Can a person with acute myeloid leukemia strengthen their immune system?

Can a person with AML strengthen
their immune system?

If so, how?

So for most of my patients,
when they ask about strengthening

the immune system, what I typically do
tell them is what we commonly think of.

You know, sleep is extremely important.

Eating proper diet is extremely important
and trying to decrease stress.

So really, it's the common things that
we normally do to help our immune system.

Oftentimes the therapy that we give
will decrease the immune system,

and that's normal.

You know, trying to prevent infections
and strengthen the body, I think is

just the common things

that we normally would do in terms
of allowing the body to recover well.

So I think that again, it all

initially, of course, comes down
to, you know, the patient

having a conversation
with his or her doctor.

I think where where I've seen things go
sort of a mess is where the patient

with good intentions is maybe, maybe,
you know, let's read on the Internet,

I'm going to take this random supplement
or that's

and then they come in and they have
their liver tests are all out of whack.

And I said, Oh, what's been going on
for taking this random thing that I found?

Oh, no.

So, so that's something
you have to be really cautious about.

Really.

It's about particularly
some of these supplements might interact,

you know, with some of the medications
that we're giving the patients.

And it's all with good intentions,
but on everyone's part.

But we just want to make sure
that conversation is, you know,

had was with the his or her,
you know, physician.

So but in terms of ways to strengthen
the immune system, what we can do.

So I would say,

first of all, what we can do on our end
as we try to protect our patients

as much as possible from infections
in some cases using medications.

So one thing that we do

is, of course, we monitor
all the blood cell counts very carefully.

But one of the immune cells that we see
and we look for

are these cells called neutrophils.

And so if you're a leukemia patient,
you've probably heard all about

neutrophils and you probably what is this,
neutrophils?

So a neutrophils,
a type of white blood cell.

And it's kind of like the first responder
of the immune system, basically.

So if there's a bacterial infection,
a viral infection or a fungal infection,

you know, there's a lot of

different immune cells that try to go in
and take care of that infection.

But the kind of the first responder there

and the one that's very, very important
is these neutrophils cells.

So they're usually the majority of cells.

If you look of different white
blood cells in the blood,

they're usually take up,
you know, more than

half the cells of the neutrophils
usually or so.

But in leukemia patients, either
because of the leukemia

or because of the treatments
sometimes that

we are giving the neutrophils
cell number may be very low.

And we look both
at the percentage of neutrophils,

but also we call the ANC
or absolute neutrophil count

and so ideally
that number would be above 1.5.

But if it's lower than that, there can be
various degrees of immunocompromised,

of weakened immune system.

So like 1 to 1.5 is sort of mild, 0.5

to 1 kind of moderate,
but less than 0.5 is pretty severe.

And actually for, you know,
I would say many of my patients with acute

myeloid leukemia, they have severe
neutropenia, meaning low neutrophils.

And so that does put them at greater
risk of infection.

So I just had this conversation
with the patient today.

So the first thing we counsel,
you know, patients on about

this is really to be aware, first of all,
of any symptoms of infection.

And if you're not feeling well,
you know, you

you know, I'm
just feeling under the weather or,

you know, my stomach hurts,
you know, nausea, vomiting, etc.,

you know, upper
respiratory symptoms, cough, you know,

if they're feeling those symptoms,
they should take their temperature.

And if you have thermometer, first of all,
to have a thermometer at home,

and if you have neutropenia and you take
your temperature, your temperature is 100.4,

100.4 above, that's that's a fever.

We call it anything, 100.4 or above a fever
and a fever and low neutrophils.

That's actually a medical emergency.

So that should prompt the patient.

You know, you
we want you to call call your doctor,

basically, and make sure that they know
what's going on.

And that would actually prompt us to refer
the patient to the emergency room,

even though they're doing otherwise. Okay.

The problem is with such a low
neutrophil count,

even though the patient might be saying,
Oh, I'm all right, there can be bacteria,

even the bacteria that wouldn't

bother a patient with a normal immune
system could still get into the blood.

And so we want that patient to come,
you know, we want them to come right away

to call the doctor
and come right away to the hospital

so that we can evaluate,
even with blood cultures

for any bacteria in the blood and treat
that,

you know, right away,
you know, accordingly.

So first thing we do with longevity
approval is counsel the patient

about making sure that they take a fever
and an infection seriously.

The second thing that we always do is
if the it looks like the neutrophil count

is going to be severely low and leukemia
patient perhaps their own treatment

and maybe going to be low
for a long period of time.

We also start the patient routinely
on preventative medications.

So we start them even if it's severely low
on three different medications

to prevent risks of bacterial infections,

viral infections
and even fungal infections.

And there are various medicines
that we use.

And again, that's where you just want
to be talking to your physician.

You know, often it's
something like levofloxacin

an antibiotic,
you know, for bacteria, aciclovir or

or something like that for viruses
or posaconazole for the fungus.

But the important thing is just to,
you know, be in close touch,

you know, with the with with the physician
and making sure that you know, that

the right medications

are being used to reduce
the risk of infection in that setting.

In terms of what can a patient
do to improve the immune system,

I wish there was a sort of a again,
a magic kind of supplement

or anything that we could do.

The fundamental problem in a leukemia
patient really is the leukemia.

And so, you know, it's really
tough to get, you know, good, healthy

levels of immune cells until you can
really get rid of that leukemia.

So the whole goal of our treatments
really is to try to eradicate to get rid

So the whole goal of our treatments
really is to try to eradicate to get rid

So the whole goal of our treatments
really is to try to eradicate to get rid

of the bad acute myeloid leukemia cells,
and then once we've gotten rid of them,

of the bad acute myeloid leukemia cells,
and then once we've gotten rid of them,

hopefully, ideally the good bone
marrow cells then have time to recover.

And after they, you know, recover,
then you be able to restore

your normal levels
of infection-fighting cells.

Patients with AML
frequently have a weakened immune system,

and that immune system can be weakened
when their blood counts are extremely low,

but also when their blood counts aren't
extremely low.

It's important to understand
whether or not your white blood

cell count is very low.

Specifically your neutrophil count
in something we call

neutropenia
When your neutrophil count is very low.

neutropenia
When your neutrophil count is very low.

At that point, you're at a higher
risk of having infections.

And we do several different things
to try to mitigate or reduce

the amount of infections
patients have when they're neutropenic.

One thing is we give
anti-microbial medications, antibiotic

antifungals, antiviral medications to try

to prevent an infection from occurring.

We also counsel
patients on avoiding patient,

other people or family members
who are ill or not

well, to try
to prevent infections from occurring.

So there is many ways that we try to be

careful with patients who have AML
and have a compromised immune system.