LEUKAEMIA

Leukaemia is a cancer of the blood.  New blood cells are continally produced in the bone marrow (in the bones).  Stem cells are the immature cells in the bone marrow which grow into different types of cells in the body, including blood.  From the early stage of being a stem cell, the cells grow and mature into functional cells.  As a result of the genetic changes to the DNA in the cell, they often stay as immature cells or cells that are now defective.  This means that the cell cannot perform its function properly, and the defective cells start increasing in number in the blood and normal cells decrease.  These damaged cells are called malignant cells, which means they are cancerous.

There is no clear explanation as to why this happens, but there are some causes that seem to be specific to the type of leukaemia.  The different types of leukaemic are characterized by whether they are acute (fast growing) or chronic (slow growing).  These cancers are also classified into lymphocytic or meyloid leukaemias, which is determined by where these abnormal cells are produced in the bone marrow.

\The specialists that treat blood cancers are called Haematologists.  You will be referred by your GP to these specialists.  There are differnt procedures and tests that are done to diagnose leukaemia, including blood tests (pathology), bone marrow biopsy, CT and MRI scans, and other tests.

Treatment options are different depending on the type of leukaemia you have.  The most common treatments include chemotherapy, biological and targeted drugs, stem cell transplant, radiation, platelet transfusion and other medications.

Acute Lymphocytic Leukemia (ALL)

This type of leukaemia is most common in childhood (2-5year) and represents almost 25% of cancer among children.  The child can be born with this leukaemia, or develop it after birth.  ALL can be caused by exposure to radiation, certain chemicals or with certain genetic conditions (e.g. Downs Syndrome).  There is a rapid onset of the disease, and this means that there are large numbers of very immature white blood cells in the blood.

Some patients will have a better response to treatment, depending on the subtype of ALL and other factors.  Total treatment takes about two years, and chemotherapy will usually be given first to achive a remission. Different combinations of chemotherapy drugs can be used.  The first month of treatment can be quite disruptive, as it requires frequent visits to the Haematologist and potentially time in the hospital for infections.  Most patients are able to achieve remission at this stage, but because these cancer cells might be lurking elsewhere in the blood, more treatment may be needed.  If the patient does go into remission, a short course of chemotherapy will follow using the same drugs as in the first treatment.  However, some patients might still be at a risk of relapse, and it would be at this stage that a stem cell transplant might take place, expecially if the patient has a sibling who would be a good donor match. After this procedure more chemotherapy can be given, depending on how the patient has responded to the first treatment.

Acute Myeloid Leukaemia (AML)

AML is a cancer caused by the rapid growth of abnormal white blood cells that accumulated in the bone marrow and interfere with the production of normal blood cells.  This is the most common acute leukaemia in adults and there are several subtypes of AML.  The chances of getting AML increases with age. As this is an acute leukaemia, it can progress rapidly and therefore must be treated as soon as possible. New research into the genetics of AML has resulted in better understanding of which treatment to use for each patient.

The causes of AML are not clear, but can sometimes be due to a congenital disorder (Downs Syndrome), exposure to radiation, exposure to certain chemicals or genetics (close family members).  There is a potential link to other blood disorders that may be present before the diagnosis of AML (Myelodysplastic syndrome or myeloporliferative disease). Thetreatment options include chemotherapy to induce remission and/or stem cell transplant.

Chronic Myeloid Leukaemia (CML)

This type of leukaemia is a cancer of the white blood cells that have accumulated in the blood.  This cancer is more common in adults. CML is linked to a genetic abnormality where there is an abnormal gene called the Philadelphia chromosome that is present in the cells of the blood.  Treatment has become tailor made for CML, as the new drugs on the market target this chromosome.  This means that these new targeted drugs (which are not chemotherapy), can be more effective and have dramatically improved the survival of patients with this disease.  These drugs have less side effects and the patient has a better quality of life than if they had been given conventional chemotherapy.

Chronic Lymphocytic Leukaemia (CLL)

CLL is a cancer of the blood which is as a result of the bone marrow making too many white blood cells.  These white blood cells have defects in the DNA and new cells include the defective DNA, resulting in CLL.  It is the most common type of leukaemia in adults over the age of 50, and the older the patient, the higher the chance of getting this disease.  The causes may be hereditary, age, gender (more common in men), and exposure to certain chemicals.  As it is a slow growing, chronic disease, it is often not picked up for many years, as the patient does not notice symptoms relating to CLL.  Therefore it is often picked up at a routine medical examination where blood is taken and tested.  Early stage CLL is not treated, but as the symptoms become more apparent, treatment will begin.  The treatments used for CLL are chemotherapy, biological and targeted drugs, radiation and surgery of affected organs (e.g. spleen).

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