Acute lyphoblastic leukemia

The doctor called and said, “You need to go see a specialist. Your white blood cell count is sky high”. For the last few days Mr. Jabbar was having night sweats and hot flashes. He wanted to get to the root of the situation, so he went to his family physician. The doctor examined his neck, arm pits, and abdomen, and took samples of his blood for analysis.

The person was no other than the famous basketball hall of fame and legend Mr. Kareem Abdul-Jabbar. Later he was diagnosed with chronic myeloid leukemia, a rare cancer of blood and bone marrow. It was December, 2008. Mr. Jabbar thought it was a death sentence. But he never lost hope and fought. He is now the spokesman for Novartis Pharmaceuticals Corp. living with leukemia, and the prognosis is positive. He is hopeful to prevail against the disease.

Blood basics: Components

Blood is a specialized tissue in the body which occupies 7-8% of the body weight consisting of four major components namely red cells, white cells, platelets, and plasma.

Bone marrow is the soft substance present in the center of the bones. Most of the blood cells develop from stem cells (specialized cells from which other cells develop).

Red cells:Also called as erythrocytes carry oxygen to various tissues in the body.

White blood cells:Also called leucocytes, they form part of body’s immune system to fight infection. Various types of white blood cells include T lymphocytes (cell that can attack foreign cells, infected cells and cancer cells) B lymphocytes (cells that produce antibodies which are proteins that bind to foreign substances and help to eradicate them), Neutrophils (cells that can ingest foreign cells), Monocytes (cells that ingest dead organisms and help to fight infection), Eosinophils (cells that can kill parasites, eliminate cancer cells and involved in allergic responses) and Basophils (cells that participate in allergic responses)

Platelets:Also called thrombocytes, they help in the clotting of the blood and control bleeding.

Generally most of these cells mature in the bone marrow and then released into the vessels of the blood.

Understanding leukemia

The word leukemia is derived from two Greek words “leukos” meaning white and “haima” meaning blood. Leukemia is the cancer (abnormal growth of cells) of the tissue in the bone marrow responsible for the formation of blood cells.

Contrary to the other cancers, leukemia does not produce tumors (abnormal mass of tissue) but results in abnormal production of white blood cells.

Though most of the times leukemia is considered as the disease of the children, it affects adults too and the incidence increases with the age. Men are more affected by leukemia than women and Caucasians are more prone to leukemia than African Americans.

Leukemia prognosis

Nearly 90% of the children diagnosed with acute lymphoid leukemia (ALL) attain remission and more than 50% are cured completely. The 5 year survival rate which was only 4% in 1960’s has risen to 50% by 1990’s.

The remission rates of adult patients with ALL are from 80% to 90% and among those who survive, 40% have the survival chance for another 5 years.

Among the adult patients treated for AML, 60% to 70% have the chance of remission and among the survivors 20% have the chance to live at least for another 3 years more with complete recovery.

The last word

Leukemia is not a death sentence. Baseball legend Mr. Kareem Abdul-Jaffar is the living example that one can prevail and continue a meaningful life. So do not lose your heart. Fight.

Leukemia symptoms

Symptoms of leukemia vary depending on the type of leukemia and the organ that is affected. People with chronic leukemia may not exhibit any symptoms in the early stages of the disease.

Patients suffering from acute leukemia may consult doctor because they may be feeling sick. ome of the common symptoms include:

  • Swelling of the lymph gland in the armpit or neck

  • Sweating in the night accompanied by chills.

  • Recurrent infections

  • Fatigue, tiredness or feeling of weakness

  • Red spots under the skin or purple patches on the skin and swollen gums with bleeding

  • Swelling of the liver or spleen causing discomfort

  • Loss of weight for unknown reasons

  • Joint pains or pain in the bones

Very often these symptoms are mistaken for infection or other health problems. Only doctors can find out the real cause. Hence, if you have any of these symptoms, you need to see your doctor for proper diagnosis.

Leukemia causes

The exact cause of leukemia is unknown. Leukemia seems to develop from genetic and environmental factors.

Leukemia occurs when the molecule containing genetic information (DNA) in the cells of the bone marrow get damaged causing them to multiply abnormally. The cells that develop from these cells have mutated (changed) genetic information that makes them function abnormally.

As leukemia progresses, these abnormal cells overcrowd the normal cells causing various symptoms.

Doctors also cannot give you the reasons as to why some people get cancer and others do not. However research studies show that some of the risk factors that may lead to leukemia which include exposure to radiation, tobacco smoking, exposure to chemical benzene, chemotherapy, genetically inherited diseases such as Down syndrome, certain blood disorders, viral infections such as with HTLV-I (Human T-cell leukemia virus type I), and a family history of leukemia.

Based on the speed at which the disease develops and worsens, leukemia is divided into two main groups. Chronic leukemia which develops and worsens slowly over a period of time and acute leukemia develops and worsens quickly.

