Elderly Leukemia

  • What is acute leukemia?

Before getting to know about acute leukemia, one should know about the basics of blood cells in our body.

Our blood has three types cells in it.

  1. The red cells are predominant and they help in carrying oxygen from the lungs to all the tissues of the body.
  2. The white cells fight against various bacteria and viruses entering our body and help to protect against infections.
  3. The platelets are the cells which constantly help in repairing any tears occurring in our blood vessels and so help to prevent any bleeding

The blood cells after circulating in the body are  destroyed in our blood after some days. So they have to be replaced continuously . All these cells are constantly produced in the bone marrow.  Bone marrow is a tiny space present inside most of our bones.

The blood cells have to be constantly produced in the marrow to keep the blood, function properly. If for some reasons, the bone marrow does not produce enough cells or produce bad quality cells, then various problems arise.

Leukemia is one condition in which the white blood cells in the bone marrow are produced in excess of what is needed. Not only they are produced in excess, but they cannot mature properly . These immature cells accumulate in the bone marrow and affect the production of other cells such as red cells and platelets.

This accumulation of immature or bad white cells in the bone marrow is called acute leukemia.

  • Why does leukemia occur?

Leukemias are produced due to abnormal production of white cells. Like a computer chip, each cell has a programme stored in the chromosome. This programme decides, how often a cell has to divide and how to mature and function. If this programme is damaged to due to some damage in the chromosome, leukemia occurs. Even though there are various causes, by which the chromosome can be damaged, in a particular individual it may be hard to say.

  • What are the symptoms of leukemia?

Since bad white cells are produced, they can not function properly. Also they affect the  production of other blood cells.

Defect in white cells make us prone for infections. So prolonged fevers can occur.

Reduced production of red cells cause anemia.

Reduced production of platelets cause spontaneous bleeding either from the gums or from other sites.

Since the bone marrow is rapidly expanded with these bad white cells, it can cause bone pains over the chest or in the back.

  • Does these symptoms always mean leukemia?

No, since various other causes can produce defect in blood cells, these symptoms never always indicate leukemia. That is why if these symptoms are there, a blood smear is examined and if necessary a bone marrow examination is done to diagnose leukemia.

  • How is leukemia diagnosed?

The bad white cells, sometimes are seen in the blood but at other times may be seen only in the bone marrow.  Just like taking blood sample , bone marrow sample is taken by piercing a needle into the bones, usually in the pelvic bone.  Since the bone marrow is the birth place of all the blood cells, we can easily find out whether the blood cells are produced and maturing normally or not. If bad cells are seen, they can be stained to know the type of leukemia and processed further to see the chromosomal changes in them.

  • What are the types of acute leukemia?

Grossly they are of two types. Acute Lymphoblastic Leukemia and Acute Myeloid Leukemia.

  • How is leukemia treated in the elderly age?

In the elderly age, treatment of leukemia is decided on whether the patient is

  • Fit enough to receive treatment
  • Whether the biology of leukemia is amenable to treatment.
  • If the patient is not fit to get definitive treatment, palliative chemo can still be given which may not cure the disease (But may give a good quality of life). However patient may be free of transfusion support, infection and stay away from hospital most of the time.
  • The best palliative option is to give hypomethylating agents (like DECITABINE) which even though does not cure the disease, keeps the disease under control in a certain percentages of people.
  • For patients who are fragile and have extensive co-morbidities like cardiac, pulmonary or renal involvement,  only supportive therapy such as frequent transfusions, treatment of infections with antibiotics are offered.
  • Definitive curative options such as standard chemo +/- transplant can be offered to few select patients
  • Unfortunately, many elderly patients are eligible for supportive and palliative care only
  • What happens during chemotherapy?

The initial chemotherapy is called induction.

Since the chemotherapy wipes off not only the bad cells but also the good ones, the patient will not have any good cells at all. This will be very severe during induction chemotherapy as even before starting therapy, the good cells are present only in a very small numbers. So till such time the good cells recover, the patient has high risk of infection (as there are no white cells) and also has high risk of bleeding (as there are very much reduced platelets).

The redcells can be supplemented by transfusing blood.

Platelets also can be transfused eventhough they last in the body for few hours to few days only.

White cells are difficult to transfuse routinely, but infections are treated with various antibiotics.

  • How does infection occur?

Since the white cells are the policemen of our body, they fight against all the infectious organisms entering our body. Our body itself have lot of bacteria in the intestine and our nose may contain fungus. These normally do not cause infections, as even if these bacteria or fungus enter our blood, they are rapidly destroyed by the white cells. But when the white cells are very few or absent, these bacteria or fungus entering our blood can grow well, and can cause infections.

In addition bacteria can also enter from outside the body. So, patient has to follow the safety precautions, as supplied by the hospital, during the chemotherapy.

  • What percentage of elderly leukemias are curable?

But for some of the good prognostic leukemias (which may have a higher cure rate),  the chance of complete cure of most of the elderly leukemias are around 15-20% only.

But in most patients the disease can be controlled with palliative chemo for many months.

  • How do I know whether my leukemia has a high chance of cure or not?

This depends on various factors.

As said earlier, the chromosomal damages in the white cells produce leukemia. Depending on the type of chromosomal damages, the leukemias are classified as good or bad types. Other factors such as age, WBC counts, response to initial therapy etc will also decide whether a leukemia is good or bad.

In general good types have a high cure rate compared to the bad ones.

  • How do I know the progress of my disease?

The first stage is to find out the response to treatment. This can be done by assessing whether the “BAD LEUKEMIC CELLS” are cleared rapidly or not. This can be done by flow cytometric, cytogenetic or molecular assessment. Your doctor will explain in detail how it is being done.

  • What should the patient and the relatives have to do during treatment?
    • Follow all measures to prevent infections (as deliberated by your doctor)
    • Follow diet as advised
    • Remember “FEVER” occurring anytime during treatment is an emergency. Even if you are discharged, get advice from doctor regarding whom to contact and what to do if you get fever.
    • We advise most of the leukemic patients to resume normal work or studies after 5-6 months. If you have any MENTAL strains due to social stigmas or FINANCIAL strains, NEVER hesitate to discuss with your doctor as we have many “HELP” groups to tackle all your problems.

Department of Hemato oncology,

Amended on Dec 14th, 2014 @VNCC, GKNM by Dr Suthanthira kannan,

Amended on 2nd Nov, 2016 @ Coimbatore Kidney centre by Dr Suthanthira Kannan

 
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