Dr. Sunil Gandhi, Cancer & Blood Disease, 02/21/12

Mr. Smith went to see his physician for a routine visit. He was found to have a high white blood cell count. He was referred to his hematologist. He had a bone marrow biopsy, which showed he has Chronic Myelomoncytic Leukemia or CMML. This is a rare condition and it is a form of myelodysplasia.

There are many different kinds of white blood cells or WBC. This can be neutrophil, lymphocyte, monocyte, etc. In CMML, patients have an elevated number of monocytes in the blood, with a monocyte count of at least 1,000. Often, the monocyte count is much higher, causing the total white blood cell counts to become very high as well. About 15 percent to 30 percent of patients go on to develop acute myeloid leukemia — a condition that is much more serious.

He was diagnosed up North. For one year, he received no treatment. When he developed symptoms, the doctor tried palliative treatment with Hydrea.

When that failed, he was started on Vidaza, a form of intravenous drug, which works well in myelodysplasia.

My patient had a markedly enlarged spleen and liver. This was causing some abdominal pain and pain while bending. Unfortunately, the doctor gave three to four months of trial with Vidaza, and his WBC count increased — and so it was stopped.

He came to Florida with a poor and essentially terminal prognosis. He was not on any medications for his CMML. His WBC count was very high and other blood cells, like platelets and RBC, were very low. He was terminal.

When he came to see me, he was feeling very poorly. I gave him the option of trying a new drug called Decitabine, or consider hospice. He knew that his overall prognosis was poor, but he was not ready to quit.

I started him on Decitabine; this is given intravenously as an outpatient procedure in my office over about an hour. It is given five days in a row (Monday to Friday) once a month. He responded well to the treatment. Just after one treatment, his WBC count normalized, his platelet count increased to normal. His liver and spleen are shrinking and he is doing very well.

He is tolerating the treatment very well.

This is a classical example of keeping hopes alive and not giving up. This patient continued to fight but did not give up and so he is doing much better. New advances in cancer are coming every day and if we continue to fight, many times it helps.

Dr. Sunil Gandhi is a hematologist and oncologist. He is the volunteer medical adviser of the Citrus Unit of the American Cancer Society. Write to 521 N. Lecanto Highway, Lecanto, FL 34461, email sgandhi@tampabay.rr.com or call 352-746-0707.