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LEUKEMIA FAQ's

Overview

 

Leukemia is a blood cancer caused by a rapid increase in the number of abnormal white blood cells. The abnormal white blood cells is characterized by non-maturation (blast cells). This starts in the bone marrow where all the blood cells (red, white, and platelet precursors) are formed. The rapid proliferation of the white blood cells cause reduction in the formation of other cellular lineages: the red blood cells and the megakaryocytes which are precursors of platelets. The most common signs and symptoms of leukemia are pallor, body weakness, easy bruisability, and recurrent infections. Patients suspected of acute leukemia should be admitted at once for evaluation and treatment.

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What is Leukemia?

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  • Leukemia is a cancer of the bone marrow where blood cells are formed. It is commonly known also as cancer of the blood cells. It is characterized by an increased production of abnormal cells, which are actually immature cells (blasts) that do not develop to maturity, Over time, as the number of abnormal blood cells builds up in the blood, they crowd out healthy blood cells, making it difficult for blood to carry out its normal functions.

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  • Most often, the abnormal cells are the white blood cells. The two types of these cells that can turn into leukemic cells are:

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1.  Lymphoid cells; and

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2.  Myeloid cells.

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When the abnormal cells are the lymphoid cells, it is called lymphocytic leukemia. When they are the myeloid cells, it is called myeloid/myelogenous leukemia.

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  • Leukemic cells can travel with the blood all over the body, reaching almost any organ, making leukemia present in many different ways, depending on which organs are involved.

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What are the different types of Leukemia?

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There are two ways of classifying Leukemia:

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  • The first way is by the rate of development of the disease, and how much the cells resemble normal cells. Thus, there is Acute (the cancer cells or blasts increase number at a very fast rate, consequently worsening the disease if untreated); and Chronic (the number of blasts grows slowly while the body still continues to produce more mature, functional cells; the disease takes longer to get worse and may remain stable for many months or even years, even without treatment).

 

  • The second way is by the type of blood cell that is affected, of which there are four most common types:

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a. Acute Lymphocytic Leukemia (ALL)

is the most common type of leukemia in young children,

but may also affect  adults, especially those 65 and older;

 

b. Acute Myeloid Leukemia (AML),

which may occur in both adults and children;

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c. Chronic Lymphocytic Leukemia (CLL),

most often affecting adults over 55 and

sometimes younger adults, but almost never affects children; and

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d. Chronic Myeloid Leukemia (CML),

which occurs mainly in adults and only rarely in children.

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What causes Leukemia?

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  • Scientists have yet to establish direct causes of Leukemia, although certain risk factors increase a person’s chances of developing the disease. Research still cannot explain why one individual gets afflicted with leukemia, while another does not.

 

  • The following risk factors increase a person’s chance of developing leukemia:

a. Older;

b. Male;

c. White;

d. Past treatment with chemotherapy or radiation therapy; and

e. Working with certain chemicals, smoking, exposure to very high levels of radiation, certain health conditions, and          genetic conditions.

 

  • Patients suspected of acute leukemia should be admitted at once for evaluation and treatment.

What are the symptoms of Leukemia?

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  • Several symptoms of leukemia are non-specific and/or commonly associated with some other ailments:

a. Fever, chills and other flu-like symptoms;

b. Pallor (ale color of skin);

c. General weakness/easily susceptible to fatigue;

d. Loss of appetite/weight; e. Swollen or tender lymph nodes;

f. Shortness of breath and chest pains;

g. Enlarged liver/spleen; h. Easy bleeding or bruising;

i. Tiny red spots (petechiae) under the skin;

j. Swollen or bleeding gums; sweating especially at night; and

k. Bone or joint pain.

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  • In acute leukemia:

a. Headaches;

b. Vomiting;

c. Confusion;

d. Loss of muscle control; and

e. Seizures, which may occur when the abnormal cells collect in the brain and spinal cord.

 

Leukemia cells can also collect in the testicles, digestive tract, kidneys, lungs and other parts of the body. These symptoms get worse quickly in acute cases.

 

  • In chronic leukemia, symptoms may not appear early on, and if they do, the symptoms are mild and progress gradually.

How is Leukemia diagnosed?

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  • Routine medical check-up. Recording a patient’s medical history; physical examination of the body for general signs of health; and for swelling in the liver, spleen and lymph nodes under the arms, neck and groin.

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  • Complete Blood Count. Blood is examined to see how the cells look, and to check the number of mature and immature cells (blasts) This test may determine that a patient has leukemia, but it does not show the type of leukemia a patient may have.

 

  • Bone Marrow Aspiration (BMA) and Bone Marrow Biopsy with Flow Cytometry. These tests check further for leukemia cells and determine the type of leukemia a patient has. For bone marrow aspiration, a needle is inserted to a large bone, usually the hip bone, to collect a small amount of liquid bone marrow. In bone marrow biopsy, a larger needle is used to collect a small bone fragment together with the bone marrow.

 

  • Spinal or lumbar tap. This is to further test the extent of the disease, particularly the presence of leukemia cells in the fluid that fills the spaces in and around the brain and the spinal cord (cerebrospinal fluid).

