Leukemia

What is leukemia?
Leukemia is cancer of the blood cells and the tissue that creates bloods cells, such as the bone marrow.
 
In a healthy person, blood cells form in the bone marrow as stem cells and later mature into different types of blood cells (such as red blood cells, white blood cells, or platelets) and move into the bloodstream. In a person with leukemia, the blood marrow starts producing many abnormal white blood cells, which enter the blood stream and start crowding out the normal, healthy blood cells. The abnormal blood cells prevent the normal blood cells from functioning and doing their job properly.

Types of leukemia
There are a few different types of leukemia. Leukemia can be acute or chronic.

Acute leukemia develops and worsens very quickly. It can be very life-threatening. The bone marrow starts to produce high numbers of immature (underdeveloped) white blood cells called blasts that enter the bloodstream. These immature blood cells quickly crowd out the normal blood cells in the bloodstream and do not function properly enough to fight infection and bleeding or prevent anemia in the body, making the body extremely weak and vulnerable. 

The two most common types of acute leukemia are:
• Acute lymphoblastic leukemia (ALL)
• Acute myelogenous leukemia (AML):

Chronic leukemia is slow-developing and worsens gradually. Symptoms may take a while to appear. Sometimes chronic leukemia is diagnosed (for example during a routine check-up) before symptoms even appear. This is because the leukemia cells are usually developed enough to function like normal white blood cells at first, before they start to gradually worsen.

There are two main types of chronic leukemia:
• Chronic Myelogneous Leukemia (CML)
• Chronic Lymphocytic Leukemia (CLL)

Another type of leukemia is called hairy cell leukemia. Hairy cell leukemia is a rare form of blood cancer that gets its name from its appearance under the microscope. Occurring mostly in older adults, this disease affects more men than women. The most common symptoms and presenting complaints are weakness and fatigue due to anemia.

What causes leukemia?
No one knows what exactly causes leukemia but there are certain factors that are thought to increase the risk of developing the disease:
• Exposure to high levels of radiation
• Smoking
• Exposure to benzene (a chemical widely used in the chemical industry and also found in gasoline and cigarette smoke)
• Certain chemotherapy drugs including etoposide and drugs known as alkylating agents
• People with myelodysplastic syndrome and certain other blood disorders are at increased risk of acute myeloid leukemia.

Having one or more of these risk factors does not mean that a person will definitely get leukemia. 

What are the symptoms of leukemia?
• Feeling weak and tired
• Losing lots of weight unintentionally
• Loss of appetite or feeling very full after only eating a little
• Bleeding or bruising easily
• Frequent infections
• Unexplained fevers or night sweats
• Swollen glands (especially lymph glands in the neck or armpit area)
• Swelling or discomfort in the abdomen
• Inflammation and bleeding in the gums (gingiva)
 
How is leukemia diagnosed?
Your doctor may perform some of the following procedures to diagnose leukemia:

• Blood tests: among the most frequently tests done are complete blood count (CBC), kidney function test, liver function test and uric acid level determination. Also, microscopic examination of a blood smear is necessary to check for the presence of malignant cells (blasts)
• Bone marrow biopsy is the most commonly used test to determine the type of leukemia
• Spinal tap to check for malignant cells in the cerebrospinal fluid (CSF), the fluid that fills the spaces in and around the brain and spinal cord
• Cytogenic analysis (where the lab looks at the chromosomes of cells from samples of blood, bone marrow, or lymph nodes) to determine if significant genetic problems exist. For example, people with CML have an abnormal chromosome called the Philadelphia chromosome
• Molecular diagnostics (PCR and FISH tests). PCR tests are able to detect minute traces of cancer cells in the body while FISH tests detect any chromosomal defects in a cell’s DNA.

How is leukemia treated at KHCC?
At KHCC, the treatment plan for a leukemia patient is determined by a multidisciplinary team of specialists that is entirely devoted to diagnosing and treating leukemia. The treatment plan depends on many factors, such as the patient’s age, and the stage of the disease. Doctors at KHCC ensure that patients receive the most effective treatment that responds best to their particular case.

Acute lymphoblastic leukemia (ALL) treatment: Treatment for ALL at KHCC typically includes three main phases: induction therapy, consolidation therapy and maintenance therapy. These therapies include the use of chemotherapy, radiation, stem and bone marrow transplant, and other drug therapies.

Acute myelogenous leukemia (AML) treatment:  Most commonly, chemotherapy is used to treat this disease with some patients being able to achieve a cure. Bone marrow or stem cell transplant can be used in some patients to increase the chance of cure or for relapse or progression. Commonly, patients need support with transfusions of blood or platelets and antibiotics in case of infection.

Chronic Myelogneous Leukemia (CML) treatment: The goal of treatment for CML is to eliminate the blood cells containing the abnormal gene. Because it is a "chronic" disease, treatment will not cure the patient, but they may begin to live a relatively normal life. Patients learn to cope with the side effects of long term medication use. Treatment may also include bone marrow transplantation, biological therapy and chemotherapy. Transplant is an important modality in young healthy individuals. Older patients benefit from less aggressive therapy that may keep their disease under control for long time.

Chronic Lymphocytic Leukemia (CLL) treatment: Different types of treatments are used to treat CLL, most commonly chemotherapy, radiation therapy and targeted therapies (when drugs and other substances are used to attack specific cancer cells without affecting normal cells. In some cases, surgery may be needed to remove an enlarged spleen.

Hairy cell leukemia treatment: Because this disease is very slow growing, some patients may not need treatment. Most will however, and though there is no cure, treatment can put this disease in long term remission. Treatment include: chemotherapy, biological therapy, and in rare cases surgery to remove the spleen.

Physicians
At KHCC, leukemia cancer patients receive top quality care from a multidisciplinary team of specialists that is entirely devoted to diagnosing and treating leukemia.

Supportive Care
The leukemia multidisciplinary clinic works in close cooperation with other departments at KHCC so that leukemia patients receive the most comprehensive care possible. Supportive care services at KHCC include: