Leukemia

A little over five years ago, right before thanksgiving my family experienced something that no one ever wishes they would experience in their life time. Our grandfather was diagnosed with acute myelogenous leukemia which is one of the four main types of leukemia. Leukemia is not only hard on the person it has corrupted but there family as well. You see your loved on struggle and theres nothing you can do it help. I was a freshman in high school when all of this played out. It was really hard at times to balance swimming year around, my school work, and all of the emotions going on in my head. At first when all of this started up my parents would not let us see our grandfather because they thought it was best for us to not to have to see him in such a terrible setting. But that never mattered me because all I wanted to do was be there for him and my grandmother through this hard time. So I kept bugging and bugging my parents to let me see him because they kept saying he is okay and will be fine and eventually gave in. You know when you are younger and you read all those books where someone gets really sick and you imagine what it would be like in your head. Like you actually were there experiencing it for yourself? Well there was nothing I could have done to prepare myself for what I saw. I walked in the room and saw my grandmother in the corner of the room and she smiled happy to see us. Then I finally turned my head and saw my grandfather for the first time in six months and a hurricane of emotions came over me. I was happy to see my grandpa, mad at my parents for not letting me see him, and devastated to see him in the condition he was in. All I could do is cry and sit there and look at him while he slept. About two days later my grandpa told my grandma that he was so tired, and asked if it was okay that he stopped fighting because he had been fighting so hard for so long. He told her he got to see all his grandchildren and it was okay now. Within a few

minutes he was gone. Losing someone know matter how old is hard. There are images in your head you wish you could delete and smells that you remember that you cant get rid of. In this paper Ill try to show Leukemia in a different light and inform you on things you could look out for in the future. Leukemia can be a deadly disease process made worse because there are four main types of leukemia, with different symptoms, different treatments, and different outcomes. The first type of leukemia that I researched is Acute Myelogenous Leukemia or for short AML. When it comes to all the defining the different types of leukemia, they are very similar but there are differences to each one. According to dictionary.com Acute myeloid leukemia (AML) is a cancer that occurs in the blood and the marrow of the bones. Marrow is sponge-like material inside the bones that produces blood cells. AML specifically affects the white blood cells of the body, causing them to form abnormally. The numbers of abnormal cells grows rapidly.(1 ) In other words, AML starts out in the bone marrow and the abnormal cells work their way to the rest of the body. Now if someone has AML their blood cells dont mature the way they are supposed to, which is the start of many problems. Once this cell production begins it rapidly increases, causing many of the different symptoms you can experience with AML. For any type of Leukemia there are always the general signs and symptoms. They include weight loss, fatigue, fever, night sweats, and loss of appetite. There are different symptoms or different problems that can occur as you go through the process of this disease. The main problem according to the American Cancer Society is the cancer cells in AML (blasts) are bigger than normal white blood cells and have more trouble going through tiny blood vessels. If the blast count gets very high, these cells clog up blood vessels and make it hard for normal red blood cells (and oxygen) to get to tissues. This is called leukostasis. Leukostasis is rare, but it is a medical emergency that needs to be treated right away. (2) Symptoms that can accompany

leukostasis are headaches, weakness on one side of the body, confusion, slurred speech, and sleepiness. When there are a high number of abnormal cells in the body it can lead to clogged blood vessels that can lead to bleeding and clotting problems. When blood vessels in the lung are affected, patients have problems with shortness of breath. Blood vessels in the eye can be affected as well, leading to blurry vision or even loss of vision. (2) With all of these potential symptoms there could be serious problems that could start showing up if the patients do not undergo treatment. There are many ways or tests you can have to find out you have leukemia. Some of the most common are physical exams where they check for any signs of disease, complete blood count where they take a blood sample and count all the platelets, red, and white blood cells. Some of the tests people do not know about is a bone marrow aspiration, cytogenetic analysis, and a reverse transcription or a (RT-PCR). During a bone marrow aspiration they take a sample of your bone marrow from either your hipbone or breastbone with a hollow needle. A cytogenetic analysis is where they take a sample of bone marrow or your blood so they can look at the chromosomes closely to see if there are any changes or abnormalities. Finally, reverse transcription is when they take a sample of tissue to look at the structure to determine if the genes are present to get AML. When someone has an acute disease it spreads rapidly through the body. With AML, the first organs affected are the lymph nodes, spleen, liver, brain and spinal cord. If you decide to go with cancer treatment there are a couple options to choose from. The first could be to have surgery and they remove your bone marrow and put in a donors healthy bone marrow and hope that it starts producing normal healthy cells again. But when it comes to the procedure it is more difficult than it sounds. Before they can give you someone elses bone marrow, they have to find someone with a close enough match to yours before moving forward. That alone could take anywhere from weeks to months and with AML it might not even be worth

