Elderly Leukemia

  • How is leukemia treated in the elderly age?

In the elderly age, treatment of leukemia is decided on whether the patient is

  • Fit enough to receive treatment
  • Whether the biology of leukemia is amenable to treatment.
  • If the patient is not fit to get definitive treatment, palliative chemo can still be given which may not cure the disease (But may give a good quality of life). However patient may be free of transfusion support, infection and stay away from hospital most of the time.
  • For patients who are fragile and have extensive co-morbidities like cardiac, pulmonary or renal involvement,  only supportive therapy such as frequent transfusions, treatment of infections with antibiotics are offered.
  • Unfortunately, many elderly patients are eligible for supportive and palliative care only
  • What happens during chemotherapy?

The initial chemotherapy is called induction.

Since the chemotherapy wipes off not only the bad cells but also the good ones, the patient will not have any good cells at all. This will be very severe during induction chemotherapy as even before starting therapy, the good cells are present only in a very small numbers. So till such time the good cells recover, the patient has high risk of infection (as there are no white cells) and also has high risk of bleeding (as there are very much reduced platelets).

The red cells can be supplemented by transfusing blood.

Platelets also can be transfused even though they last in the body for few hours to few days only.

White cells are difficult to transfuse routinely, but infections are treated with various antibiotics.

  • How does infection occur?

Since the white cells are the policemen of our body, they fight against all the infectious organisms entering our body. Our body itself have lot of bacteria in the intestine and our nose may contain fungus. These normally do not cause infections, as even if these bacteria or fungus enter our blood, they are rapidly destroyed by the white cells. But when the white cells are very few or absent, these bacteria or fungus entering our blood can grow well, and can cause infections.

In addition bacteria can also enter from outside the body. So, patient has to follow the safety precautions, as supplied by the hospital, during the chemotherapy.

  • What percentage of elderly leukemias are curable?

But for some of the good prognostic leukemias (which may have a higher cure rate),  the chance of complete cure of most of the elderly leukemias are around 15-20% only.

But in most patients the disease can be controlled with palliative chemo for many months.

  • How do I know whether my leukemia has a high chance of cure or not?

This depends on various factors.

As said earlier, the chromosomal damages in the white cells produce leukemia. Depending on the type of chromosomal damages, the leukemias are classified as good or bad types. Other factors such as age, WBC counts, response to initial therapy etc will also decide whether a leukemia is good or bad.

In general good types have a high cure rate compared to the bad ones.

  • How do I know the progress of my disease?

The first stage is to find out the response to treatment. This can be done by assessing whether the “BAD LEUKEMIC CELLS” are cleared rapidly or not. This can be done by flow cytometric, cytogenetic or molecular assessment. Your doctor will explain in detail how it is being done.

  • What should the patient and the relatives have to do during treatment?
  • Follow all measures to prevent infections (as deliberated by your doctor)
  • Follow diet as advised
  • Remember “FEVER” occurring anytime during treatment is an emergency. Even if you are discharged, get advice from doctor regarding whom to contact and what to do if you get fever.
  • We advise most of the leukemic patients to resume normal work or studies after 5-6 months. If you have any MENTAL strains due to social stigmas or FINANCIAL strains, NEVER hesitate to discuss with your doctor as we have many “HELP” groups to tackle all your problems.
  • Is stem cell transplants useful in elderly people?

“Mini Transplants” which are less intensive than standard transplants are still useful in selected elderly patients, provided they have serious disease with good performance status . In those patients complete cure is the aim of such therapy.

Department of Hemato oncology,

Amended on Dec 14th, 2014 @VNCC, GKNM by Dr Suthanthira kannan,

Amended on 2nd Nov, 2016 @ Coimbatore Kidney centre by Dr Suthanthira Kannan

Coimbatore heamatology
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