Types of Leukaemia, Diagnosis and Treatment

• Acute leukaemia – where the history is brief and the survival without treatment, short.
• Chronic leukaemia – the onset of disease is insidious, diagnosis often incidental in screening health checks, and survival is over many years.

Acute leukaemia

• The white blood cells, namely lymphoblasts and myeloblasts, fail to mature into lymphocytes and myelocytes
• there is a progressive increase in the number of these immature cells, initially in the bone marrow, which eventually spills into the blood
• the incidence of acute lymphoblastic leukaemia is more common in children, while that of acute myeloblastic leukaemia is more common in adults

Symptoms

• recurrent fever
•  malaise and tiredness
• headache and visual disturbances
• bleeding from unusual sites like gums, nose, skin
• joint pains, backache
• enlargement of the liver, spleen and lymph nodes

Diagnosis

• bone marrow examination is most valuable and shows an increase in the number of malignant immature cells which replace the normal cells of the marrow
•  blood examination may show anaemia, the number of white blood cells varying from more than normal to less than normal, but there is the definite presence of abnormal cells, which is diagnostic
• there is impairment in coagulation function of blood, increase in levels of serum uric acid and Vitamin B12.

Treatment

• The existing infection is treated.
•  Anaemia is treated by blood transfusion.
• Bleeding controlled by platelet transfusions.
• Specific anti-malignant treatment is given, first to control the leukaemia, and then to cure the disease. Some of the commonly used drugs are – Cytosine arabinoside, Vincristine, Daunorubicin, Etoposide, Methotrexate, Prednisolone, etc.
•  Bone marrow transfusion is an option in young patients who have histocompatible sibling donors. Autologous (self) transplantation is also sometimes used.
• Counselling and psychological support plays an important part – the patient should always be kept informed about the disease, fears allayed and contact with support groups facilitated.

Chronic leukaemia – essentially of two types

• Chronic myeloid leukaemia
• Chronic lymphocytic leukaemia

Chronic Myeloid Leukaemia (CML)

•  The symptoms are more or less similar to the ones in acute leukaemia.
• Males are affected more commonly than females, the major age of incidence between 30 and 80 years, peak incidence at 55 years.
• Most patients have a chromosome abnormality known as Philadelphia (Ph.) chromosome.

CML has three main phases:

• Chronic phase, when the disease is easily controlled;
• Accelerated phase, when the disease becomes more difficult to treat;
• Blast crisis phase, when the disease aggravates into either acute myeloblastic or acute lymphoblastic leukaemia.

Most patients of CML die due to blast crisis, the timing of which is random and unpredictable.

Treatment

• Anti-cancer drugs, the most common being busulphan and hydroxyurea.
• Interferon, especially in the chronic phase of the disease
• Surgical removal of the spleen, known as splenectomy.
• Bone marrow transplantation.

Chronic Lymphocytic Leukaemia (CLL)

• It is the commonest leukaemia.
• Disease onset is insidious.
  
• Occurs commonly in the older age group between 45-60 years of age.
• There is enlargement of the liver, spleen and lymph nodes.
• Recurrent infections can occur.
• Blood examination shows increased number of white blood cells, over 90% of them being lymphocytes.

Treatment

•  Existing infection is treated. 
  
• A combination of anti-cancer drugs like chlorambucil and radiotherapy is used.
• Splenectomy.