leukaemia

Stem cell (also called bone marrow) is a spongy substance that produces three types of blood cells- red blood corpuscles, white blood corpuscles and platelets. Leukaemia arises in the bone marrow when there is a huge production of abnormal white blood cells. These white blood cells do not fully develop and are called leukaemia cells or blasts.

Leukaemia types are divided into four categories:

• Acute myeloid leukaemia- develops rapidly and affects myeloid cells
• Chronic myeloid leukaemia- develops slowly and affects myeloid cells
• Acute lymphoblastic leukaemia- develops rapidly and affects lymphocytes
• Chronic lymphocytic leukaemia- develops slowly and affects lymphocytes

Acute leukaemia and chronic leukaemia can be treated and managed, while the former can be cured through bone marrow transplants in younger and fitter patients, the latter cannot be cured even with standard treatments.

What causes the blood cells to act eerily and produce abnormal white blood cells is still unknown. Although, the exact cause of leukaemia is still not known, there are a few risk factors of leukaemia that can help you become cautious beforehand:

• Age- most types of the disease is common in older people
• Chemical exposure- exposure to high levels of radiation and chemicals rapidly increases the chances of leukaemia.
• Gender- Males are likely to get the disease more
• Genetics- although, it is not inherited, there are slightly higher chances of people getting the disease whose close relatives have been patients of leukaemia.
• Bone marrow disorders- those with disorder problems are likely to get the disease

The common symptoms of leukaemia include anaemia, shortness of breath, weakness, palpitations, light-headedness, frequent infections that are severe, fever, sweat, malaise (feeling of illness), bruises in the skin, nosebleeds, heavy periods, pain in joints and bones, bleeding gums, etc.

Although the signs and symptoms of leukaemia may help an oncologist determine whether a person has the disease or not, a laboratory test helps confirm the results. Diagnosis of leukaemia is done by taking a bone marrow sample from the patient.

After the skin is numbed with anaesthesia, a needle is placed inside to withdraw liquid bone marrow which is sent to the laboratory for testing. Additional tests like X-rays are done to look for swollen lymph nodes. Several blood tests are done to investigate more. Staging of leukaemia cannot be specifically determined, since the disease spreads throughout the body via the bloodstream.

Treatment of leukaemia may vary. Some Leukaemia patients may not get any treatment initially, since they are kept under observation and monitoring to evaluate their condition. Regular check-ups and assessment helps these patients to get well gradually without requiring any treatment at all.

Patients with acute leukaemia can eventually receive a cure, but those with chronic leukaemia may not get cured, but their condition is treatable. Sometimes, the disease may come back (called relapse) which is treated with standard treatments. The types of treatments for leukaemia are:

• Radiation therapy- this is required for local disease, eg: the spleen or for stem cell transplant
• Chemotherapy- steroids along with chemotherapy is used for lymphoid leukaemia
• Targeted therapy- drugs are used for killing specific leukaemia cells
• Stem cell transplant- Only younger and fitter patients undergo stem cell transplants. There are two procedures followed- autologous and allogeneic. The procedure is the right option for acute leukaemia, if chemotherapy does not cure
• Biological therapy- this treatment uses the immune system to destroy cancer cells. Antibodies are used against the markers on leukaemia for killing the abnormal cells.

Before leukaemia treatment, get yourself ready with a few preparations that have been given below.

• Before you get a stem cells transplant, you may have several appointments with your doctor.
• Discuss with your doctor regarding the side effects of the transplants and the recovery time. You may have to stay 3-4 weeks in the hospital from the pre-transplant procedure until you are fit to go home.
• Before the transplantation, you doctor will conduct several tests of your lungs, heart, and other organs and check if they are functioning fine. Before having an autologous stem cell transplant, you are given daily injections to boost production of stem cells from the bone marrow to the bloodstream.

The stem cell is then collected by using a stem cell separator machine by segregating blood from the stem cells. While the blood is returned to you through another arm, the stem cells are stored, frozen and thawed. The same procedure is followed in case of allogeneic stem cell transplant, with the only difference that stem cells are collected from a matching donor.

• You may also have to see a dentist and get a thorough check-up before the transplant appointment to check if your teeth are in proper condition while you are recovering since it is the first spot likely to get infected.
• If you want to have a child in the future, your doctor will talk to you about fertility and preserving eggs/sperms.
• Have someone close by your side throughout the procedure to help you give moral support.
• Make sure you have some personal stuff with you like phones, laptops, DVDs to help you stay relaxed before the transplant.

Have a look at the treatment options and the performance procedure of each:

• - This is a drug treatment given in the form of oral pills or chemicals injected in the bloodstream to kill cancer cells. You are asked to lie down, and an IV channel is created in the arm to inject the chemo drugs in order to help it reach various parts of the body to destroy cancer cells.
• Targeted therapy- Targeted therapy is given in the form of pills that work by allowing your immune system to recognize and destroy leukaemia cells.
• Biological therapy- This type of therapy is similar to targeted therapy that allows the immune system to locate and destroy the cells.
• Radiation therapy- A type of radiation beams are directed on the patients. First, you will have to lie down on a table. A machine moves around, directing radiation to specific parts of your body. The radiation beams are focused only on those areas where a collection of leukaemia cells gather. This type of therapy is generally used before a stem cell transplant.
• Stem cell transplant- This type of cell transplant, also called bone marrow transplant (BMT), helps replace diseased bone marrow with a healthy bone marrow to help produce normal blood cells in the body. There are two types of stem cell transplants- autologous BMT and allogeneic BMT.

Autologous BMT- On the day of transplant, a central nervous catheter is placed in your chest through which your own stem cells (previously collected and stored) are given into you.

Allogeneic BMT- The procedure is the same like autologous stem cell transplant. The collected and stored stem cells from a matching donor are inserted through a central line in the chest of the patient.

Post treatment, several appointments are required with your doctor to help you get better quickly. Normally, after a full course of leukaemia treatment, it takes over several months to help your immune system to get back to normal. The recovery of Leukaemia treatment may take time, but during the recovery period you are vulnerable to infections, bleeding and bruising. Visit your doctor for follow-up appointments to evaluate your progress of healing.