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Diagnosed with AML M2, under treatment. Do we need to go abroad for treatment & which is the best hospital in world?

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Hi .
The son of my younger brother has been diagnosed with AML 2 days ago. No family or past history(age 16 years). We have admitted him to the "Medanta Cancer Institute, Gurgaon, Delhi NCR" & the consulting doctor is " Mr. XXXXXXX Bhargava". No doubt the doctor is capable, sincere & enthuses enough confidence in us.
However since with the grace of god we are financially well off & can afford the best treatment in the world. The main concern is to tak this child out of this.
Can you advice that are we on the right path or should we take him to USA for treatment & at what stage. He is under observation & cure since last 2 days only.
Also why people go to USA for such treatments. Are the institutes there better in terms of Doctors or treatment or knowledge.......
It's a case of M2 what doctor tell us & of AML for sure.
They say they are starting the process of chemotherapy today & shall be administrating 7 doses in next 7/14 days.Do we need to take him abroad for the cure (blood cancer, AML, M2) abroad for sure shot treatment & which in that case is the best place worldwide.
Awaiting reply.
Thanks a lot

Posted Wed, 30 May 2012 in Blood Cancer(Leukemia)
 
 
Answered by Dr. Indranil Ghosh 25 hours later
Hi XXXXXXX

Sorry to hear about your nephew.

AML M2 is potentially curable if treated properly. However, only about 40% survive in the long run. Treatment standard is the 3+7 protocol which is given over 7 days as your doctor has correctly decided. This is pretty much standard all over the world.

Medanta is a very good hospital as is Dr XXXXXXX Bhargava. I know him personally (he was a former colleague), and hold him in high esteem. I am sure he will deliver treatment of international standards.

The things which are different in US are--
1. Clinical trials-they have a lot of trials going on and most of their patients will be treated on a trial of new drug or new protocol. (This may or may not be good for the individual patient enrolled but helps future patients definitely)
2. Some drugs may not be available here but available there. Fortunately for AML M2 all the drugs are available in India.

In any case if you have decided on going to the US, the best center is probably MD XXXXXXX Cancer Center, Houston, XXXXXXX But taking him for such a along journey at this stage may be risky.

I sincerely feel that you should continue treatment here and hope for the best.

I will be available for any further queries. Best wishes.
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with AML M2, under treatment. Do we need to go abroad for treatment & which is the best hospital in world? 29 hours later
Dear Dr. XXXXXXX

Thx for your reply.

We are currently continuing with the treatment from Dr. XXXXXXX Bhargava for atleast the first 30 days period, till he is out of danger.

Subsequently should we take him to US for further treatment. As the child, like for any other parent, is extremely precious to us & with the grace of god, we can afford the treatment overseas.

We explore this option since one & sundry advice us that the treatment in US is definitely more advanced then India. The success rate is much higher.

Kindly advice.

Thx & regards

XXXXXXX
 
 
Answered by Dr. Indranil Ghosh 2 hours later
Hi
If Dr XXXXXXX can pull him out of danger, I am sure he can keep him out of danger as well.
The initial therapy is most crucial and most difficult. If he comes out of it, the rest is much easier.
Definitely some things are better in the US as compared to India in general, but good hospitals are certainly competent.
If you want to make sure that your nephew is getting the right treatment you can certainly take an opinion from a good center in the US and then may continue the rest of treatment there as well.

Best wishes.
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with AML M2, under treatment. Do we need to go abroad for treatment & which is the best hospital in world? 6 hours later
Thanks for your prompt reply Dr. XXXXXXX

A few positive things mentioned in the mail certainly give a lot of confidence to us. This is a phase where everyone concerned goes through hell.

Can we ascertain on day to day basis what is the level of improvement. Where our case is heading.

The platelets counts have fallen from 80K to 60K (by 33%) but the WBC has fallen fallen from 21.29 to 2.29 (by approx. 90%). Is it a good sign.
I am sharing with you a few more details pertaining to the blood report of my nephew, of the last few days (since the chemo has started).

Can you please advice me in which direction the case is moving.

Hemog. WBC RBC Platelets
19/04 8.8 21.29 3.39 80K

20/04 7.9 2.29 2.99 60K

21/04 7.3 0.48 2.76 60K

Needless to say all the queries are out of anxiousness, being so close to the kid, with absolutely XXXXXXX faith & regards in Dr. Bhargava & the institute.

