Introduction
Leukaemia is a cancer of the blood in which there is a rapid production and growth of many abnormal white blood cells. These cells grow in such a way that they outnumber the normal healthy cells. Such abnormal white cells are incapable of fighting infections. They also impair the bone marrow’s capability to produce erythrocytes and thrombocytes. Erythrocytes are red blood cells while thrombocytes are platelets.
Leukamias are not characterized by tumor growths as seen in other cancers.
Causes
The exact causes of leukaemia are not yet clearly known. Individuals with this condition have some abnormal chromosomes, but these shave not been implicated to cause leukaemia.
Types
There are 4 broad classes of leukaemia. These can be either acute or chronic leukaemia.
The 4 types are as listed;
- Acute lymphocytic leukaemia(ALL)
- Acute myelogenous leukaemia(AML)
- Chronic lymphocytic leukaemia(CLL)
- Chronic myelogenous leukamia(CLL)
Epidemiology
Leukaemia occurs in adults and children. ALL and CML are the most common types of leukaemia in children.
In adulthood, AML and CLL are the most common adulthood leukaemias.
Risks
Risk factors include;
- Genetic conditions such as Down Syndrome , Klinefelter Syndrome and Neurofibromatosis
- Family history of leukaemia
- Frequent exposure to chemicals such as benzene
- Radiation exposures
- Chemotherapeautic agents
- Smoking
- Race- Children of Latino and Hispanic descent are more likely to get leukemia as compared to other races
- Gender-People assigned male at birth are at relatively higher risk of getting leukaemia
- Age- Children and adults above 55 years old
Signs & Symptoms
There are a variety of symptoms and signs related to leukaemia. These can vary depending on the type and stage.
Common clinical signs and symptoms include;
- Paleness
- Headache
- Loss of weight
- Fatigue
- Night sweats
- Fever
- Bleeding gums
- Bone pain
Laboratory features
ALL;
- Complete Blood Count shows anaemia, normal, decreased or elevated Total White Blood Cell count, thrombocytopaeni)
- Peripheral Blood Film shows Blasts
- Bone Marrow is : HYPERCELLULAR; With more than 30% blasts
CML;
- Leucocytosis
- Basophilia
- Platelets: normal, increased, low
- Increased serum Vitamin B12
- PBF: complete spectrum of myeloid cells
- Bone Marrow Aspiration: Hypercellular-increased granulopoiesis
- Cytogenetics: Philadelphia chromosome
Diagnosis & Tests
- Physical examination- Health care practitioner checks for swollen lymph nodes and palpates abdomen to check for splenomegally or hepatomegally.
- Detailed patient history
- Also, a doctor orders for;
- Complete blood count test
- Peripheral blood film
- Flow cytometry
- Imaging tests such as X-rays, CT scans and MRIs
- Bone marrow biopsy/ aspiration
- Spinal tap/ lumbar puncture
Management & Treatment
- Stem cell transplantation
- Biological therapy/ Immunotherapy. Two forms of biologic therapy employed in treating leukemia rare monoclonal antibody therapy and chimeric antigen receptor T-cell therapy
- Chemotherapeutic agents
- Targeted therapy drugs. Examples include monoclonal antibodies and tyrosine kinase inhibitors
- Surgery
- Radiotherapy such as X-ray radiation. These rays kill leukaemic cells or hinder them from growing further
Phases of treatment of leukaemia include;
- Induction therapy- Intended to kills many of the leukaemic cells in blood and for the bone ,arrow to attain remission. This stage lasts 1 to 1.5 months(4 to 6 weeks)
- Intesinsification/Consolidation-Kills remaining leukaemic cells that are undetected. This ensures that the cancer does not return. Consolidation phase lasts 4 months to half a year.
- Maintenance therapy- Intended to kill any remaining cells which have not been hit by the first two phases. It targets the cells that have survived the prior tratement strategies. It also prevents relapse of cancer. Treatment period can ast fpr upto 2 years.
Prevention
Avoid exposure to repeated radiations and chemicals such as benzene, toluene.