If God had answered our prayers and returned Sunder to us, then the prognosis does not look very appealing. It would have been hell for both of us. Firstly, we are not aware of the brain damage that had taken place during those crucial minutes. Just imagine a well-built and happy-go-lucky boy being at the mercy of others.
Treatment of AML is usually divided into 2 chemotherapy phases:
remission induction
post-remission therapy (consolidation)
Remission Induction
This first part of treatment is aimed at getting rid of all visible leukemia. It usually involves treatment with 2 chemotherapy drugs, cytarabine (ara-C) and an anthracycline drug such as daunorubicin (Daunomycin) or idarubicin (Idamycin). Sometimes a third drug, 6-thioguanine, is added. This intensive therapy, which usually takes place in the hospital, typically lasts one week. How intense the treatment is may depend on the person's age and on other prognostic factors.
In rare cases where the leukemia has spread to the brain or spinal cord, chemotherapy may be given into the cerebrospinal fluid (CSF) as well.
Most of the normal bone marrow cells as well as the leukemia cells will be destroyed by the treatment. During chemotherapy and the following couple of weeks, the patient's blood cell counts will probably be dangerously low, and drugs to raise white blood cell counts, antibiotics, and blood product transfusions may be used to help protect against complications. Usually, the patient stays in the hospital during this time. If induction is successful, no leukemia cells will be found in the blood, and the number of blast cells in the bone marrow will be less than 5% within a week or two. Normal bone marrow cells will return in a couple of weeks and start making new blood cells. If one week of treatment does not induce remission, the process may be repeated.
Consolidation (Post-remission) Therapy
If remission induction is successful, further treatment may be given to try to destroy any remaining leukemia cells and help prevent a relapse. The options for AML consolidation therapy are:
1. several courses of high-dose cytarabine (ara-C) chemotherapy
2. allogeneic (donor) stem cell transplant
3. autologous stem cell transplant
4. High-dose consolidation chemotherapy differs from induction therapy in that usually only cytarabine (ara-C) is used. The drug is given at very high doses, typically over 5 days. This process is repeated once or twice. When examined four years after this treatment, about 40% of young patients (younger than 60 years) will not show any signs of leukemia. In older adults, this number is around 15%.
Another approach after successful induction therapy is a stem cell transplant. Patients first receive very high doses of chemotherapy to destroy all bone marrow cells. This is followed by either an allogeneic (from a donor) or autologous (patient's own) stem cell transplant to restore blood cell production.
It is not clear which of the 3 treatment options (high-dose chemotherapy, allogeneic transplant, or autologous transplant) is best for consolidation. They each have their pros and cons. Doctors look at several different factors when recommending what type of post-remission therapy a patient should receive. These include:
How many courses (cycles) of chemotherapy it took to bring about a remission. If it took more than one course, some doctors recommend that the patient receive a more intensive program, which would involve a stem cell transplant.
The availability of a brother, sister, or an unrelated donor who matches the patient's tissue type. If a close enough tissue match is found then an allogeneic (donor) stem cell transplant may be offered for post-remission therapy.
The potential of collecting leukemia-free bone marrow cells from the patient. If cytogenetic studies show that a patient is in remission, collecting stem cells from the patient's bone marrow or blood for an autologous stem cell transplant is an option for post-remission therapy. Stem cells collected from the patient would be purged (treated in the lab to try to remove or kill any remaining leukemia cells) to lower the chances of relapse.
The presence of one or more adverse prognostic factors, such as certain chromosome changes, a very high initial white blood cell count, AML that develops from a myelodysplastic syndrome or after treatment for an earlier cancer, or spread to the central nervous system. These factors might lead doctors to recommend more aggressive therapy, such as a stem cell transplant. On the other hand, for people with good prognostic factors, such as favorable chromosome changes, many doctors might advise holding off on a stem cell transplant unless the disease recurs.
The age of the patient. Older patients may not be able to tolerate some of the severe side effects that can occur with stem cell transplants. Therefore, this may not be as practical an option for them.
The patient's wishes. There are many issues that revolve around quality of life that must be discussed. An important issue is the higher chance of early death from allogeneic transplant. This and other issues must be discussed between the patient and the doctor.
Stem cell transplants are intensive treatments with real risks of serious complications, including death, and their exact role in treating AML is not clear. Some doctors feel that if the patient is healthy enough to withstand the procedure and a compatible donor is available, an allogeneic transplant offers the best chance for survival. Others feel that studies have not yet shown this conclusively, and that in some cases a transplant should be reserved in case the leukemia comes back after standard treatment. Because most studies of stem cell transplants have involved patients who tend to be younger and in better health, their improved survival might not be due to the procedure. That is, they might have done just as well with standard high-dose chemotherapy . (More of Trial and Error and Experimentation)
Chemotherapy drugs work by attacking cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.
The side effects of chemotherapy depend on the type and dose of drugs given and how long they are taken.
- These side effects may include:
hair loss
mouth sores
loss of appetite
nausea and vomiting
lowered resistance to infection (due to low white blood cell counts)
easy bruising or bleeding (due to low blood platelets)
fatigue (due to low red blood cells)
Reading all this, at least he did not have to go through all this suffering and we have a picture of a happy and smiling Sunder in front of our eyes instead of a rag-doll, bed-ridden, lifeless member of our family!!! THANK GOD FOR THE SMALL BLESSINGS
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