Leukemia, Essay Example

Group of malignant disorders of the hematopoietic tissues characteristically associated with increased numbers of white cells in the bone marrow and / or peripheral blood

Clinical Overview

• Acute myeloid leukemia (AML) is one of four types of leukemia.
• AML is cancer of the blood-forming tissue (bone marrow).
• Normal bone marrow produces red cells, white cells, and platelets.
• AML causes bone marrow to produce too many immature white blood cells (blast cells).
• Suppresses normal blood cell production.

Anemia, leucopenia, thrombocytopenia

• AML is acquired from genetic damage to the DNA of a single cell in the bone marrow; resulting in malignancy.
• Diagnosed by clinical laboratory tests performed on blood and bone marrow.
• Primarily affects adults and children younger than one year old.
• Incidence is 2.5 out of 100,000 people.

Signs and Symptoms

• atigue
• Shortness of breath on exertion
• Easy bruising
• Petechiae
• Bleeding in the nose or from the gums
• Prolonged bleeding from minor cuts
• Recurrent minor infections or poor healing of minor cuts
• Loss of appetite or weight loss
• Mild fever

Risk Factors

• Age
  • Older adults are more likely to develop AML
• Smoking
  • 20% of AML cases are linked to smoking
  • Doubles the risk of disease in people older than 60
• Genetic disorders
  • Down syndrome, Fanconi’s anemia
• High doses of radiation
  • Long-term survivors of atomic bombs
• Previous chemotherapy treatment
  • Breast cancer, ovarian cancer, lymphoma
• Exposure to industrial chemicals
  • Benzene

Treatments for AML

• Chemotherapy

Phase One – Remission induction therapy

Phase Two – Remission continuation therapy

• Radiation therapy for certain cases
• Bone marrow transplantation

Prognosis for AML

• Survival rates greatly improved over past 25 years.
• Majority of patients still succumb to the disease.
• Remission rates inversely related to age.
  • 5-year survival rate in adults under 65 is 33%
  • 5-Year survival rate in adults over 65 is 4%
• Dependent upon several factors.
  • Age
  • White blood cell count
  • Presence of translocations in bone marrow

After the oncologist performed a bone marrow aspiration to confirm the diagnosis of leukemia, we learned specifically what type it was and the count. “D had acute lymphoblastic leukemia, early pre-B cell.

Etiology

Predisposing factors:

• Ionizing radiation exposure
• Previous chemotherapy : alkylating agents
• Occupational chemical exposure : benzene
• Genetic factors: Down’s Syndrome, Bloom’s, Fanconi’s Anemia
• Viral infection ( HTLV-1)
• Immunological : hypogammaglobulinemia
• Acquired hematological condition –Secondary

Management

1. Supportive care :

• Anemia – red cell transfusion
• Thrombocytopenia – platelet concentrates
• Infection – broad spectrum IV antibiotics
• Hematopoietic growth factors : GM-CSF, G-CSF
• Barrier nursing
• Indwelling central venous catheter

A leukemia Patient

The white blood cell count in her peripheral blood was about 550,000. Her bone marrow was packed with leukemia blasts.” The next thing that occurred was a procedure called leukopheresis. This procedure lasted 4 hours and cut D’s white blood cell (WBC) count in half–to about 250,000. She was administered chemotherapy immediately following the leukopheresis procedure. The next day we learned that the chemo had produced an effect as well: The WBC had halved again–125,000. At day 29 of the induction protocol D was declared to be in complete remission.
We were all relieved with this news.

Poor prognostic factors

• Increasing age
• Male sex
• High WBC count at diagnosis
• CNS involvement at diagnosis
• Cytogenetic abnormalities
• Antecedent hematological abnormalities (eg. MDS)
• No complete remission