Leukaemia

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Leukaemia is a type of cancer that forms in the blood. Bone marrow is where blood cells are formed. The disease is characterized by the uncontrolled growth of blood cells, usually white blood cells in the bone marrow. Leukaemia cells crowd out and replace normal blood and marrow cells.

Types of Leukaemia

There are different types of leukaemia and it is important to identify each as treatment and prognosis differ widely. There are 4 main types of leukaemia, which are acute or chronic, and myeloid or lymphocytic:

  • Acute lymphocytic leukaemia (ALL) – This is the most common form of childhood leukaemia. It can spread to your lymph nodes and central nervous system.
  • Acute myelogenous leukaemia (AML) – This is one of the most common forms for adults.
  • Chronic lymphocytic leukaemia (CLL) – This is the other most common form of young adult leukaemia. Some kinds of CLL will be stable for years and won’t need treatment. But with others, your body isn’t able to create normal blood cells, and you’ll need treatment.
  • Chronic myelogenous leukaemia (CML) – With this form, you might not have noticeable symptoms. You might not be diagnosed with it until you have a routine blood test. People who are 65 years old and older have a higher risk of this type.

Symptoms

The symptoms of leukaemia generally depend on the type of leukaemia, how quickly it grows and at what stage the disease is diagnosed. Many of the symptoms of leukaemia don’t become apparent until a large number of normal blood cells are crowded out by abnormal cancer cells. Symptoms can be unspecific such as fever, weight loss and low energy. Others can be such seen on the diagram above.

Leukaemia Complications

Possible complications of leukaemia inclusive of:

  • Serious infections
  • Severe bleeding (haemorrhage)
  • Thickened blood from large numbers of leukaemia cells

Possible long-term complications from leukaemia or the treatment can include:

  • Heart and lung problems
  • Problems with the ability to have children in the future
  • Bone problems such as thinning of bones (osteoporosis)

What causes Leukaemia

There are several factors that can increase a person’s risk of getting leukaemia. For example,

  • Exposure to radiation
  • Previous exposure to chemotherapy drugs
  • Exposure to certain chemicals eg. Benzene
  • Genetic disposition in patients with Down’s syndrome

Leukaemia Diagnosis

If an individual has any of the above symptoms, a full examination is recommended.

  • Blood tests – By looking at a sample of your blood, a doctor can determine if you have abnormal levels of red or white blood cells or platelets which may suggest leukaemia
  • Bone marrow test – A doctor may recommend a procedure to remove a sample of bone marrow from your hipbone. The bone marrow is removed using a long, thin needle. The sample is sent to a laboratory to look for leukaemia cells. Specialised tests of your leukaemia cells may reveal certain characteristics that are used to determine your treatment options.
  • Cytogenetic is involves testing samples of bone marrow, tissue, or blood, to identify the changes in chromosomes.
  • Molecular tests are the test that checks for certain genes, proteins, or other molecules in a sample of tissue, blood, or other body fluid as well as certain changes in a gene or chromosome.

Prognosis

The stages of leukaemia relate generally to a patient’s prognosis, mainly in that patients who are diagnosed in early stages tend to have better outcomes. Nevertheless, the stage of the condition alone cannot predict a patient’s outcome with any degree of certainty, and furthermore, there is a wide range of outcomes for patients with the same stage of leukaemia.

There are many factors to consider that affect an individual’s chance of recovery, including:

  • Patient’s Age
  • General Health Status
  • Type of blood cell
  • White Cell Count
  • Responses to treatment
  • Molecule Abnormalities
  • Chromosomal abnormalities

Leukaemia Treatments

Treatment method depends on the type of leukaemia and can be treated with any treatment method below:

Chemotherapy – Chemotherapy is a major form of treatment for leukaemia. Chemotherapy drugs are given to destroy cancer cells or impede their ability to grow and reproduce.

Type of Chemo Drugs
  • Alkylating agent is a type of chemo drug that is capable of damaging the DNA of a cancer cell to ensure that the cell doesn’t make more copies of them.
  • Topoisomerase inhibitor is a compound that can block the human enzymes that contribute to the growth of cancer cells.
  • Antitumor antibiotic is an anticancer drug that is capable of slowing down or stop the growth of cancer cells.
  • Antimetabolites is a chemo drug that is capable of interfering with more than one enzyme that’s necessary for the growth of DNA inside the cancer cell.
  • Mitotic inhibitor is a type of chemo drug that is capable of stopping the body from producing the protein which contributes to cancer cell growth.
  • Corticosteroids are man-made steroids used to help reduce the side effects of chemotherapy

Targeted Therapy – Targeted therapy directs drugs or other specially created substances (e.g., immune system proteins developed in the lab) to attack cancer cells. Targeted therapy may be used alone or in combination with other treatments, such as chemotherapy.

Type of Targeted Therapy Drugs used in Treating Leukaemia:
  • Dasatinib is known as kinase inhibitors which blocks the abnormal proteins that causes the cancer cells to multiply and stop the spread of cancer cells.
  • Nilotinib is known as kinase inhibitors which blocks the abnormal proteins that causes the cancer cells to multiply and stop/slow down the spread of cancer cells.
  • Ponatinib is known as kinase inhibitors which blocks the growth of tumour cells by targeting the protein on the surface of cancer cells.
  • Bosutinib is known as kinase inhibitors which blocks the abnormal protein that causes the cancer cells to grow and eventually stop the spread of the cancer cells.

Immunotherapy – A type of treatment that uses the body’s immune system to fight cancer by stimulating the immune system to help it do its job more effectively.

Types of Immunotherapy Drugs:
  • Rituximab is classified as a type of monoclonal antibody that will attach protein found on the surface of blood cells with cancer and by attaching to it would enable one’s own immune system to destroy the cancer cells as well as annihilating the cancer cells on its own.
  • Blinatumomab is a monoclonal antibody which directs the body’s T-cells (part of the immune system) to target and bind more than one protein on the surface of leukaemia cells. This drug bringing the cancer cells and the immune cells work together which results with the immune system to attack the cancer cell.
  • Chimeric Antigen Receptor T-cells (CAR T-Cell) – is genetically engineered to produce an artificial T-cell receptor, which give these T-cells the new ability to target a specific protein. The infused CAR T-cells may eradicate all of the cancer cells and may remain in the body months after infusion has been completed, providing immune-surveillance resulting in prolonged remission and survival.

Stem Cell Transplant – A procedure in which you will be given healthy stem cells to replace your diseased stem cells. These stem cells can be obtained from your own stem cells (Autologous transplantation) or from a donor (Allogeneic transplantation).

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