Leukemia - Causes, Diagnosis and Treatment

Leukemia

Dr.Senthil Jagannathan Rajappa profile Authored by Dr.Senthil Jagannathan Rajappa on 22 Aug 2014 - 12:59.

Leukemia refers to a group of cancers characterized by increased production of abnormal white blood cells known as leukemic blasts by the bone marrow. As the number of leukemic blast cells increase, it suppresses the production of normal blood cells. These cells can also spill over into the blood and affect other organs including the brain. Leukemic cells have growth advantage and ability to overcome programmed cell death. Although many factors including genetic, exposure to drugs etc are implicated as causes for leukemia, it is seldom possible to point out a single factor in a particular patient. It is usually multi-factorial where in a genetic predisposition to develop the disease results in leukemia when exposed to other causative factors during ones life time.

Types of Leukemia:

Leukemias can be classified based on:

Rate of disease development:

  • Acute Leukemia: characterized by a rapid increase in leukemic blast cells needing immediate therapy.
  • Chronic Leukemia: characterized by slow multiplication of cells with many patients detected when asymptomatic.

Type of cell involved:

  • Acute Myeloid Leukemia (AML): Affects myeloid cells or granulocytes progressing rapidly
  • Acute Lymphoblastic Leukemia (ALL): Affects lymphoid cells progressing rapidly
  • Chronic Myeloid Leukemia (CML): Affects myeloid cells with slow progression
  • Chronic Lymphoblastic Leukemia (CLL): Affects lymphoid cells with slow progression

Most symptoms result from decreased production of normal blood cells.

Deficiency of red blood cells may cause:

  • Fatigue
  • Breathing difficulty
  • Loss of appetite

Deficiency of platelets may cause:

  • Bruising
  • Bleeding

Deficiency of white blood cells may cause frequent infections in specific sites like:

  • Throat
  • Around the anus
  • Oral cavity/gums
  • Gastro intestinal tract & lung

Other principal symptoms include:

  • Fever
  • Night sweats
  • Bone pain
  • Abnormal swellings due to lymph node or organ (liver, spleen) enlargement
  • Complete Blood Picture (CBP): Elevated levels of WBC with decrease in hemoglobin and platelets. Leukemia can also be sometimes associated with low WBC counts.
  • Bone marrow test: A small volume of blood is aspirated from the bone (hip bone) and subjected to examination under the microscope.
  • Spinal tap: Cerebrospinal fluid is removed from around the spinal cord to examine it for the presence of leukemic cells.
  • Cytogenetic analysis and Flow cytometry are additional tests done on blood or bone marrow to determine the type of leukemia and risk stratify patients for therapy.
  • X-ray, MRI, Ultrasound and CT-scan may be used to determine areas affected by the leukemia.

Factors that increase ones likelihood of developing leukemia include:

  • Radiation exposure
  • Chemical exposure
  • Smoking
  • Genetic disorders
  • Family history of Leukemia

Management of leukemia is one of the success stories of cancer therapy. The goal of treatment is to eradicate leukemic cells from the marrow, restore normal blood cell production and ultimately achieve cure. Chemotherapy and rarely radiotherapy are used in the treatment. The drugs used and duration of treatment will depend on the type of leukemia (lymphoid or myeloid, acute or chronic). Some patients may need a bone marrow or stem cell transplant to achieve cure.                        

Acute leukemia warrants immediate treatment whereas a significant number of patients with chronic lymphatic leukemia may not need treatment at the time of diagnosis. The treatment of chronic myeloid leukemia has been revolutionised by the advent of targeted therapies like imatinib, dasatinib and nilotinib and a vast majority of patients lead a normal life while on these drugs.  

The treatment of acute myeloid leukemia is shorter (4 months) and while acute lymphoblastic leukemia is treated for around 2 years. Some patients with acute leukemia will need a bone marrow or stem cell transplantation to improve their chances of cure. The need will be determined by certain tests done at the time of diagnosis and response to therapy.

Once leukemia is treated, there is a chance for it to relapse (or return). Hence, patients will be on regular follow up to look for relapse as well as certain long term side effects of chemo and radiotherapy.

Treatment options for Leukemia include:

  • Chemotherapy: It uses drugs to kill the cancer cells. These drugs are administered orally or as injections. These drugs are not specific for the cancer and can lead to certain short and long term side effects
  • Targeted therapy: Abnormal proteins on cancer cells are targeted by drugs to block their action. This therapy has least effect on normal cells.
  • Biological therapy:  These are the medications which help improve the body’s defense mechanism thereby acting against the disease causing agents and residual leukemic cells. Monoclonal antibody and interferon are used in biological therapy.
  • Radiation therapy: High energy rays are aimed at the body parts affected by leukemia. Radiotherapy is used in acute lymphoblastic leukemia to prevent occurrence of leukemia In the brain.
  • Allogenic Stem cell transplant: Stem cells or bone marrow from a matched sibling donor is given to the patient. These cells mount an immune response against the leukemic cells and destroy them.

Supportive care:

  • Keep away from contagious diseases, as the body’s weak defense mechanisms may not be able to fight the infection.
  • Activities such as walking, cycling and yoga may help the patient feel better.
  • Avoid consuming uncooked food stuffs which have the potential to cause infections
  • Stay away from sharp objects to avoid bleeding.
*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.