April 12 Update

Things can change in an instant. They sure did for all of us when we heard dad had AML. And, they did again today when we heard that the leukemia has again spread to dad's bloodstream. If you remember, his post-chemo bone marrow biopsy showed leukemia cells still in his marrow. Since then, the leukemia has done its dirty work and spread. Dad's blood counts had decreased over the last week, but yesterday was the first time they noticed an indication of leukemia in the blood.

If dad were well enough, the doctors would recommend the next course of treatment - chemo, bone marrow transplant - but he is not. He's still quite ill and they can't seem to fix him. It seems that perhaps parts of his body are done fighting before we expected.

The entire family (sans Jon) gathered in the hospital room with dad to hear the options from the doctor. After hearing the grim reality of the situation - that, given his type of AML a chance of achieving remission from chemo is around 20% and with a transplant is around 40% - and the fact that there is no possibility of such treatment any time in the near future because he's ill, Dad has decided to change the focus of his care to hospice care.

We support and completely understand the decision. Tomorrow they'll start the process of moving him to a hospice facility and in the mean time will change his care to focus on comfort and not treatment.

It's obviously a difficult time for all of us. I'll update when we know where he'll be staying.

Understanding AML

I've often heard that people enter our lives for different reasons. We don't always know why at the time, but at some point it becomes clear. It's become quite clear to me why a woman named Aimee is in my life - she is also the wife of an Air Force pilot and we met when our husbands worked together in Florida. Her husband was diagnosed with AML in November. She has been incredibly gracious and generous with her knowledge of the disease since dad's diagnosis. I'm so grateful.

Aimee recently sent me a copy of a talk by a world renowned researcher on topic of AML. Dr. Elihu Etsey spoke to the Leukemia & Lymphoma Society about "Understanding AML: From Diagnosis to Treatment." The best part is that much of the speech was in plain English making it easy to read and actually understand. I've copied some of the most helpful parts below.

Explaining AML

In the normal bone marrow there are immature cells that mature to form functional red blood cells and platelets and neutrophils. And these cells all have distinct roles: the red cells to carry oxygen and the neutrophils to prevent infection and the platelets to prevent bleeding. And without the bone marrow the number of these cells would rapidly dwindle to very low numbers.

In AML the normal AML immature cells (“blasts”) undergo transformation, becoming dysfunctional. As a result they are incapable of maturing.The abnormal blasts also prevent maturation of the normal blasts. The result is bone marrow failure and low blood counts. The symptoms of AML result from these low counts, particularly low numbers of red cells, which is called anemia. As a result of the anemia the patient feels tired, they’re weak, they have trouble going up stairs, etc. And they go to see the doctor and after a while of saying it’s probably something that will get better, it doesn’t and that leads to a blood count, which is found to be abnormal, leading to a bone marrow.

And the diagnosis of AML is based on seeing an increased number of immature cells in the bone marrow. This results from the transformation we described above and the inability of abnormal blasts to mature. As a result they accumulate in the bone marrow. And so there are increased numbers of immature cells when you do the bone marrow and this is the hallmark of AML. Because blasts are not difficult to recognize, the diagnosis is almost always correct when we see people referred from outside physicians.

On Treatment

The standard treatment in the United States for 35 years has been what’s called 3 plus 7 or 7 plus 3. And this refers to three days of an anthracycline, which is generally daunorubicin or idarubicin (with probably very few differences between them) and seven days of a drug that’s called Ara-C (also called cytarabine), and because the 3 plus 7 combination has been used so long there’s a lot known about how it performs.

The goal of giving the 3 plus 7 is to get the patient into remission. And the value of being in remission is that in general the people who are cured of this disease (because the disease is curable) are those who get a remission. And it’s very, very, very unlikely that the patient would be cured if they don’t get a remission. So the first step is to get a remission and, as I said, it’s usually accomplished with the 3 plus 7.

What is AML?

Acute myelogenous leukemia (AML) is a fast-growing cancer of the blood and bone marrow. In AML, the bone marrow makes many unformed cells called blasts. Blasts normally develop into white blood cells that fight infection. However, the blasts are abnormal in AML. They do not develop and cannot fight infections. The bone marrow may also make abnormal red blood cells and platelets. The number of abnormal cells (or leukemia cells) grows quickly. They crowd out the normal red blood cells, white blood cells and platelets the body needs.

Understanding AML

About 12,330 Americans are expected to be diagnosed with acute myelogenous leukemia (AML) this year. The chance of getting AML increases with age. However, children and adults of any age can develop AML. About one in five children with leukemia has AML. The goal of treatment for AML is to bring about a remission or to cure the disease.

The number of patients with AML who enter remission, stay in remission for years or are cured has increased significantly over the past 30 years.

sources: National Bone Marrow Donation Program, Leukemia & Lymphona Society