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Is bone marrow transplantation necessary in acute leukemia patient?

Is bone marrow transplantation necessary in acute leukemia patient?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At March 25, 2018
Reviewed AtNovember 6, 2023

Patient's Query

Hello doctor,

A 27-year-old female has acute leukemia (ALL). Her vision is lost because of the presence of malignant cells in the brain now but her treatment was finished six months back. Previously she got relapsed CSF 13 months back when her maintenance phase was going on. The doctor gave high dose ITMX that time but it relapsed again. We do her CBC twice in every week and it is totally fine.

Hi,

Welcome to icliniq.com.

Acute lymphoblastic leukemia has a very high relapse rate in adults (about 60 %), the higher the white cell count, the worser the prognosis. Those with Philadelphia chromosome (chromosomal abnormality) have poor prognosis and bone marrow transplantation is required. Relapsed cases with confirmed bone marrow biopsy require intensive chemotherapy aiming for achieving new remission, then either bone marrow transplantation or maintenance chemotherapy. I strongly advise to consult a physician for bone marrow stem cell transplantation.

For more information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

Patient's Query

Thank you doctor,

Is bone marrow transplantation compulsory? Can it cure through radiation because patient PBF is normal? It did not show any blast cell. We are hopeless now. Her treatment was started four years back and finished five months back. We already used too much money on chemotherapies. Please tell me can malignant cell cure through radiation or not?

Hi,

Welcome back to icliniq.com.

She most likely has a relapse focus in her brain as her bone marrow is free. In such cases, intrathecal (spinal) chemotherapy along with radiation of her brain (relapse focus) will be required. The prognosis depends on:

  1. The time between the first remission and first relapse (good if more than 18 months).
  2. The number of relapses (the higher, the worst).
  3. The presence of Philadelphia chromosome.
  4. The response to second course of chemotherapy.
  5. The total WBC (white blood cells). Please send me her last CBC (complete blood count).

Of course radiotherapy will be beneficial but still bone marrow stem cell transplantation is a good option.

For more information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

Patient's Query

Thank you doctor,

I have sent you MRI and CBC as well. Please check it out and let me know what we need to do and would it curable or not? We all were very happy because she is a dentist but I do not know what God wants.

Hi,

Welcome back to icliniq.com.

I have checked the attached reports (attachment removed to protect patient identity). The CBC report results are within normal which is a good sign. The brain MRI is suggestive of brain relapse focus which will require intrathecal chemotherapy and radiation therapy to the brain. Also, the report describes lesions which are as a result of the past chemotherapy. The prognosis cannot be estimated, you should do your best and hope for the best.

For more information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Mahmoud Ahmed Abdelrahman Abouibrahim
Dr. Mahmoud Ahmed Abdelrahman Abouibrahim

Internal Medicine

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