Leukemia

Leukaemia, which can occur at almost any age, is a disease that occurs as a result of uncontrolled proliferation of any of the blood cells called leukocytes in the bone marrow. Leukaemia, which are divided into two different types as acute and chronic, can vary according to age. Leukaemia, which is not a hereditary disease, is a frequently encountered health problem today and can be treated with early diagnosis.

At Liv Hospital Hematology Clinic, we achieve successful results by creating personalized treatment programs for all our patients in the diagnosis and treatment process of leukaemia

What is leukemia?

Leukemia is a blood disease characterized by uncontrolled proliferation of a type of blood cell called leukocytes in the bone marrow, invading the bone marrow and mixing into the blood.
 

At which age range is it more common?

It can be seen at any age. However, the type of leukemia that occurs varies depending on age. When classified as acute and chronic leukemia depending on their biological behaviors, chronic leukemias usually occur in later ages.
 

Is leukemia an inherited disease?

Leukemia is not inherited. It is associated with cell immortality and proliferation caused by defects (genetic defects) that develop for some reason in the cell nucleus.

Who is at risk for leukemia?

• People who are exposed to high doses of radiation
• Patients with some genetic diseases (Phanconia anemia, Down syndrome, etc.)
• Patients who receive bone marrow or organ transplantation
• Patients who receive chemotherapy and/or radiotherapy for another cancer (eg. breast cancer)
• People who are exposed to certain chemicals
• Smokers
• People with a family history of leukemia
• Some blood diseases (such as aplastic anemia, myelodysplastic syndrome)

 

What are the symptoms of acute leukemia?

Bone marrow is the organ where blood cells are produced. When one of these blood cells starts to proliferate unchecked, they gradually suppress the production of other healthy blood cells and take their place. Often in leukemia, a decrease in healthy blood cells, symptoms caused in the body by factors released from leukemia cells, and  rarely symptoms associated with tissue invasion constitute the complaints.

• Anaemia: It is one of the main symptoms of leukaemia, which causes complaints such as fatigue, headache, weakness, chest pain.
• Infection and fever: Symptoms such as sinusitis, pneumonia, gingivitis and uncontrolled fever are frequently seen in leukaemia patients.
• Bleeding: In particular, bleeding from the gums, nose bleeding, bruises on the skin even with small blows, excessive menstrual bleeding in women can be listed.
• Fatigue and weakness: They are tumour-related conditions released from leukaemia cells.
• Organ and tissue growth: These are organ and tissue growths such as tonsils, gums, liver, spleen, lymph nodes.
• Rashes: These are red, raised rashes on the skin.

Tissue and organ enlargement: Gingival enlargement, tonsil enlargement, swelling of the lymph nodes, liver and/or spleen enlargement, red and fluffy rashes on the skin may be signs of leukemia.
 

What are the symptoms of chronic leukemia?

Chronic lymphocytic leukemia (CLL) is usually caught incidentally. An increase in the number of leukocytes is noticed during a blood count performed for other reasons. It may contradict the public's knowledge of “early diagnosis, early treatment" but no treatment is performed at the early stage.  The patient is educated and treatment begins if there is a significant increase in the number of leukocytes, sweating, weight loss, fever, signs such as lymph node swelling, splenic enlargement related abdominal pain, swelling after meals in the upper left quadrant.

Chronic myeloid leukemia (CML) causes symptoms such as weakness, exhaustion, fatigue, or spleen overgrowth. It is often detected incidentally. Treatment begins as soon as the diagnosis is made.
 

How is leukemia diagnosed?

In the diagnosis phase of leukaemia, primarily blood count and microscopic examination are required. If a suspicious condition is diagnosed, bone marrow examination is applied. If leukaemia is found after the examination, the test processes for the type of the disease begin. Since acute leukaemia responds to cortisone disease, drug therapy is preferred first. In this step, chemotherapy is also a method used for the treatment of the disease. Since it is a disease that weakens the immune system, patients should be followed regularly. In case of recurrence of the disease, bone marrow transplantation is performed in addition to an intensive chemotherapy process.
 

Is it possible to treat acute and chronic leukemia?

The treatment of leukemia varies according to the type of leukemia. Acute leukemias are roughly divided into acute myeloid and acute lymphoblastic leukemia. Each acute leukemia has sub-categories in itself. Acute promyelocytic leukemia is a type of acute myeloid leukemia. It exhibits a specific genetic change. A drug discovered by the Chinese called retinoic acid can provide full recovery, similar to the survival duration of other healthy people.

