Leukaemia: Diagnosis & Treatment

Blood cells are all manufactured by the bone marrow – the soft, spongy inner portion of certain bones. Normal, healthy white blood cells have a very short life span sometimes only a few hours long and are continuously replenished in the bone marrow. They proceed through their life cycles in an orderly way, and when they die they are replaced by new cells.

What is leukaemia?

Leukaemia develops when the genetic material, or DNA, of a white blood cell is altered. These diseased cells cannot mature beyond an early stage in their life cycles, so they never develop into functional cells. The diseased cells, called blasts, eventually take over the bone marrow and do not allow normal RBC, WBC and platelet development.

As the numbers of normal cells decline, patients may develop anaemia, a low level of oxygen-carrying red blood cells; infections caused by low counts of micro-organism fighting white blood cells; and bruising and bleeding, resulting from low levels of platelets. Leukaemic cells may also invade the liver, spleen, lymph nodes, and other organs.

This can be classified as Acute or Chronic Leukaemia depending on the type of blood cell affected. 

1. Acute Lymphocytic Leukaemia (ALL) – This is the most common type of Leukaemia in young children. These are also seen in adults.
2. Acute Myelogenous Leukaemia (AML) – AML is a common type of leukaemia. It occurs in children and adults. AML is the most common type of acute Leukaemia in adults
3.  Chronic Lymphocytic Leukaemia (CLL) – The most common chronic adult Leukaemia
4.  Chronic Myelogenous Leukaemia (CML) – This type of Leukaemia mainly affects adults. A person with CML may have few or no symptoms for months or years before entering a phase in which the Leukaemia cells grow more quickly.

Risk Factors:

1. People who have had some types of radiation or chemotherapy for other cancers
2. People with certain genetic disorders
3. Exposure to certain chemicals like Benzene
4. Smoking
5. Family history

However, most people with known risk factors don’t get Leukaemia. And many people with Leukaemia have none of these risk factors.

Diagnosis:

Leukaemia is diagnosed by looking for physical signs like pallor, lymph node swelling, enlargement of liver and spleen and by testing for a complete blood count which would show abnormal levels of the blood cells. Then a bone marrow biopsy is done to classify the disease and determine treatment options for the patient.

Treatment options:

Leukaemia is treated by any of these methods or a combination of them: 

1. Chemotherapy
2. Biological therapy 
3. Targeted therapy- where medications are used to target specific vulnerable areas in the cancer cells. This helps in disease control
4. Radiotherapy
5. Stem cell transplant

What is a Stem cell transplant?

One of the most advanced and innovative therapies for Leukaemia is the Stem cell transplant, a procedure to replace the diseased bone marrow with healthy bone marrow.

Before a stem cell transplant, high doses of chemotherapy or radiation therapy are used to destroy the diseased bone marrow. Then an infusion of blood-forming stem cells is given to help rebuild the bone marrow.

Stem cells can come from a donor [allogeneic], or in some cases we may be able to use the patient’s own stem cells [autologous]. A stem cell transplant is very similar to a bone marrow transplant.