospital stay? How do clinical trials actually work? Her doctor has mentioned Duke many times (we live in NC, so Mom is comfortable with Duke I think) - any experience with Duke on here?
It is hard to find any information in detail about next step for relapsed AML. Her primary desire, which ultimately may be a challenge, is to stay out of the hospital for these long periods. She has been in 4 weeks this time and it has been tough on her spirit - but she is fighting!
Did your mom have a second induction or a first consolidation? Most folks are familiar with the terms but not everyone, I guess, so I want to make sure we're talking about the same thing.
After a patient has had induction chemo, there is usually a series of shorter term treatments. That's what lies ahead, I would guess, although her age might lead them to alter that protocol. I really don't know. As I said, for a woman her age to get chemo is really impressive and not typical.
I know the Hutch is doing transplants on folks in their 70s. Some places state that they do but Seattle's the only place I know of actually doing them. And it sounds as if your mom might be strong enough to do one.
But there's no way for me to anticipate what the docs are going to do here. Your mom, as I've said, seems to be an exceptional patient. There might be all kinds of options open to her that aren't usually available to folks in their 70s.
I don't have any personal experience with Duke. There have been a few folks who've posted here and had their transplants at Duke who've all done pretty well. I'd certainly feel confident about a family member going there.
I hope this helps.
Sorry for the delay. Trying to balance a career and care taking is a handful to say the least. We are still in holding pattern these days here in NC. To answer your question above, Mom had a second full induction treatment - she had a first induction about a year and half ago followed by 3 rounds of consolidation. Total time in remission was a little over a year.
The good news is she has responded to the chemo and was able to come home for a while Her blood tests are generally showing improvement, although she is physically much more tired than last time when she came home. There are some problems with liver function right now, so we are getting more blood tests today - but the whites, hemoglobin, and platelets are all rebounding finally - it took much longer this time. This Friday we get the ever important bone marrow biopsy results which will determine next steps apparently.
Thanks to everyone for replying - not sure what will happen. Mom has expressed a good deal of concern about any treatment that places her back in the hospital for more chemo or radiation. I think her hope is that she qualifies for some sort of clinical trial at Duke - although we are also realistic that she might not meet the entry requirements just due to her age. Her overall mood is hard to decipher right now - swings wildly between optimism and dread.
But for today, we are taking it one step at a time - just have no idea what to prepare for in the next phase, which is what is most challenging.
My Mom came down with AML in November 2009 and in her early 80's. We were able to bang it into remission with a 50% dose of Mylotarg and Vidaza. However, she was not a candidate for consolidation. A few months later the FDA requested Pfizer to withdraw Mylotarg from the market. Unfortunately in November 2010, her leukemia came out of remission. The statistics show this could have (and probably would have) happened regardless if she could have tolerated consolidation. I took Mom from Florida to New York Presbyterian Weill Cornell, where they were very aggressive with Dacogen treatments, the only therapy she could tolerate at her age.
Based on my two year journey, this is what I would like to say. My mother's doctor in Florida is affiliated with Duke and I found their knowledge and support to be excellent. I did find New York Presbyterian to be leading edge and I think that's because of the quantity of patients they see.
If I were in your shoes, based on my experience, I would take your mother to Duke. I believe it is an excellent medical institution. I believe she will get the latest technology that she can support. And most importantly, it appears from your post that your Mom will support going to Duke.
My mother's physician in Florida was Dr. Robert Jacobson at Palm Beach Cancer Institute.
In November 2010 it was determined from a blood test, follow-up by a bone marrow biopsy, that her AML came out of remission. Her WBC skyrocketed to over 100,000 in a matter of weeks and while she was visiting my sister in New Jersey. She was admitted into New York Presbyterian Weill Cornell, where they slowly brought her WBC down, followed by a few months of aggressive Dacogen treatments. In March of 2011 she developed leukemia cutis, which while rare, is generally considered a progression of the disease and with a poor prognosis. I brought her back home to Florida.