If I developed acute leukemia.
Submitted by Dr.Kattlove’s Cancer Blog
I’ve often wondered what I would do if I developed acute leukemia. When I was in my 40’s or 50’s there was no question that I would go for the most aggressive treatment. Even in my 60’s, especially early that would also have been my choice. But now, a little past 70, I’m not so certain about what I would do.
At one time, early in my practice, I treated several patients over 60 with acute leukemia. Almost all of them did well – for a while. I treated them with the standard chemotherapy (which, unfortunately, hasn’t changed much in the last 30 years). They developed the usual side effects, which made them pretty sick, but recovered and went on to pretty good lives for a while. But, after a year, more or less, their leukemia came back and couldn’t be treated and they all died.
Now, recent articles in the New England Journal (September 2009) and the Journal of Clinical Oncology (February 2010) have presented a more hopeful picture. Both articles tested newer treatments although the authors of the studies did not think they were much better than the ones I used 30 years ago. The difference was that they could give full doses of these drugs, because there are newer drugs to handle the side effects. In both studies, there were a substantial number of patients who did quite well.
In the New England Journal study, about one-fourth of patients were still alive at two years – much better than what I saw. The study in the Journal of Clinical Oncology didn’t follow their patients that long but, at one year, about 40 percent of patients were still going strong – still better. None of these survival numbers is earth shaking. After all well over half the patients have died. But it is better than what I saw in my practice many years ago. Most of this improvement is probably due to better supportive treatment like antibiotics, antifungal drugs, better ways of preventing nausea and vomiting, etc and just a general improvement in medical care.
One thing that hasn’t changed, though, is that when the researchers looked at the oldest people in this group of older patients, these folks always did worse. This may happen because as we get older, the genes in our cells develop more abnormalities that make the leukemia cells more resistant to treatment. After all, a major reason for the aging process itself is flawed genes. In fact, one of the big reasons for treatment failure in leukemias as well as other cancers is very abnormal genes. Doctors will look for these before they treat someone with leukemia, because sometimes the abnormalities are so bad that the outcome is hopeless and treatment just wouldn’t pay. Or, maybe some non-conventional treatment would offer a better chance.
So right now, I’d probably go for it if I didn’t have some terrible gene mutation that guaranteed failure, but as I get older, I may be less certain.
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