Leukaemia: signs, symptoms & outlook

Leukaemia: signs, symptoms & outlook


Leukaemia is a type of cancer that starts in
the blood forming cells in the bone marrow with excess of white cell production. Normal
white cells are supposed to help the immune system, whereas the abnormal production of
the white cells, they’re not functionally good. Hence, they lead on to symptoms like
excess infection and other symptom complex related to leukaemia. So, it is almost like
an overproduction of white cells which shouldn’t be happening with very mature types of cells
circulating in the blood. Normal blood cells are produced inside the
bone marrow. They come from common stem cells, which produces various different blood cells
including red blood cells, white blood cells, and platelets. The red blood cells are produced
mainly to carry the oxygen levels in the blood. And it is the main symptom which causes towards
tiredness. The white blood cells are mainly to fight infections. And they’re mainly of
two different types: granulocytes, which constitutes predominant part of the white cells, and they
are the main fighting power towards infection. If you don’t have enough white cells, you’re
at a high risk of infection. Similarly, the lymphocytes are a different way of fighting
infections. They have two different types: T lymphocytes and B lymphocytes. The B lymphocytes
produces antibody and they fight infections, and the T lymphocytes are like memory cells.
Right from the birth, the baby’s having vaccinations; they’re all stored in those memory cells over
the lifetime. So, it is a very important type of cell. And platelets are the third type
of cells which produce mainly to help stopping bleeding. And they’re produced from cells
called megakaryocytes. And it is very important to have these cells to prevent bleeding. Symptoms of leukaemia can be quite vague which
depends on the types of blood cells affected. The most common feature is related to red
blood cells, which is anaemia, which can cause severe fatigue, malaise, and tiredness. The
white cells involvement can lead on to increase risk of infections. Predominantly chest infections,
water infections, skin infections which can be the main presentation. Whereas, involving
the platelets, it’s mainly bleeding manifestations including nosebleeds, gum bleeds, and excessive
periods in females which can be the main presentation. And also, it can cause bone pain which is
more common with the acute lymphoblastic leukaemia, and also increased spleen and liver size,
which can again cause abdominal pain, which can be a feature. And excessive bruising can
be another feature of acute leukaemia. The leukaemia can be divided into acute leukemias
and chronic leukemias. The acute leukemias, again, is classified into acute myeloid leukaemia
and acute lymphoblastic leukaemia. The acute myeloid leukaemia is a common presentation
in adult leukaemia, whereas acute lymphoblastic leukaemia is more common in children. Chronic
leukemias can again be sub-classified in the chronic myeloid leukaemia, which is less common
and chronic lymphatic leukaemia, which is much more common in the Caucasian population. The treatment of leukemias have evolved over
the last few decades. The acute leukemias mainly the acute myeloid leukaemia and acute
lymphoblastic leukaemia is predominantly still treated with chemotherapy. Mainly in patient-based
chemotherapy which is combined with immunotherapy as well part of clinical trials. And there
is also a major contribution by the stem cell transplantation which has made the treatment
very effective in this group. Coming to chronic leukemias, it is mainly a field of targeted
treatment. In chronic myeloid leukaemia, the tyrosine kinase inhibition has been a very
successful story and it’s almost replaced the previous option of stem cell transplantation.
And in the chronic lymphatic leukaemia, there may be a proportion of patients may not need
any treatment and to watch and wait. But when they need treatment, there are various treatment
options targeting various molecules and cell membrane receptors like Bruton tyrosine kinase,
PI3 kinase, and BCL-2 inhibition, which has made the CLL treatment extremely effective
and has got good leukaemia kill. The general outlook for acute leukemias is
improving. Especially acute myeloid leukaemia and acute lymphoblastic leukaemia with the
chemotherapy, immunotherapy, and stem cell transplantation has made a massive progress
and people are getting cured. But the elderly population, it is still a challenge. With
various new modalities of treatment, it’s very promising. The chronic myeloid leukaemia,
the story is much more fruitful and it has almost made a huge impact by the targeted
treatments. They’re almost having a good quality of life and longer survival with the new modalities
of treatment, especially chronic myeloid leukaemia and chronic lymphatic leukaemia. And this
has made an increased life span as well as good quality of life.