Leukaemia

While a diagnosis of leukaemia is certainly frightening, many forms of this disease can be held in check for years with minimal treatment and appropriate follow-up. Some amazing new therapies are also putting scientists closer  than ever to a cure.

What is happening

Leukaemia is a cancer of the body's infection-fighting white blood cells. Unlike most cancers, in which solid turmours form in specific organs, the malignant cells in leukaemia appear in your bone marrow, where all blood cells are made, and then spread through-out your body. No-one is sure what causes leukaemia, although pesticides, industrial chemicals, radiation, high-voltage power lines, a virus called HTLV-1 and previous treatments for cancer have in some cases been linked to an increased risk for developing it. Some people may  also possess genetic factors that increase their susceptibility to certain forms of the disease.
      The broad categories of leukaemia are grouped according to the type of cells affected and how fast the disease progresses. Acute forms develop rapidly, whereas chronic forms may remain stable for many years. There are four major types of leukaemia: acute lymphoblastic leukaemia (ALL), chronic lymphocytic leukaemia (CLL), acute myeloid leukaemia (AML) and chronic myeloid leukaemia (CML), as well as many subcategories. One of the rarer forms of the disease is  a chronic variation called hairy cell leukaemia, because the malignant cells look as though they have projecting hairs when they're examined under a microscope.
 
LIKELY FIRST STEPS

• Imaging techniques (X-rays, ultrasound, bone scans) may be done to check the chest, kidneys, liver, spleen, bones or other areas.
• A lumbar puncture may be needed to see if leukaemia has spread to the brain and nervous system.
• For acute leukaemia, chemotherapy and a bone marrow transplant.
• For chronic leukaemia, a wait-and-watch approach may suffice. If the disease progresses, chemotherapy, interferon or a bone marrow transplated may be indicated.
• New drugs such as Glivec may be an option for some.

    In all forms of leukaemia, white blood cells proliferate or grow out of control. But your sypmtoms will depend on the type of leukaemia, you have. In acute leukaemia (ALL or AML), you produce lots of white blood cells, but they are immature and can't perform their normal infection-fighting duties. That's why flulike symptoms (respiratory or throat infections, fever, fatigue) often arise suddenly and recur. By contrast, chronic leukaemia (CML OR CLL) often causes no symptoms at all; it's commonly discovered during a routine blood test. Over time chronic leukaemia sometimes develops into a more acute form.

QUESTIONS TO ASK

• What type of leukaemia do I have? What's the treatment?
• What are the chances I will go into remission?
• What are my long-term chances for survival?
• Should I see a specialist? Where would you send a family member who was diagnosed with my illness?
• Am I eligible for a bone marrow transplant?
• What signs show that my leukaemia is getting better or worse?
• What about alternative therapies?

  As white blood cells run amok, they can crowd out other cells made in your bone marrow, such as platlets and red blood cells. Platelets help your blood clot and keep you from bleeding. If your platelet counts are low, you may develop swollen and bleeding gums or nosebleeds; you may also bruise easily, or have small purple splotches on your skin called petechiae. Red blood cells deliver oxygen to tissues throughout the body; if their levels drop, anaemia results. You may then become pale, fatigued, short of breath or suffer from headaches. Headaches can also occur if white blood cells infilitrate the fluid around the brain, and bone pain may result if these cells congest 

                                                Treatment Options
MEDICATIONS
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Chemotherapy                                        Effective for acute and some chronic forms.
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Anti-emetics                                            To help with nausea related to chemotherapy
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Antibiotics                                               To treat infections from reduced immunity.
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Oral corticosteroids                               Prevent chemo from attacking healthy cells.
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Interferon                                                Often used to extend time in remission.
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Glivec                                                        New drug that disables enzyme in cancer cells.

PROCEDURES
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 Bone narrow transplant                       New cancer-free stem cells grow in marrow.
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Blood transfusions                                  Replace blood cells, platelets; fight fatigue.
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Radiation                                                    Kills leukaemia cells; shrinks nodes, spleen.
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Leukapheresis                                          Special filtering process for the blood.

your bone marrow. Lymph nodes in your neck, armpits or groin may swell with huge numbers of whiteblood cells, as may your spleen, liver or, if you're a man, your testers. By self-monitoring symptoms and body changes, you can aid your doctor in choosing the best treatment for you.

TAKING CONTROL

• Get a referral from your doctor to an appropriate specialsist. An oncologist specialises in cancer care, a haematologist in diseases of the blood. A haematology-oncologist specialises in leukaemia and other blood related cancers. One of these specialists likely to work with you to coordinate your ongoing care.
• See your doctor for regular follow-up visits. It's important that you report any new symptoms so your doctor can guage treatment success and disease remissions.
• Try relaxation therapies. Coping with leukaemia can be emotionally exhausing. Relaxation therapies (guided imagery, meditation, massage) may all improve your ability to deal with daily stresses.
• Start a healthy eating program to bolster your strength and reserves. Leukaemia treatment is hard on the body. A nutritionist can help you design an optimal diet.
• Avoid exposure to known toxins, such as benzene, which may increase your leukaemia risk.

>NEW TREATMENTS OFFER HOPE. In Australia about 200 children under age 15 are diagnosed each year with leukaemia. In the 1960s, almost all children with leukaemia died. In the 1980s, half survived. Today, chemotherapy drugs have boosted the cure rate for childhood leukaemia to over 80%.
 

Treatments

Innovative therapies are now revolutionising the treatment of leukaemia, and exciting new approaches are in development as well. Once highly fatal, many forms of leukaemia are now kept in check or even cured (see on shortly). Treatment depends on the type of disease you have, its aggressiveness, your age and other factors.
  If you have acute leukaemia, your doctor will begin prompt treatment with potent chemotherapy drugs. These can have strong side effects but can also be very effective in bringing about remission, which means that evidence of disease has disappeared, at least for a time. Other medicines such as inteferon may also be used to induce remissions or boost the effect of chemotherapy. Radiation, bone marrow transplant, surgery and other procedures may also be needed at some point in your illness.
  If you have chronic leukaemia, your doctor may suggest a wait-and watch approach, holding off treatment but checking your blood regularly to see if your disease is changing in some way. Overtime, some (but certainly not all) cases of chronic leukaemia turn into more acute forms, requiring treatment. Doctors then use approaches designed for acute disease, including chemotherapy or a bone marrow transplant. Many older people which chronic leukaemia, however, never need any treatment  at all for their condition.