it by the time they get the okay to proceed. The second and most common treatment is chemotherapy which comes in three phases. The first phase is called induction chemotherapy. This is where give you the medication over a six to seven day period of time which tries to eliminates all of the leukemia cells from your body. There is more than one way to receive chemo as well. The medication can come in a multitude ways, including being pumped in your body through an IV, taken as a pill, implanted, or even a rubbing cream. The UCSF Medical Center said that at the end of the induction therapy, a bone marrow biopsy is performed to see if a complete remission has been achieved. Approximately 70 percent to 80 percent of patients are expected to enter complete remission. (3) After you end the first phase you get a month to recover and see if the chemo worked and if it didnt then you start the second phase called consolidation. Now in this phase you basically repeat the first phase but with a higher dose of the medication and an autologous transplant. An autologous transplant is where they do a small bone marrow transplant with the patients own bone marrow or blood in hopes that it will cure them of AML. Overall, approximately 30 percent to 40 percent of patients receiving consolidation chemotherapy are cured of their AML.(3) The final stage is high dose chemotherapy. This includes your chemotherapy through a constant IV, a stem cell transplant, and at the end you undergo allogeneic transplantation. Which is similar to an autologous transplant, but this time you get bone marrow or the blood from a close relative or something with a close enough match to yours. There can be risky when patients enter this stage because there is a chance it could kill you in the process. There is not the greatest recover rates with this phase, according to UCSF Medical Center 20 percent to 25 percent may be achieved. (3) Overall, people that do not accept treatment can live anywhere from a few weeks to 3 months and people that do accept

treatment live anywhere from 6 months to a year. Treatment of patients with this disease can be complicated and can be compared to patients with Chronic Myelogenous Leukemia. The second type is Chronic Myelogenous Leukemia also known as CML. According to dictionary.com Chronic Myelogenous Leukemia is a cancer of the white blood cells. In CML, blast cells, or immature white blood cells, form and multiply uncontrollably, they crowd out all the other types of necessary blood cells. (1) CML is a very interesting when it comes to its symptoms, it has a lot of similar symptoms as AML but according to Cancer Research UK about 1 in 4 people have no symptoms at all when they are diagnosed. (4) Most people get diagnosed with CML after having blood tests done but if they were the 25 percent that didnt get diagnosed the first time they could be experiencing other symptoms that start out mild and becomes worse as they go. Some of those symptoms could include becoming sick more than normal, weight loss, tiredness, looking pale, swollen lymph glands, night sweats, loss of appetite, and abnormal bruising or bleeding. Less common symptoms can me anything from eyesight changes to a painful erection. CML is not like the other types of leukemia, it is cause by a genetic mutation in the in two chromosomes. The ninth and the 22 chromosome have pieces that switch with each other make chromosome 22 a short chromosome and a long chromosome nine. People that end up with a short chromosome 22 have about a 90 percent chance of being a person diagnosed with CML. Most of the treatments for Leukemia are pretty similar for the most part there is chemotherapy, bone marrow transplant, and targeted therapies. According to Mayo Clinic Cancer center Targeted therapies are typically used first in CML treatment. These are drugs that attack a specific part of the cancer cell to kill it. In the case of CML, these drugs block the protein made by the BCR-ABL gene. They may include imatinib, dasatinib, or nilotinib. These are newer therapies that have been very successful. (5) With that being said The

multicenter Imatinib long term side effects study conducted my Medscape Medical News took a total of 832 patients who were treated and on average they lived about 5.8 (6) Only one percent of people with CML live past eight years. The third type is Acute Lymphocytic Leukemia or ALL for short. ALL is said to be acute leukemia characterized by proliferation of immature lymphoblast-like cells in bone marrow, lymph nodes, spleen, and blood; most common in children. (1) In other words, ALL is one of the fastest growing types of cancer cells. When someone has ALL there lymphocytes are the first thing that is attacked. Normal lymphocytes are the cells in the body that fight off infections so you do not get sick. But when they become cancerous the person diagnosed with ALL gets sick really quickly. It is so fast that a normal person could be in the hospital in the next week. On average about 6,000 people are diagnosed with it each year. Just Like all the other types of Leukemia the signs and symptoms are pretty similar. The biggest difference would have to be how frequently they get infections and how fast and hard the symptoms come on because this is an acute disease. But again some of those signs could possibly be shortness of breath, fever, cuts that take away to heal, vomiting, tiny red spots on the skin known as petechiae, and much more. Since ALL comes on really quickly they have to take action as soon as possible for the best outcome. They person always has the choices between induction chemotherapy, consolidation therapy, intrathecal chemotherapy, and also maintenance therapy. Maintenance therapy is where a patient stays in remission after induction and consolidation therapy, and decides not to get a transplant, he/she starts maintenance therapy. The goal is to destroy any diseased cells that remain so that they are completely gone. It may take several years to complete. (7) Which is a very uncommon treatment for ALL because its a fast working disease. For ALL the outcomes are different between adults and children. Cancer Center UK said