Leukemia is also grouped based on the type of the cell that is affected. Leukemia that affects lymphoid cells called lymphoid and termed as lymphocytic or lymphoblastic leukemia. Leukemia that affects myeloid cells is called as myeloid, termed as myeloid or myeloblastic leukemia.

Leukemia is categorized into four common types:

Chronic lymphocytic leukemia (CLL):CLL is a lymphoid leukemia affecting lymphoid cells and generally grows slowly. Every year more than 15,000 new cases of lymphoid leukemia are diagnosed and effects mostly elderly above the age of 55. Children are not affected.

Chronic myeloid leukemia (CML):CML affects adults and progresses slowly at first. 5,000 new cases of CML are diagnosed every year.

Acute lymphocytic (lymphoblastic) leukemia (ALL):ALL grows quickly affecting lymphoid cells. Though it affects adults, it is the most common type of leukemia found in children. Each year, it accounts for more than 5,000 new cases of leukemia.

Acute myeloid leukemia (AML):AML occurs in both adults and children and grows quickly affecting myeloid cells. Every year more than 13,000 new cases of leukemia are diagnosed.

Treatment of leukemia depends on your age, type of leukemia, your overall health and whether leukemia has spread to the other parts of your body or not.

You may not need any immediate treatment if you have chronic leukemia without any symptoms.

During this period, your doctor watches you closely so that any necessary treatment can start immediately as soon as you have the symptoms of chronic leukemia. When you are under watchful waiting treatment, you will not receive any receive any specific treatment right away.

Using medicines to kills the cancer cells is called chemotherapy. These drugs are given either in oral form or in injectable form.

Sometimes if required a combination of drugs may be used. Specific targeted therapy uses medications that exploit certain vulnerabilities in the leukemia cells. For example, drug imatinib stops the action of a protein within the leukemia cells of the people with chronic myelogenous leukemia. These drugs may block the action of certain proteins in the leukemia cells that cause their proliferation.

Another treatment called biological therapy involves medications that are given to help your immune system to recognize these cancer cells and launch attack on them so that they can be eliminated. Sometimes, these biological products carry toxins that can kill the leukemia cells. Some of the biological can slow down the growth of leukemia cells.

Radiation is also a treatment modality. High energy beams such as X-rays, are targeted against specific leukemia cells where they are concentrated or against specific organs where these leukemia cells are found. Though the side effects of radiation therapy are quite stressful or painful, these can be controlled through available treatments.

Replacement of your diseased stem cells with new healthy stem cells is called stem cell transplant. First you will be subjected to either radiation or chemotherapy or both to kill the malignant leukemia cells and then replaced with fresh, new and healthy stem cells which will give rise to healthy blood cells.

These healthy stem cells are given by transfusion and similar to bone marrow transplant. The healthy stem cells can be from your own body or from a family member or your twin or they could be donated.

Most often, doctors accidentally find leukemia in the routine blood tests. Subsequently, your doctor may enquire about your medical and family history.

Your physician may perform a physical examination to check for swollen glands in the neck and in the armpit.

Blood tests are performed to check for any abnormal presence of the blood cells such as leucocytes, erythrocytes and platelets.

Your doctor may order sample of the bone marrow during which your bone marrow cells shall be removed either from your hip bone or from any other large bone through a needle under local anesthesia (causing temporary loss of feeling through medication at a specific place)

Further tests may be necessary to confirm the type and stage of leukemia. These include:

Study of chromosomes (part of the cell that contains genetic information):From the blood or bone marrow samples, your chromosomes are studied to check whether there are any abnormalities in your chromosomes. This can also identify the type of leukemia you have.

Spinal tap:Sample of the fluid surrounding your brain and spinal cord is taken with the help of a long and thin needle to check for leukemia cells.

Chest X-ray:X-ray of your chest is taken to check for swollen lymph glands in your neck and arm pits and for any other signs of disease.

The side effects of leukemia treatment result from the possible damage to the healthy cells, tissues and organs. The side effects also vary depending on the type of treatment. They also can vary from person to person and even from session to session.

The side effects of chemotherapy and biological therapy depend on the drugs used and in general affect the cells that divide rapidly.

When blood cells are affected, patients are more prone to infections and may feel very weak and tired.

As the chemotherapy affects cells in the hair roots, one may experience hair loss. Once the therapy is stopped the hair may re-grow but the texture and color of the hair may not be the same. Some anti cancer drugs may affect the fertility of the patients.

Radiation therapy may cause the patient to be very tired. The skin where the radiation therapy is given may become tender, red and dry. If given along with chemo therapy the side effects may worsen.

Side effects of stem cell transplant include severe infections, bleeding and other side effects associated with chemotherapy and radiation therapy as the patients might have received these therapies prior to stem cell transplant. Beside the patient may experience Graft- versus-host-disease (GVHD) which can be mild or severe. The donor’s stem cells react with host’s tissues affecting liver, skin or digestive tract.