Medically Reviewed by Dr. K on 28 April 2021
Symptoms and Diagnosis
Since certain types of leukaemia have no outward symptoms early in the disease, it's possible that leukaemia might be discovered by chance through a physical exam or routine blood tests. A doctor should suspect leukaemia if an individual is pale, has enlarged lymph nodes, swollen gums, an enlarged liver or spleen, severe bruising, bleeding, fever, persistent infections, fatigue, or a small pinpoint rash. An abnormal white cell count on a blood test can indicate the diagnosis. A needle biopsy and aspiration of bone marrow from a pelvic bone may be performed to screen for leukemic cells, DNA markers, and chromosome changes in the bone marrow to verify the diagnosis and determine the specific type of leukaemia.
The patient's age, the type of leukaemia, and the chromosomal abnormalities identified in leukaemia cells and bone marrow are all important factors in leukaemia.
Although the reported incidence of leukaemia hasn't changed significantly since the 1950s, due to the advances in chemotherapy, more patients are living much longer. Childhood leukaemia (3 out of 4 diagnoses in children is ALL), for example, is one of the most dramatic success stories in cancer treatment. Children with ALL now have a five-year survival rate of about 85%.
The immediate goal in treatment for acute leukaemia is remission. To minimise the risk of infection, the patient undergoes chemotherapy in a hospital and remains in a private room. Acute leukaemia patients are provided blood and platelet transfusions to either prevent or stop bleeding when they have very low counts of healthy blood cells. Antibiotics are given to them to avoid or treat the infection. Medications are often given to control treatment-related side effects.
When chemotherapy is used as the primary treatment for acute leukaemia, the patient is most likely to accomplish remission. They will then undergo consolidation chemotherapy for 1-4 months to get rid of any remaining malignant cells to keep the disease under control.
Patients with ALL will often receive intermittent treatment for up to two years.
Some patients with acute myeloid leukaemia (AML) may need an allogeneic stem cell transplant after achieving complete remission. This involves a willing donor, ideally a family member, with compatible tissue type and genetic characteristics. A compatible unrelated donor or umbilical blood may also be used as a donor.
Induction, conditioning, and transplantation are the three steps of a stem cell transplant. First, chemotherapy is used to get the individual's white blood cell count under control. Then a single dose of chemotherapy may be administered, followed by a high-dose chemotherapy conditioning regimen. This will destroy the individual's bone marrow as well as any remaining leukaemia cells. The donor cells would then be transferred into the patient.
The individual is left with practically no blood cells — white cells, red cells, or platelets — before the donor marrow cells begin producing new blood. As a result, infection or bleeding mortality is a significant possibility. Long-term remission becomes a strong possibility after the donor stem cells have grown enough into the marrow, which normally takes two to six weeks. The individual will also take medication to avoid and treat graft versus host disease in addition to chemotherapy. Donor cells attack the person's normal tissue cells in this condition. Medication is also provided to prevent the donor stem cells from being rejected.
Allogeneic stem cell transplantation is both costly and risky, but it provides the greatest hope for long-term remission in high-risk AML and most cases of ALL.
If these treatments don't succeed or the cancer returns in children and young adults with B-cell type ALL, their doctor may want to consider a different type of gene therapy. Certain immune cells can be “reprogrammed" to attack cancer through CAR T-cell therapy. Only certified hospitals and clinics are permitted to provide this treatment due to the risk for serious side effects.
Chronic lymphocytic leukaemia (CLL), a form of leukaemia that often affects the elderly, is a slow-progressing disease. As a result, care may be conservative. Not all patients need therapy right away. The so-called “B" symptoms of fevers, night sweats over 14 days in a row, or a 10% unintentional body weight loss over 6 months are all symptoms that require treatment. Some symptoms that also need treatment include painful swollen lymph glands, painful swollen liver or spleen, or signs of bone marrow failure.
Oral chemotherapy has the ability to effectively control CML symptoms for several years. Since most instances of CML eventually progressed to an acute phase even after treatment in the past, doctors recommended bone marrow transplantation during the chronic stage. For people with CML who are resistant to treatment or whose disease is in the acute phase, allogeneic stem cell transplantation is still a choice.
The drug imatinib (Gleevec) has revolutionised CML treatment. It's a molecular targeting medication that targets the genetic alterations that trigger out-of-control white blood cell growth. Gleevec does not cure CML, although it can lead to long-term remission and survival of patients with the disease. This medication outperformed previous treatments including busulfan, hydroxyurea, and interferon-alpha. If the leukaemia remains immune to Gleevec, there are currently four additional medications (bosutinib, dasatinib, nilotinib, and ponatinib) that can be used.
The FDA has approved nilotinib (Tasigna) for chronic phase CML. The FDA has also recommended dasatinib (Sprycel) as a first-line treatment for chronic phase CML. If an individual is allergic to or cannot handle the other medications, bosutinib (Bosulif) and ponatinib (Iclusig) may be used at any stage of CML. Another prescription, omacetaxine mepesuccinate (Synribo), has been authorized for CML patients that have progressed after receiving two or three of the previous prescriptions.
Referenced on 27/4/2021
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- Cancer stat facts: Chronic lymphocytic leukemia (CLL). (n.d.).
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- American Cancer Society: “Learn About Cancer (Detailed Guide): Leukemia–Acute Lymphocitic."
- American Cancer Society: “Learn About Cancer: Leukemia – Acute Myeloid (AML)."
- American Cancer Society: “Learn About Cancer: Leukemia – Chronic Lymphocytic (CLL)."
- National Cancer Institute: “Leukemia."
- Leukemia & Lymphoma Society: “Leukemia."