Leukaemia

Leukaemia is named after the leukocytes, white blood cells which mutate before maturity and become cancerous. These cells reproduce rapidly, suppressing the production of normal white cells that are essential to fighting infection in the body, and red cells that are needed to carry oxygen in the blood. Cancer cells may spread to the liver, spleen, lymph nodes, genitals, or brain.

Types

1. Chronic lymphocytic ( CLL)
2. Acute lymphocytic ( ALL)
3. Acute myeloid (AML )
4. Chronic myeloid (CML )

Acute Leukaemias

Acute leukaemia is rapidly progressive if not treated and involves more immature cells. It develops rapidly from the earliest forms of cells in the immature bone marrow cells (blasts). It requires urgent medical treatment but is generally responsive to chemotherapy.

Causes

• Chromosomal defects
• Radiation exposure
• Some chemotherapy drugs
• Toxins (benzene)
• Persons with Down syndrome having a brother or sister with leukaemia are at increased risk

 Symptoms and signs

• Blurred vision
• Bone and joint pain
• Breathlessness
• Dizziness
• Easily bruised skin
• Excessive sweating
• Headaches
• High fever of 38 c (100.4 F) or above
• Pale skin
• Recurrent infections
• Seizures
• Swollen liver
• Swollen lymph nodes
• Swollen spleen
• Tiredness
• Unusual and frequent bleeding( bleeding gums or nose bleeds)
• Vomiting
• Weight loss

Investigations

• Blood test (Full blood count)
• Biopsy(To know whether leukaemia cells are in bone marrow)
• Chromosomal studies(Cytogenetics)
• Spinal tap
• Chest x-ray(To see swollen lymph nodes or other signs of disease in the chest)

Treatment

• Chemotherapy
• Transfusion of blood products ( platelets or red blood cells)
• Medicines
• Radiation therapy
• Bone marrow or stem cell transplant( for leukaemia not responding to any treatment)

Complications

• Bleeding
• Disseminated intravascular coagulation (DIC)
• Relapse of ALL
• Severe infection

Chronic Lymphoid Leukaemia

CLL affects lymphoid cells and usually grows slowly.  It almost never affects children.

Causes

The cause is unknown. There is no link to radiation, cancer-causing chemicals, or viruses.

CLL primarily affects adults. The disease is more common in Jewish people of Russian or East European descent and is uncommon in Asians.

Symptoms and signs

• Breathlessness
• Early satiety
• Loss of appetite
• Night sweats
• Repeated infections
• Swollen lymph nodes
• Swollen spleen
• Tiredness
• Unintentional weight loss
• Unusual bleeding and bruising
• Weakness

Investigations

• Full blood count
• Bone marrow biopsy
• CT scan-Abdomen, chest, pelvis
• Flow cytometry
• Serum immunoglobin level
• Serum lactate dehydrogenase (LDH) level

Treatment

• Chemotherapy
• Radiation(rarely used)
• Blood transfusion
• Bone marrow or stem cell transplantation

Complications

• Autoimmune hemolytic anaemia
• Hypogammaglobulinemia
• Idiopathic thrombocytopenic purpura (ITP)
• Other cancers
• Side effects of chemotherapy

Chronic myeloid leukaemia

Chronic Myelogenous Leukaemia (CML) can be called chronic granulocytic leukaemia or chronic myeloid leukaemia. It is a cancer of the bone marrow, the spongy tissues in the bone responsible for producing blood cells. CML affects myeloid cells and usually grows slowly at first.

Causes

• Genetic Mutation- The mutations in the DNA causes the stem cells to produce more white blood cells too quickly
• Reduction in the blood cells other than WBCs
• Exposure to radiation-nuclear disaster, treatment of previous cancer(thyroid cancer or Hodgkin’s lymphoma), chemical benzene
• Exposure to pesticides.

Symptoms and signs

• The chronic phase lasts for months or years with few or no symptoms
• The accelerated phase is a dangerous phase with few symptoms like-

1. Fever (without infection)
2. Bone pain
3. An enlarged spleen

• Untreated CML progresses to the blast crisis phase with the following symptoms:-

1. Bleeding and bruising
2. Fatigue
3. Infections
4. Low-grade fever
5. Night sweats
6. Petechiae
7. Pressure under the left ribs from a swollen spleen
8. Weakness

Investigations

• Bone marrow aspiration
• Biopsy
• Full blood count with white blood cell differential
• Chromosomal study

Treatment

• Early-stage chronic myeloid leukaemia

Medicines

• Advanced chronic myeloid leukaemia

1. Chemotherapy
2. Bone marrow and stem cell transplants-Transplantations have better outcomes if the donor has the same tissue type as the person who is receiving the donation. The best candidate to provide a donation is usually a brother or sister with the same tissue type.

Complications

• Diarrhoea
• High fever of 38 C (101.4 F) or above
• Infertility
• Recurrent infections