Hello and thanks for the query.

As you know, acute leukemia is a very serious illness which can be very challenging to treat and maintain in remission. Frequently the low platelet count Is encountered with chemotherapy an is usually treated with periodic platelet transfusions. His bone marrow will again be assessed with a biopsy to see how well he responded to the initial treatment.

This can be treated but is very difficult to cure. If he is at a reputable hospital he should continue treatment there unless there are some newer treatments available at the hospital in Greece.

Leukemia is a disorder where the white blood cells proliferate uncontrolled in the bone marrow. Chemotherapy attempts to eliminate most of the leukemia cells but cure is very limited.

Depending on his age, he may be eligible for a bone marrow transplant from a donor but in older patients this is generally not recommended.

I think a good discussion with his current oncologist should be had an you should find what treatments they can offer him where he is right now. A long car trip is generally not a good idea in a debilitated and immune compromised state.

Cytarabine remains one of the best treatments we have available right now Sony appears he is getting the right treatment.

Thanks again for submitting the query. If you have any additional concerns I would be happy to address them.

Sincerely,

Dr. Galamaga

---

Hello and thank you for your follow-up questions.

I completely understand that you are dealing with a significant degree of anxiety and worry at this point and I will continue to do my best to provide you with helpful responses.

As far as I know there are no treatments anywhere in the world which actually Chuar this disease immediately without a leukemia into remission for as long as possible.

So far your father has received appropriate chemotherapy. I would encourage you to ask the oncologist what his impression of the response to therapy is right now. You cannot use the platelet count to actually decide whether the chemotherapy worked. The only true way to find this would be to have another bone marrow biopsy performed and then a pathologist can tell if there is any remaining leukemia in the bone marrow. If there is residual leukemia sometimes we will treat immediately again with additional chemotherapy.

If your father obtains a good response and initially has a remission he will then probably be set up to have additional chemotherapy treatments in order to help maintain him in good remission. It would seem doubtful that he would be a candidate for a bone marrow transplant in light of his age.

Bleeding is very common in these patients and is often secondary to a low platelet count. Platelet transfusions are often used to help improve the platelet count. In addition anemia is often a problem in the setting of leukemia. Blood transfusions are usually very helpful for this. Doctors usually try to minimize the number of transfusions that patients will receive because sometimes it can be more difficult for the transfusions to take full effect if a patient has received multiple prior transfusions.

In the absence of platelet transfusions it is safe to look tame blood transfusions. The blood supply is tested and is generally regarded as safe. Your father should be monitored closely with any transfusions as well to minimize the likelihood of any problems.

There is actually no maximum number of transfusions. The patient can sometimes receive hundreds of transfusions over the course of the treatment. I want to reassure you that it is okay for additional transfusions to maintain his blood counts.

I thank you again for summoning your question. I hope you found my response to be helpful and informative. If you have additional concerns I would be happy to discuss those with you.

Sincerely,

Dr. Robert

---

Hello and thank you for your follow-up question.

Regarding the brown spots on his leg which resolved aftertreatment this may be due to low platelets. When the platelet count is low it can cause some bleeding under the skin. As the platelet count improves this will slowly resolve. I am not 100% sure that this is the case but this is what I am suspecting.

as physicians we are very careful with trying to predict what the real survival will be in cases such as this. Leukemia again is a very serious illness. Depending on the baseline health of the patient this can significantly influence overall survival. With good treatment and if a good remission is obtained survival can range up to two years. Sometimes survival can be much longer than that or even much shorter depending on how well people tolerate therapy.

Again a lot of what we can predict regarding survival in response is dictated by what the pathologist describes under the microscope with a bone marrow biopsy. Also special genetic tests are often performed on the bone marrow sample which can also sometimes predict how well patients will do. Since I do not have access to this information regarding your father it is again very difficult to predict how well we might expect him to perform.

Many thanks again for your question. I hope this has been a helpful experience for you and if you have additional concerns I would be happy to follow up with you in the future.

Sincerely,

Dr. Robert

---

Hello and thank you for your question.

I want to reassure you that I do not see any possible genetic link between the leukemia that your father has right now and your family. You do not need to worry about that in the future. Also your relatives should not have anything to worry about in this case is well. I am not familiar with any obvious genetic link between a sporadic diagnosis of this type of leukemia and any type of inherited syndrome.

I have to be honest with you that having 60% blasts remaining within the marrow means that the leukemia is still active. I suspect the swollen lymph notes in the neck also reflect active disease. the only way to a really improve those lymph nodes would be with additional treatment or chemotherapy.

The oncologist which is managing his leukemia should be discussing the prognosis and future treatment with you in greater detail at least once every few days. If this is not happening I would advocate that you request a phone call for a detailed discussion.

I am not trying to frighten you but I am trying to be realistic regarding the management of this illness. I think with 60% blasts remaining in the bone marrow additional treatment will be needed. If he is healthy enough to have these treatments the oncologist should discuss those with you.

Thanks once again for your question. I am always happy to hear from you and look forward to helping you with any of your additional concerns.

Sincerely,

Dr. Robert

---

Hello and thank you for your follow-up question.

I think it would be a good idea to have your father treated in Greece but he needs to get medical clearance from his current oncologist before doing any traveling. It is impossible for me to declare whether this is safe without being able to actually examine him and review his laboratory studies to make a very informed decisions regarding this.

If he is deemed to be medically fit for transport I would recommend that you use all precautions to make sure the trip is without significant stress on him. He should also be wearing a face mask in order to avoid any environmental exposure to infection.

Again I urge you to do your best to try to establish good strong lines of communication between the doctors and yourself. Sometimes this might require you to be very assertive in demanding the time of the physician to speak with you. As physicians sometimes it becomes difficult for us to take time to communicate with families. In your case this is critical and I really think you should try to make a priority of speaking with the oncologist so that you are very well-informed.

Again I thank you for submit in your question. I hope you found my response to be helpful and informative. If you have any concerns beyond this I am always happy to address them.

Sincerely,

Dr Robert

---