Leukemia

Leukemia is generally thought to be caused by mutations (changes) in the DNA of the blood cells, resulting in them not functioning normally.

The exact causes of leukemia are not known. However, risk factors may include:

Risks factors for leukemia

• Family history of leukemia
• Genetic disorders like Down’s syndrome
• Exposure to radiation or chemicals like benzene
• Having an impaired immune system (or taking drugs that suppress the immune system)
• Developing certain infections, including the Epstein-Barr virus and Helicobacter pylori infection

Leukemia can also develop in people who have received certain types of chemotherapy for previous cancer treatment.

Preventing leukemia

While leukemia cannot totally be prevented, you can reduce your risk of developing leukemia by doing the following:

• Stop smoking.
• Maintain a healthy body weight. Being overweight and obese increases the risk of leukemia.
• Always eat a balanced diet that includes whole grains, fruits, vegetables and foods rich in protein.
• Avoid chemical substances like benzene and high doses of radiation.

The early signs and symptoms of leukemia may vary, depending on the type of leukemia a person has. They may also be difficult to spot as they resemble other conditions. Common symptoms of leukemia include:

• Bleeding or bruising easily or tiny red spots on your skin
• Bone pain or tenderness
• Fever or chills
• Frequent infections
• Loss of appetite or weight loss
• Ongoing tiredness or weakness
• Shortness of breath or excessive sweating, especially at night
• Swollen lymph nodes (glands), large liver or spleen

If you experience signs or symptoms that suggest leukemia, your doctor may carry out the following diagnostic tests:

Physical examination

After asking about your symptoms, your doctor will conduct a physical exam to check for swollen lymph nodes, particularly in the neck or under the armpits. Your gums will also be checked for any swelling or bleeding. Your doctor will check your body for bruises, tiny red skin rash and signs of an enlarged spleen.

Blood tests

Blood tests are necessary to determine unusual levels of red or white blood cells or platelets. Lower than normal counts of red blood cells and platelets and higher than normal count of white blood cells are signs of leukemia. The blood test result can also detect leukemia cells.

Bone marrow test

If your white blood cell count is not normal, your doctor will require you to undergo bone marrow test. In this procedure, a sample of bone marrow from your hipbone will be removed. The sample will then be examined in a laboratory.

Cytogenetic and molecular testing

This test is used to help characterise the leukemia type and determine the best course of leukemia treatment. The test searches for chromosomal variations or abnormalities in the cells.

Treatment options are dependent on the person's age and health, the type of leukemia a person has have, and whether it has spread to other parts of the body, including the central nervous system.

Your doctor may recommend leukemia treatment options involving:

Bone marrow transplant

Also known as stem cell transplant, bone marrow transplant is a procedure that replaces the damaged bone marrow by infusing healthy blood-forming stem cells into the body. Bone marrow transplant can use either cells from your own body or cells from a donor. Its goal is to manage or cure the disease, extend life, and improve quality of life.

Biological therapy

Biological therapy or immunotherapy fights leukemia by using drugs to boost your immune system. There are various types of immunotherapy for leukemia, including Allogeneic bone marrow transplant, Therapeutic cancer vaccines, T-cell therapies, Monoclonal antibody therapies, and Donor lymphocyte infusions.

Chemotherapy

In chemotherapy, strong medicines are used to destroy cancerous cells and prevent them from reproducing. Chemotherapy as leukemia treatment usually involves several drugs given together in one therapy regimen. The drugs can be given either orally or intravenously.

Radiation therapy

Radiation therapy makes use of high-energy radiation to destroy cancer cells. The procedure, which takes only a few minutes, is similar to having an x-ray. It is painless, but the radiation is much stronger.

Targeted therapy

In targeted therapy, drugs are used to target the genes and proteins that contribute to the growth and survival of cancer cells. The drugs can be given to you orally through pills or capsules or intravenously.

Treatment at Mount Elizabeth Hospitals

At Mount Elizabeth Hospitals, we treat both common and uncommon types of blood disorders and cancers, such as leukemia.

Our hematopathologists, who specialise in diseases of the blood, work closely with the Parkway Cancer Centre care team to ensure an accurate diagnosis of this complex disease, which has many variations and rare forms.

The multidisciplinary team includes haematologists, pathologists, radiologists, dermatologists, respiratory physicians, renal physicians, cardiologists, neurologists, and physiotherapists.

Our experienced specialists also perform bone marrow biopsies, which are done routinely for patients with blood disorders, especially for those with malignancies like leukemia.

Haematology and Stem Cell Transplant Centre, located at Mount Elizabeth Orchard Hospital, is headed by Dr Patrick Tan, a haematologist with more than 30 years of experience in the treatment of blood disorders including leukemia, and in performing bone marrow transplants.

Parkway Cancer Centre, which also runs the Children’s Haematology & Cancer Centre, provides specialised clinical care, including diagnostic evaluation and chemotherapy, for children and adults with blood diseases.

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Leukemia and its treatments may cause some complications including:

• Infections – Due to a low level of white blood cells, the body's ability to fight infections weakens. Thus, even simple infections can quickly progress into life-threatening conditions such as sepsis or septic shock.
• Graft versus host disease (GVHD) – Allogeneic stem cell transplantation can increase the risk of developing GVHD, an immune condition that occurs when immune cells in the donor’s tissue damage the host's tissues.
• Anaemia – Chemotherapy as leukemia treatment can cause anaemia or low numbers of red cells.
• Weight loss – Leukemia treatments cause side effects like nausea, vomiting, and lack of appetite. These factors contribute to weight loss. Likewise, cancer cells use a large amount of energy which would otherwise be stored as fat.