Definition and Overview
Leukemia is a progressive cancer of the blood cells. A patient with this disease produces abnormally high or immature white blood cells, preventing the normal blood cells from performing their job.
It affects both adults and children. Diagnosis is more common among adults, but the prognosis is better for those who are 20 years old and above.
Like most types of cancer, the exact cause of leukemia is unknown. What is clear though is how it develops: The body produces different blood cells from the bone marrow, a soft part of the bone. These blood cells are produced by stem cells. While red blood cells are responsible for carrying oxygen to other types of cells, a critical component of their function, white blood cells act as soldiers. They are the body’s line of defense and are, therefore, a part of the immune system.
Cells, however, have to die in a process called apoptosis. Leukemic cells don’t go through this phase, which then results in overproduction of white blood cells. In the long term, they cause a myriad of serious health issues including anemia.
There are four major types of leukemia:
Acute Myeloid Leukemia – This is one of the most rapidly developing leukemias. It is characterized by the production of immature cells that don’t transform into white blood cells. Under it are eight subtypes determined by the source.
Acute Lymphocytic Leukemia (ALL) – This often occurs in specific age groups: among children 15 years old and younger and adults who are 45 years old and above. However, it’s more often diagnosed in children, especially among boys. In this type of leukemia, the immature cells accumulate from the marrow, go through the bloodstream, and are distributed to various parts of the body including the brain and the liver. Because of the cells’ ability to divide and spread everywhere, the patient’s case can worsen very quickly. Patients with ALL also often have more B cells, which means they can fight infection, but not kill the germs.
Chronic Myeloid Leukemia – This leukemia is unique as this is the only one that is strongly linked to defective genes called ABL and BCR, which are caused by a problem in the Ph chromosome.
Chronic Lymphocytic Leukemia – It shares similar characteristic with ALL, except that the progression of CLL is very slow, often taking years.
While chronic leukemia takes time to develop and progress, it can also change and become acute. Patients are strongly encouraged to always keep track of their progress and go through the needed treatments to improve prognosis.
Leukemia is also associated with certain risk factors including genetic disorders, blood disorders, and chemical exposure especially to benzene. Those who have been treated for other types of cancers also have a higher risk of developing leukemia later on. Smoking is associated with an increased risk of acute myelogenous leukemia. Family history can also play a role, though, as in most cancers, it makes up a small percentage of the risk factor.
- Unexplained weight loss
- Lack of appetite
- Feeling of fatigue
- Night sweats
- Frequent infections
- Swollen lymph nodes
- Bone or joint pain
- Swelling of the liver or spleen
- Red or purple spots on the skin
Who to See and Types of Treatments Available
If you suspect that you have leukemia, the first step is to see your doctor right away. The doctor would typically start by requesting for a blood test to determine your blood count and to rule out any presence of infection, whether bacterial or viral. The doctor also checks your body for any swollen lymph nodes, fever, and bruising. Other information such as your family and medical history, lifestyle, occupation, and symptoms will also be obtained during the consultation.
If the blood count is abnormally high, the doctor may then request for a bone marrow aspiration, a form of biopsy, to confirm the disease and to identify the subtype.
Leukemia patients are then referred to an oncologist for a more through diagnosis and treatment. Children, meanwhile, are referred to pediatric oncologists.
Treatment options depend on a host of factors such as the type of leukemia, prognosis, age, and overall health.
A treatment plan usually includes chemotherapy to destroy rogue cells, especially if they have already spread to other parts of the body.
Stem cell and bone marrow transplants may also be recommended to significantly increase the chances of eliminating the leukemic cells and allow the body to produce new and hopefully healthy cells. However, these may not be recommended for everyone. Normally they are intended for patients who are no more than 55 years old. In addition, it’s important that the donor is a perfect match for the patient. The primary candidates for donors are immediate family members and relatives. If there’s no match, patients can then request help from registries.
A successful bone marrow or stem cell transplant, nevertheless, doesn’t guarantee zero complications. Some patients develop Graft-versus-host disease, where the patient’s body attacks the newly transplanted cells. A number of patients also experience leukemia recurrence even after the transplant.
Surgery is also an option particularly if the swollen organ is already damaged.
If the patient has gone through the standard treatment protocol but stops responding, he or she may then apply to be accepted for clinical trials.
For chronic leukemia, the patient may not immediately be recommended for chemotherapy or radiation. Rather, the oncologist may suggest medications such as Gleevec (for CML patients).
Supportive care is also necessary to help the patient deal with the different symptoms of the illness such as fatigue and fever. Growth factor therapies may be provided to stimulate the production of good white blood cells. Chemotherapy can eliminate any form of defense, making the patient more susceptible to various kinds of infections. To complement the treatment, the doctor may then give anti-viral and antibacterial drugs.
They may also need spiritual, emotional, and psychological support. Patients are encouraged to join support groups.
Meanwhile, the prognosis can vary. For instance, children with ALL may experience remission as early as six weeks from the start of the treatment. If there’s no recurrence within ten years, they are considered cured.