adults diagnosed with acute lymphoblastic leukemia, up to 4 out of 10 people (40%) will live for at least 5 years. For children diagnosed between 2001 and 2005, more than 8 out of 10 (88%) lived for more than 5 years. (4) This would be the only case where you would want to be diagnosed at a younger age. Finally, the last type of leukemia is Chronic Lymphocytic Leukemia or CLL. CLL is veru similar to ALL but instead of it being more common in children it is more common in older males. Like ALL, CLL starts out in the Lymphocytes in the bone marrow and works its way into the blood. Since this is a chronic disease it could take people a few years before they even figured out that they even had it. The reason why it takes a few years to see any signs or symptoms is because the disease is slowly building itself up over time. Like the other 3 main types of leukemia the signs and symptoms are similar but some vary. Some of CLL symptoms include weakness, feeling tired all the time, weight loss, fever, enlarged lymph nodes, and a pain or sense of feeling full all the time due to enlarged spleen. Any of these symptoms can pop up due to your body not having enough white blood cells which is called anemia or your body having too many in your body. When it comes time to receive treatment for CLL there are 5 standard types of treatment. The five most common are watchful waiting, radiation therapy, chemotherapy, surgery, and target therapy. They also have a couple new treatments they have been trying out lately. The first is chemotherapy with a stem cell transplant; doctors found that doing both increases their chances of getting rid of the cancerous cells. Secondly would be biologic therapy, which is according to National Cancer Institute is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. (8) To all the doctors that use these new

treatments it gives them and their patients a little more hope that they will recover. Since CLL is a slow developing disease doctors have an easier time keeping it under control for many years. Statistics show that on average 44 out of 100 men (44%) and 52 out of every 100 women (52%) will live for at least 5 years after being diagnosed. Depending which stage you are in. (4) For some lucky people they have lived around eight to ten years. Leukemia can be a deadly disease process made worse because there are four main types of leukemia, with different symptoms, different treatments, and different outcomes as you can see from what you read above. Even with my terrible first-hand experience with Leukemia I hope I showed it in a different light than most in my shoes. This research paper gave you so much information that most probably did not even know about. So now that you are more aware of all the signs and symptoms you can catch it quicker, the treatments that are offered to get better, and the outcomes of most patients. But with that being said, you dont have to be a part of those statistics. We make our own futures and if you have hope, faith, and strength to never give up there is always a possibility to get better.

Worked cited page 1) "Acute Myelogenous Leukaemia | Reference.com." Acute Myelogenous Leukaemia | Reference.com. N.p., n.d. Web. 25 Mar. 2014. <http://ask.reference.com/web?q=Acute%20myelogenous%20leukaemia&l=dir&qsrc=28 91&ld=250:1&o=10616>. 2) "Signs and Symptoms of Acute Myeloid Leukemia." Signs and Symptoms of Acute Myeloid Leukemia. N.p., n.d. Web. 24 Mar. 2014. <http://www.cancer.org/cancer/leukemia-acutemyeloidaml/detailedguide/leukemia-acute-myeloid--myelogenous--signs-symptoms>. 3) "Acute Myeloid LeukemiaTreatment." Acute Myeloid Leukemia Treatment. N.p., n.d. Web. 25 Mar. 2014. <http://www.ucsfhealth.org/conditions/acute_myeloid_leukemia/treatment.html>. 4) "Symptoms of Chronic Myeloid Leukaemia (CML)." : Cancer Research UK : CancerHelp UK. N.p., n.d. Web. 25 Mar. 2014. <http://www.cancerresearchuk.org/cancer-help/type/cml/about/symptoms-of-chronicmyeloid-leukaemia>. 5) "Chronic Myelogenous Leukemia (CML)." Chronic Myelogenous Leukemia (CML). N.p., n.d. Web. 25 Mar. 2014. <http://ask.healthline.com/health/chronic-myelogenousleukemia-cml#Treatment>. 6) "Medscape Log In." Medscape Log In. N.p., n.d. Web. 25 Mar. 2014. <http://www.medscape.com/viewarticle/739535>. 7) "Initial Treatment of ALL." Initial Treatment of ALL. N.p., n.d. Web. 26 Mar. 2014. <http://bethematch.org/For-Patients-and-Families/Learning-about-your-disease/Acutelymphoblastic-leukemia/Initial-treatment-of-ALL/>. 8) "Chronic Lymphocytic Leukemia Treatment (PDQ)." - National Cancer Institute. N.p., n.d. Web. 26 Mar. 2014. <http://www.cancer.gov/cancertopics/pdq/treatment/CLL/Patient/page4#Keypoint22>.