Therapy-therapy induced Leukemia after Treatment

[lolam]

As I have mentioned, I find out on Wed. why my counts are so low. The onc. mentioned as a possibility disease caused by chemotherapy, a precancerous disease like leukemia. Well of course I can't just sit here for days and wait. I am on the hunt for information so I know more than he does by Wed. The problem is I can't understand what I am reading!!
Can you help?
http://www.annalssurgicaloncology.org/cgi/...nt/full/9/8/738 (http://www.annalssurgicaloncology.org/cgi/content/full/9/8/738)
Waiting but not patiently, Lola

[Esther]

Lola try not to worry too much. About a month ago, I went in for my usual lab tests before chemo. Well one count came back abnormal, and one of the possibilities was leukemia.

I researched the web and leukemia can be caused by chemo. Of course I worried until the results of the repeat tests came in.

Anyway, both blood samples were reviewed by the head of the lab, and the first results were an error.

Keep in mind that if you believe all the information on the web, our situation looks pretty grim. Liver mets like I have, according to the liver stats on the web, supposed to be impossible to put into any kind of remission, and have a life expectancy of 1-3 years.

Well, here I am a year after mets diagnosis, just about to reach NED status, and just last week I was skiing on one of the steepest mountains in the US, in Aspen!

Don't lose hope, and try not to worry too much. And remember, we are all breaking the old statistics now.

[Sheila]

Lola
I understand your concern and confusion...yes chemotherapy can cause leukemia,heart problems, etc...but so can alot of other drugs we take without worrying. The low counts due to leukemia is a remote possibility...but very remote, and if caught early, leukemia is highly treatable nowadays. It is amazing any of us can keep our sanity and smiles with all the info out there....we take a drug to cure a life threatening disease with the possibility of getting a life threatening disease...seems unfair and a poor trade off! I am sure there is a simple explanation about your white count...and the Dr. probably wanted to make you aware of possibilities, although slim...that could be the cause. Try not to worry, I am sure everything is OK and you have lots of prayers that things will be fine....think positive......
Hugs and Prayers
Sheila

[StephN]

Dear Lola -

First - the good news. The current issue of CURE magazine has a bit about a new drug just for "older leukemia patients." Called Zarnestra (tipifarnib) - an oral medication being investigated for acute myelogenous leukemia, as well as in myelodysplastic syndrome (MDS), a disorder where abnormal cells crowd out normal cells in the bone marrow. There are some ongoing trials with this drug.

That is a good article, but full of lab science. I tried to pick through all the big words and stats and get a sense of the incidence and which drugs are more likely to contribute to such a condition.
Mainly it is a RARE condition, even though on the increase as we are able to outlive our predecessors by some years and so the risk gets a little more.

This article explains how the toxic effects of the chemo also works to the detriment of our other cells and in our bone marrow, which, as living tissue, are constantly breaking down and and being built back up. [The rebuilding is called "remodeling," which is how we grow and heal from injury. As we age the remodeling process gets interrupted and the breaking down begins to outpace the the bone building leading to osteoporosis, and other conditons.]

So, we already have this problem developing with our bones, adding to that the chemos and their possible effects. (This is why I took Fosamax while on chemo and now take Zometa.) I also had one heck of a LOT of chemo.

We know you can HANG TOUGH and stay positive. There are still some open possibilities before anything is really determined in your case.


"Regardless of the specific alkylating agent used, the leukemia induced after treatment with these agents can be characterized according to the latency to onset after initial therapy, clinical presentation, phenotypic expression according to the FAB classification of hematological malignancies, prognosis, and cytogenetic abnormalities (Table 1). Classically, these agents have a long latency period from 1 to 20 years after treatment before the onset of leukemia, with 4 to 6 years being the average.27 Patients typically present with a myelodysplastic syndrome or preleukemic phase, and then they ultimately develop a clinical leukemia.28 The induced leukemia is generally described as an M1 (myeloblastic leukemia without maturation) or M2 (myeloblastic leukemia with maturation)8 or, rarely, as an M6 (erythroleukemia) or M7 (megakaryocytic leukemia),29 according to the FAB classification.30–33 The prognosis after diagnosis is especially poor because of the scarcity of successful treatment regimens.34,35


The precise mechanism by which alkylating agents induce leukemias is unclear, but it is possibly related to chromosomal damage that produces mutations or translocations of genes that are important for cellular growth and differentiation. These specific DNA alterations are thought to lead to a survival advantage for a pluripotent cell that eventually leads to clonal expansion of this malignant clone. Cytogenetic abnormalities seen with alkylating agent therapy are generally deletion or loss of all or part of chromosomes 5 and 7,16,36 particularly in the regions of the long arm of chromosome 5 (5q31–33), where a multitude of genes—including granulocyte-macrophage colony-stimulating factor; interleukin-3, -4, -5, and -9; interferon regulatory factor-1; early growth response-1; CDC25C; and the FMS oncogene—are located and are thought to play an active role in hematopoiesis.27,29 Although the precise mechanism of leukemogenicity remains to be determined definitively, alkylating agents are not the only therapeutic culprits known to induce AML/MDS. In fact, the topoisomerase inhibitors—the epipodophyllotoxins (etoposide and teniposide), the anthracyclines (doxorubicin), and the camptothecins (topotecan)—are a broad category of agents that have been shown to induce a distinctive form of secondary AML/MDS. "

[lolam]

Steph, that is just cracking me up. I was trying to read that out loud. Soooo funny. I think I will just wait for my doctor to give me that bottom line that he is sooo good at. " YOu are between a rock and a hard place" in his scientific little voice. He cracks my up too.....
A merry heart doeth good like a medicine====so I cure myself!!!

Thanks for the info.

Curiosity killed the cat, so I think I'll go read a romance novel of sit down with Oprah until Wed. She cracks me up too......

[StephN]

Lola -
We will all wait right along with you - you are taking more than just yourself into that doc's office on Wed.

Glad to be able to interject a little humor into your day - and help sidetrack you to some other endeavors.

We all know how these new situations can be unnerving!

I had a call to come into my med onc today for an interim blood draw for my CEA as he was concerned as it went up again after my Gamma Knife and he wants more frequent draws. We want to see it start to DROP now. So, we all get those little butterflies flittering around!

[lolam]

Steph, I hope everything will be okay for you.

I am up late. Tomorrow is my big day and I can hardly sleep.

Life is hard; God is good. All the time.

Hugs, Lola