WHAT EXACTLY IS LEUKEMIA?
Leukemia is cancer of the blood. Blood has a number of cells in it. Among them are white cells that fight infection, red cells that carry oxygen and platelets that cause blot to clot and cause wounds to stop bleeding. Cancer is when a group of cells grow uncontrollably and symptoms are due to too many of those cancerous cells crowding out good cells and preventing their function.
WHAT ARE THE EARLY SIGNS OR SYMPTOMS OF LEUKEMIA?
Signs of leukemia commonly include fatigue, frequent infections, bleeding or bruising, and lymphadenopathy which is a swelling of lymph glands in the neck, armpit, groin or elsewhere.
HOW IS LEUKEMIA DIAGNOSED?
The physician will first use a microscope to look at a blood smear which is blood drawn from a vein put on a glass slide. Many patients will need a bone marrow biopsy. This involves a small hole being placed into skin in the lower back/buttocks and a needle being inserted into the bone to withdraw bone marrow from the pelvic bone.
ARE THERE DIFFERENT TYPES OF LEUKEMIA?
There are a number of types of leukemia. We most commonly divide them into acute (fast-growing) or chronic (slow-growing). There are other subdivisions of these two types. A number of laboratory tests are done to determine the specific type of leukemia a patient has. The type determines the treatment and the prognosis.
WHAT ARE THE RISK FACTORS OF LEUKEMIA?
Most leukemias occur for unknown reasons. Most patients who get leukemia are in their 60’s and beyond at diagnosis.There is a cluster of children with leukemia. A small number of families have a genetic risk.
DO WE KNOW WHAT CAUSES IT? IS IT HEREDITARY/GENETIC?
Leukemia occurs when one or more of the genes in a white cell that instruct the cell to stop dividing is damaged and can no longer function. We call that damage a genetic mutation. These mutations are inherited in a small proportion of leukemia patients. These patients are usually children. Most adults acquire these mutations due to some biologic exposure (see below) or the mutation can occur simply by chance.
WHAT TREATMENT OPTIONS ARE AVAILABLE?
The treatments vary by type of leukemia.
Some are treated with traditional chemotherapy, often for several years.
Others are treated with newer molecularly targeted drugs that exploit a genetic weakness that causes the cancer.
Imatinib also known as Gleevec is a molecularly targeted drug used in the treatment of chronic myelogenous leukemia (CML). Most people with CML do very well and have a normal life expectancy. That was not true 20 years ago.
Some leukemias are treated with immunotherapy.
We infuse manmade antibodies to attack a number of cancers. The leukemia must have a molecular target specific to the antibody in order to be effective.
CAR T cell therapy involves taking a type of white cell called T cells out of the patient, manipulating them to put a CAR (chimeric antigen receptor) on the T cells and re-infusing them. The T cells find the cancer and if successful destroy it. This therapy has received a lot of press because its cost is $500K
Some are treated with high dose chemotherapy and bone marrow transplant. The patient gets very high doses of chemotherapy that destroys their bone marrow (the bone marrow makes blood). The bone marrow is replaced with bone marrow obtained from a relative or person that is a close match.
WHAT ARE SOME FACTORS THAT DEFINITELY DO AFFECT CANCER RISK?
Tobacco use is linked to a type of leukemia (Acute Myelogenous Leukemia) and can complicate treatment of other leukemias. Exposure to high doses of ionizing radiation can cause leukemia, as can some chemical exposures. Scientists are concerned that exposure to certain petroleum products, pesticides, herbicides and organic chemicals are carcinogenic.
ARE THERE PROGRAMS AND RESOURCES AVAILABLE TO HELP WITH CANCER RELATED EXPENSES?
Some charities will help advocate for the patient to get health insurances to pay for therapy. One, that I know has helped patients is The Patient Advocate Foundation (www.patientadvocate.org). In some circumstances they can also help with co-pay relief.
ARE RESEARCHERS CLOSER TO FINDING A CURE FOR LEUKEMIA??
Some leukemias are curable, most that are not curable are treatable. Many that are that curable can be treated for a long time with the patient having a reasonable quality of life. Treatments are improving. Indeed there were 18 new therapies approved by the FDA in 2018 alone.
HOW CAN PEOPLE GET INVOLVED?
The Leukemia and Lymphoma society (www.LLS.org) is the largest private funder of blood cancer research. They also provide support for patients, survivors, and families affected by leukemia.
The American Cancer Society funds leukemia research and provides patient support (www.Cancer.org). The ACS also has grassroots advocacy through its arm known as American Cancer Society Cancer Action Network (www.FightCancer.org)
Dr. Brawley answers your ‘Text Tom’ questions on the next page.
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