His cytogenetics will tell you whether he is high, intermediate, or low risk. I believe intermediate or high risk is when a transplant is suggested. Consolidation is done no matter what. Normally there are several rounds, whether a transplant is needed or not.

That report has finally come back, we were told it is intermediate
and involved chromosone 9-21

My understanding is an intermediate diagnosis has about a 50% chance of being put into long term remission with chemotherapy. Depending on the center, the available donors, the patient's general health, they will decide whether chemo or transplant is the way to go. Many centers try chemo and reserve transplant in case of a relapse. Some go to transplant in first remission if a good match is available. Plan on at least one round of consolidation even if they decide on transplant to buy time to take care of the logistics and paperwork. Our friend Cliff was intermediate and he went to transplant in first remission. So did I but I was high risk. On the other hand we have many chemo only types, like Dave, who went chemo only and are doing fine. Either way, this is doable so fasten your seat belt for a bit of a bumpy ride but a winnable race.

Lou

I think they also take into account from my limited knowledge your age and also your health.

If they can get you into remission and you are strong healthy and under 40 they may just do the chemo ... as you have more time and health as well..

What we do have to remember is its all an individual case by case basis, im sure your doctor will give you the best options.

My mum is currently day 50 after her BMT, this was done after being in remission for about 10 months, it was her choice to do it which was recommended that she do due to her age rather than waiting for AML to come back (maybe) ... there was no guarantee that it would ever come back but she was in a high risk category + over 60

xx

Did his test results show his flt3 test. About one third of all aml patients have this mutation. If this is positive a bmt ifs recommended

Technically, I believe my son had intermediate cytogenetics (though we were never told for certain). I wonder if perhaps protocols are determined differently for children, but for him, they did a bone marrow biopsy after he recovered from induction. That test confirmed that he was in remission. Another sample of his bone marrow was sent to Children's Oncology Group in Washington, where they do a test called MRD (Minimal Residual Disease). It is a very sensitive test that tests for the number of leukemic cells present in a sample of 10,000 cells. Your basic lab only tests 500 cells or less. The results of the MRD test would place him in either a high risk protocol (for those with more than 0.1% leukemic cells) or low risk protocol (for those with less than 0.1% leukemic cells. My son had 0.03% leukemic cells after induction, so he was placed in the low risk protocol and completed three rounds of consolidation (technically, it was one round of consolidation and 2 rounds of intensification). I think this must be somewhat different for adults, but it does seem as though most adults also do a total of 4 rounds of treatment if they complete a chemo only protocol.

Liz:

They do not totally know why some relapse and others do not. MY theory is that the chemo either kills or disables the mutant stem cells. If this has happened, then the chance of relapse are low. If, however, the chemo only killed the blasts and for some reason the mutant stem cells are just sort of in a state of shock and in a "recovery mode" themselves, then there could be a relapse when they fully recover. We rarely hear the word cure ... we substitute the word remission -- just like an alcoholic is always recovering, and never recovered. I think if he goes a couple months without the blasts reappearing, it can be said that he is in remission and has a very good chance of long term freedom from AML.

I am told that I still have MDS, which is mis-shaped blood cells -- this can be determined under a microscope. MDS can be latent or it can develop into AML. Whether and how it is treated depends on a continuous monitoring of the blood. It could just be latent forever, or it could start to cause problems again, perhaps by causing other stem cells to mutate. I have very little concern about this, since I will probably be hit by a car or something tomorrow. I have learned to allow the Lord to worry about things that are out of my control (Matthew 6).

It sounds like Jamie is doing quite well compared to his problems over the last few weeks. I am sure this is a great relief to you. Please keep us up on how he is doing.

Thanks -- daveB

The question on whether or not he is still considered to have aml is one i have never got a straight answer on from anybody. My np said that if i can go two years with no relaspe then they would consider me "cured". If you can get a answer on that from your docs i would be very interested to hear what it is. It is wonderful news that he fell in the intermediate risk category. Jamies chances sound real promising to me.

As far as returning to building homes, he won't be able to do real intense labor for a while. With the consoldiation rounds it will be all he can do to recover in time for the next round of chemo. I am in the construction industry also but we do large commercial and industrial projects. I'm a project manager and estimator so that doesnt involve hard labor. Maybe he can manage the crews and projects and spend time bidding projects for a while to keep him going while his treatment continues. I was bidding jobs while i was in the hospital. If he can hire framing crews and the other subcontractors and take more of a management role that would be good. I havent had the severe fatigue that gets a lot of people, it sounds like he was in good shape prior to getting aml so he may not either.

I'm glad he is doing well. Continuing prayers for you both.

Dave J.