Acute myeloid leukemia, which is known to show a good prognosis depending on the genetic defects, requires only chemotherapy while the remaining leukemias require marrow transplantation.

In acute lymphoblastic leukemia, drugs against the molecule on the cell surface (targeted; anti CD 20) are added to chemotherapy. Generally, in patients with acute lymphoblastic leukemia older than 35 years, marrow transplantation is performed after chemotherapy if there is a suitable donor with compatible tissue group.

In chronic myeloid leukemia, smart drugs (imatinib, nilotinib, dasatinib) are used to make the cells with disease-specific genetic defects mortal. With these treatments, patients almost achieve a similar survival time as their non-ill peers.

Today, in addition to targeted drugs (anti CD 20), new and extraordinary drugs have been developed for the treatment of chronic lymphocytic leukemia, which inhibit leukemia cell function (Ibrutinib).

Treatment in leukaemia varies according to the type of leukaemia. While chemotherapy is used for treatment in acute myeloid leukaemia, a marrow transplant is required for other leukaemia types. Smart drugs that can eliminate cells with genetic defects in the disease also make it possible to achieve success in the treatment process. In recent years, developments in medical science have made it possible to treat with target-specific drugs that can cause functional deterioration in leukaemia cells.
 

About what should patients be careful during treatment?

• Emotional adaptation is very important because it is a life change.
• The patient must not forget how to make the best of every moment.
• Physical maintenance should be performed.
• Regular, frequent (every day if possible) bathing.
• The skin should be lubricated against cracks.
• Careful hand, foot, nail care should be done.
• Hands have to be washed very regularly
• Oral care should not be neglected. Teeth should be brushed regularly until the doctor tells you otherwise.
• Mouthwash should be applied to the pharyngeal area 3-4 times a day with food-grade carbonate in order to prevent the involvement of oral wounds or fungus.
• Every day stool has to be soft in consistency.
• Adequate fluids should be taken to replace lost fluid in patients with diarrhea. (Such as water, juice, soda).
• Hard food, such as bread crusts or  breadcrumbs, which damage the gums and oral mucosa should be avoided.
• Low-fat, light meals that do not cause nausea should be eaten in small portions but often.
• Uncooked vegetables and fruits should be avoided when leukocyte count is low, especially when neutrophil count is low, but rind fruits can be eaten after peeling (such as Banana orange tangerine).
• It is important to consume daily cooked meals.
• The patient should be mobile as long as it is physically possible. Daily exercise will reduce the likelihood of muscle loss.

 

What should be considered in life after treatment?

It is possible for people who have changed from a social life to another to return to their family and work environments, sometimes with the support of friendly relatives, friends and sometimes with the support of specialist psychologists and psychiatrists. This is not a strange situation.
 

What should be considered in nutrition habits after treatment?

There is no specific diet to prevent blood disease from coming back.

Sudden weight gain may occur in fully recovered patients. The prescribed drugs may cause a long-term risk of heart disease. Like healthy people, they should be careful of their diet.
 

What are the latest advancesin treatment? Are there any promising new developments?

Treatment has reached a very important point. A function-correcting drug is being developed for almost any unruly molecule. In the last 15 years, leukemia has become a diagnosis for which physicians don't fear taking part in the biological war.
 

What should be paid attention in the treatment of leukaemia?

• The process should be carried out in a disciplined manner for both the physical and psychological health of the individual with leukaemia.
• In the treatment, the patient's personal care should be taken care of, and if possible, s/he should be helped to take a bath frequently.
• Since it is a disease that exhausts the immune system, the environment of the patient should be kept sterile.
• The skin should be lubricated against cracks that may occur on the skin due to leukaemia.
• The patient's hand, foot and nail care should be maintained regularly.
• Oral care should not be interrupted; the patient's teeth should be brushed regularly.
• Low-fat and light meals should be preferred in the patient's diet.
• Exercises should be emphasized, and sports movements should be given priority in order to keep the body vigorous in condition.
• In some patients, water needs should be met regularly against fluid loss due to diarrhea.
• Foods that are stiff for the oral mucosa (breadcrumbs, crusts of bread, etc.) should be avoierate bone.