Cancers of the Blood

Acute Myelogenous Leukemia

Acute myelogenous leukemia (AML) is a cancer of the blood in which too many granulocytes, a type of white blood cells, are produced in the bone marrow.

Normally, bone marrow cells mature into several different types of blood cells. Acute myelogenous leukemia affects the young blood cells (called blasts) that develop into white blood cells called granulocytes. The main function of granulocytes is to destroy infection by bacteria and fungi. They also regulate allergic reactions. AML prevents monocytes from maturing. Immature blasts cannot carry out the functions of the mature granulocytes. This results in the patient becoming anaemic and prone to infection. In AML the disease progresses quickly and more immature blasts are formed.

AML is a common type of leukaemia in adults.

Symptoms
Diagnostic Tests
Treatment Options

Symptoms

The following are the most common symptoms for acute myelogenous leukaemia,

• Anaemia
• Bleeding
• Bruising
• Fever
• Persistent weakness
• Tiredness
• Aches in bones and joints
• Swollen lymph nodes
• Loss of weight.

Diagnosis

The doctor reviews the complete medical history and performs a physical examination.

He will advise one or more of the following tests:

• Blood tests
• Bone marrow biopsy to determine the number of blast cells.
• Lumbar puncture or spinal tap

Treatment:

Treatment as in all cases of cancer depends upon the stage to which the disease has progressed. Unlike carcinoma, where cancer can be identified with a particular area of the body (at least in the early stages), staging cannot be done on TNM basis. Two other types of classifications, karyotyping and the FAB classification, are used to determine the most effective treatment possible.

But AML patients are categorised according to whether they have been treated before for the disease. AML patients fall into one of the following groups:

• Untreated

  These patients are newly diagnosed and have had no prior treatment for leukaemia.

• In Remission

  Patients are considered to be in remission if they have received the initial remission induction treatment, the amount of blasts in their bone marrow is less than 5 percent, and they have no signs or symptoms of disease.

• Having Recurrent or Refractory Disease

  These are patients whose disease has recurred after remission or whose disease did not respond to treatment (refractory disease).

Treatment may include:

• Chemotherapy
• Radiation therapy
• Bone marrow transplantation

Chemotherapy is used to achieve remission, or a state where no cancer symptoms are exhibited.

The next stage is post remission therapy. This tries to eliminate remaining leukaemic cells. Agents to stimulate the patient’s immune system may be given. A stem cell or bone marrow transplant is an option for some AML patients

However, AML is a little more difficult to treat than ALL. Fewer people attain complete remission and subsequent recurrence is more common. However, stem cell transplantation and other procedures have substantially improved the chances of survival.

Chronic Leukaemia

This type of leukaemia progresses slowly and tends to involve more mature cell types.

It may not need treatment immediately. The usual form of treatment is chemotherapy.

Symptoms

Chronic Leukaemia could be present for months or even years without any symptoms.

Patient exhibit many of the following symptoms:

• Tiredness
• Bruising easily (often without having had any blow or fall)
• Repeated infections
• Enlarged lymph glands ( lymph glands swell up in the neck, armpits, groin or sometimes in areas where a physical exam cannot detect)
• Weight loss
• Night sweats
• Fever

Chronic Myelogenous Leukaemia

Chronic myelogenous leukemia (CML) is a cancer of the blood in which too many white blood cells are produced in the bone marrow. Myelogenous leukaemia affects the young blood cells (called blasts) that develop into white blood cells called granulocytes. The main function of granulocytes is to destroy infection by bacteria and fungi. They also regulate allergic reactions. Myelogenous Leukaemia prevents monocytes from maturing. Immature blasts cannot carry out the functions of the mature granulocytes. This results in the patient becoming anaemic and prone to infection

CML is the most common type of leukaemia in adults. Higher incidence in men, rather than women, over forty years of age.

It progresses slowly with more mature-looking cancer cells.

Symptoms
Diagnostic Tests
Staging
Treatment Options

Symptoms

The common symptoms include:

• Anaemia
• Bleeding
• Bruising
• Fever
• Persistent weakness
• Tiredness
• Aches in bones and joints
• Swollen lymph nodes

Investigations

Patients with CML usually approach their doctors with complaints about persistent fever, aches and pains or tiredness. Apart from a physical exam and review of medical history, the doctor usually asks for:

• Blood Tests
• Bone marrow biopsy.

If it is determined that the patient has CML, other tests may be required for information on how much the disease has progressed.

Staging:

Staging, or determining the extent to which the disease has spread, is an important aspect of cancer treatment.

For CML, three stages are identified:

Chronic phase

In this early phase there are few blast cells in the blood and bone marrow. The patient may not exhibit symptoms of leukaemia. This phase may last from several months to several years.

Accelerated phase

In this phase the disease is advancing. There are more blast cells in the blood and bone marrow, and fewer normal cells.

Blastic phase

By the time the patient reaches this phase, more than 30% of the cells in the blood or bone marrow are blast cells. Sometimes blast cells will form tumours outside of the bone marrow in places such as the bone or lymph nodes.

Treatment:

As always with cancer, treatment is individualised. It varies according to the age of the patient, general health, stage of the disease etc.,

Treatment may include:

• Chemotherapy
• Radiation therapy
• Bone marrow transplantation
• Splenectomy or surgery to remove the enlarged spleen