Dear Dr. Roach: On a Monday, I took my 91-year-old mother out for a belated birthday lunch. She has had a long and, until now, fairly healthful life. She still had her driver鈥檚 license and thought nothing of driving the 112 kilometres between her house and mine.
She mentioned that she was having a little trouble catching her breath after walking from my car, up a few steps, and into the restaurant. This is the first time that she has had this problem.
She went to the doctor on Thursday. He had my sister take her to the emergency room for some precautionary tests and blood panels. They said she had a touch of pneumonia and were keeping her overnight for observation.
Around 10 p.m., my sister called and asked if I could come because the news was worse than originally thought. She told me that Mom had acute T-cell leukemia and only had a few days to a week to live!
Later, when I called to check on Mom, my sister said they were sending her home that night on full oxygen and with hospice and 24-hour nursing care. All this in a little over 30 hours!
On Saturday, Mom passed away. Luckily, she slept most of the day on medication to ease her breathing and wasn鈥檛 in any pain.
Her primary-care physician (whom she had for over 20 years) told us that her blood work for the previous six months showed nothing out of the ordinary. In less than a week, this vibrant woman went from enjoying lunch out with a daughter to passing away in her own home with her two daughters by her side.
I guess my question is: What can you tell us about this fast-acting leukemia? Where does it come from, how does it strike?
B.A.
I am very sorry to hear about your mother. She had an unusual situation. Acute T-cell prolymphocytic leukemia is a rare leukemia of older adults. The word leukemia comes from 鈥渓euko-,鈥� meaning 鈥渨hite,鈥� and 鈥渉eme,鈥� which means 鈥渂lood.鈥�
So, it鈥檚 too many white cells in the blood. This is a type of cancer of white-blood precursors in the bone marrow, and at the time people come to medical attention, the white cell count can be 10 or 20 times the normal amount.
Unfortunately, the white cells, which normally fight off infection, are not normal and people are at higher risk for infection. More importantly, the bone marrow is so full of cancer cells that the normal red blood cells and platelets made by the bone marrow are reduced.
Although many leukemias are curable now, this is not one of them. Most people with this condition have less than a year to live, but your mother鈥檚 course is unusually fast even for this rare disease. We don鈥檛 know why this disease attacks certain people.
I do want to say a word of thanks for hospice workers, the physicians, nurses and staff who, in my extensive experience, are almost without exception truly dedicated, giving people who help people in the last stages of many diseases pass with dignity and peace.
They do patients and their families a wonderful service.