Looking forward to the response.

Kind regards

XXXXXXX
 
 
Answered by Dr. Indranil Ghosh 35 hours later
Hi

sorry for the late reply.
As of now we can say that the WBC count (leukemic cells) have gone down rapidly in response to the therapy. The platelet counts and hemoglobin have also fallen, expectedly. These have to be supported by transfusions till the marrow recovers.

The immediate effects of treatment (whether the leukemic cells have been killed or not ) can be answered by doing a bone marrow test after 14-21 days of starting therapy. Till then we can only hope for the best and treat the complications, ie infections, fever, low hemoglobin and platelets.

Good luck.
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with AML M2, under treatment. Do we need to go abroad for treatment & which is the best hospital in world? 22 hours later
Hi,

The chemo is on. Today is the 5th day. By tonight the 6th chemo will start.

Doctor doesn't reveal any thing at this stage. He sums up the situation by saying after the protocol of chemo 3+7 is over, they shall observe the condition for next 14 days(day 8-21). This period, he says is going to be extremely crucial.

Very difficult times. Fighting between hope & despair.

Is every thing as per normal process. Hope nothing to worry.

Can you reflect on above.

Thanks

XXXXXXX

 
 
Answered by Dr. Indranil Ghosh 15 hours later
Yes, I would agree that so far everything has followed routine.
We just have to hope that he does not catch a serious infection and his bone marrow clears to therapy.
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with AML M2, under treatment. Do we need to go abroad for treatment & which is the best hospital in world? 15 days later
Hello Dr. XXXXXXX

It has been a while since we last communicated.

Today is the 21st day of the treatment.

Doctors are pretty happy with his response to the treatment.

His WBC, Neutrophil, Lymphocyte are slowly moving towards normal indicator benchmarks.

Hemoglobin is 7.2, WBC 2.44, Neutrophil 48.3, Lymphocyte 23 & RBC 2.72 as on date.

They say that he is entering a phase of remission now & they shall be performing a bone marrow test in next 3-4 days.

They add that if everything goes well he shall be discharged in next 7-8 days which then shall be followed up by the next stage which is consolidation :)

I due to my anxiety would like a few answers from you:

1) Is he out of danger now?

2) What are the next challenges now?

3) How do we ensure that the problem does not relapse?

4) What are very important do's & dont's now, related to food, outdoor activities, education/ school, his room hygiene.........

5) How much time will it take for the problem to completely go out of his system?

Eagerly awaiting response.

Thanks & regards

XXXXXXX
 
 
Answered by Dr. Indranil Ghosh 28 minutes later
Hi

I think he is doing pretty well. These are the responses to your queries--

1) Is he out of danger now?
Yes, I think he has done well in the initial part of the therapy which is most difficult

2) What are the next challenges now?
To see whether he is in remission and then to maintain it. Approx 50% patients who achieve remission, relapse in long run.

3) How do we ensure that the problem does not relapse?
Standard consolidation chemo if he is standard risk, or bone marrow transplant if he is high risk (risk is based upon cytogenetic analysis)

4) What are very important do's & dont's now, related to food, outdoor activities, education/ school, his room hygiene.........
Schooling is out till he completes treatment. he has to avoid crowd, take only home cooked food and boiled water.

5) How much time will it take for the problem to completely go out of his system?
Another three cycles of chemo are to be given and then he has to be under life long follow-up. After three years relapse chance is low but not zero.

Best wishes.
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with AML M2, under treatment. Do we need to go abroad for treatment & which is the best hospital in world? 23 minutes later
Thanks doctor for the prompt response.

Does that mean that the quality of his life shall remain compromised for ever? Will he never be a normal healthy person again??

One crucial thing to be noted here is that the Cytogenetic report related to his bone marrow sample taken on day one of the treatment has been screwed by the hospital where he was put up for treatment for first 2 days. The report did not reflect any thing on the pretext that the sample was not fit enough for the report analysis.

Now how do we overcome this problem? How/can the cytogenetic analysis can be done at this stage.

Regards

XXXXXXX
 
 
Answered by Dr. Indranil Ghosh 8 hours later
I am afraid the cytogenetic analysis can not be repeated.We just have to treat him like standard risk.

Of course he can have a normal life but he has to be under follow-up.
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