How zealously should a patient with relapsed acute myeloid leukaemia be treated?

Abstract

A relapse of acute myeloid leukaemia occurred in a 45-year-old woman 18 months after the disease was initially diagnosed and treated. During remission reinduction therapy, she developed a Gram-negative septicaemia, acute respiratory failure, acute renal failure, diabetic hyperglycaemia with ketoacidosis, and probable bacterial meningitis. She required assisted respiration for two days, received peritoneal dialysis for five days, and was unconscious for seven days. The patient eventually recovered, achieved full remission of her leukaemia, and survived a further 2 1/2 years, mostly in excellent health. Oncologists are often criticized for unjustifiable optimism and excessive zeal in the treatment of patients with malignant disease. This case illustrates that such optimism and zeal may be justified, and that intensive efforts to save the lives of seriously ill patients with chemosensitive malignant diseases are worthwhile.