 

  • Chest X-ray. Reveals the signs of the disease in the chest area.

 

  • Cytogenetics. Determines the type of leukemia by identifying the chromosomes in the cells of the collected samples from the blood, bone marrow or lymph nodes. Chromosomal findings at diagnosis are also important, independent prognostic factors.

How is Leukemia treated?

 

Treatment of Leukemia is complex, depending on the many factors, namely:

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  • Type of leukemia;

  • Features of leukemia cells;

  • Location of leukemia cells in the body;

  • Extent of the disease;

  • Whether there has been prior leukemia treatment;

  • Patient’s age;

  • Symptoms; and

  • General health condition.

 

A specific treatment plan is prescribed to fit each patient’s needs. Whenever possible, patients should be treated at a medical center that have doctors who are experienced in treating leukemia.

What are the standard methods for the treatment of Leukemia?

 

  • Chemotherapy. Uses a combination of two or more drugs, depending on the type of leukemia and severity of the disease, to eliminate the cancer cells; administered either orally, by IV or catheter.

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  • Intrathecal Chemotherapy. Administered if leukemia cells are found in the area of the brain and spinal cord; injected directly to the cerebrospinal fluid via the lower part of the spinal column (for adults) or through a special type of catheter (Ommaya reservoir), which is placed under the scalp (for children). Chemotherapy is given in treatment cycles, with corresponding periods of treatment and recovery.

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  • Radiation Therapy (Radiotherapy). Uses high-energy rays to suppress the growth of, and damage cancer cells. The rays may be directed to a specific part of the body where the leukemia cells have collected, such as the spleen or testicles, or may be directed to the entire body (total irradiation), which is usually done before a bone marrow transplant.

 

  • Biological or Antibody Therapy. Uses molecularly targeted drugs (monoclonal antibodies) that directly kill specific cancer cells or stimulate the immune system to kill them. It is less toxic than chemotherapy and radiotherapy.

 

  • Targeted Therapy. A newer type of treatment that uses drugs to attack specific factors that make cancer cells different from normal cells, causing fewer side effects since it only affects the leukemic cells and not the normal cells; usually used as initial treatment for chronic myelogenous leukemia (CML).

 

  • Stem Cell Transplant. A method of rescuing the stem cells in the bone marrow, which may have been damaged by high doses of chemotherapy/radiotherapy, by implanting healthy stem cells taken from the blood (peripheral stem cell transplantation) or bone marrow (bone marrow transplant) of a donor (allogenic transplant) or from a patient’s own blood or bone marrow (autologous transplant), wherein healthy stem cells are collected and stored before the patient’s chemotherapy treatment or from the umbilical cord of a newborn (umbilical cord blood transplantation).

 

  • Surgery. Used less in leukemia cases; sometimes done to remove an enlarged spleen.

What problems may arise during Leukemia treatment?

 

  • Infections. Leukemia patients are immune-compromised, i.e. they are prone to all types of infection. Thus, they must avoid exposure even from the simple cold and large crowds. Some patients may have to be confined in the hospital for supportive care.

 

  • Anemia and Thrombocytopenia. These are conditions that will require supportive care through red blood cell transfusions for anemia, and platelet transfusion to help reduce the risk of serious bleeding.

 

  • Mouth-specific problems. Infection and bleeding in the mouth area may require supportive dental care.

What are the known side effects of Leukemia treatment?

 

Chemotherapy

 

  • May damage healthy cells that also easily divide like: blood cells; cells of the roots of the hair; and cells of the digestive tract. This leads to lowered resistance, weakness, easy bruising or bleeding, vomiting, nausea and mouth sores.

 

  • May affect a patient’s fertility:

 

- Women. Irregular or absence of monthly period; possible symptoms of menopause, such as vaginal dryness and hot flashes.

 

- Men. May stop producing sperm cells.

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- Children. While most children do not lose their fertility when they mature, some lose the ability to bear children when they mature (depending on their age, drugs used and dosage).

 

Radiation Therapy

 

  • May cause extreme fatigue.

 

  • May cause scalp and skin to be dry, scaly and itchy.

 

  • May cause nausea, vomiting and loss of appetite.

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  • May cause long-lasting effects, such as learning and coordination problems in young children.

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  • May affect fertility and hormone production when applied to the testicles, especially for young boys.

 

Bone Marrow Transplant

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  • May cause the development of graft versus host disease (GVHD) any time, when the bone marrow is from a donor, wherein the patient’s tissues, especially the liver, the skin and digestive tract react to the donated bone marrow. They may last even years after the transplant. Certain drugs are given to reduce the risk of GVHD.

 

References:

 

  1. National Institutes of Health (NIH) — National Cancer Institute (NCI). https://www.cancer.gov/types/leukemia/hp

  2. The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James). www.cancer.osu.edu

  3. University of Rochester Medical Center Health Encyclopedia. www.urmc.rochester.edu

  4.  Mayo Foundation for Medical Education and Research. www.mayoclinic.org/diseases.conditions/leukemia

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