Leukemia or known as Leukemia (Leukemia) occurs when immature white blood cells grow at an abnormally high rate for unknown reasons and divide uncontrollably in the bone marrow, disrupting the normal function of the bone marrow in producing red blood cells, white blood cells, and platelets, leading to prominent symptoms.
Leukemia commonly known is acute leukemia due to its rapid and severe progression that can be fatal. It can be found in all genders and ages, with increasing incidence in the elderly.
The exact cause of the disease is still unclear, but these risk factors are believed to contribute to the development of leukemia, such as exposure to high doses of radiation by any means, receiving chemotherapy for other types of cancer since some chemotherapy drugs may increase the risk of leukemia, exposure to chemicals from other sources such as benzene group chemicals from petrochemical industries and certain pesticides, hair dye, genetic disorders such as Down syndrome, and individuals aged 60 and above who are at risk of developing all types of cancer including leukemia, especially patients with initial bone marrow degeneration and dysfunction.
Symptoms of Leukemia
These are symptoms indicating impaired bone marrow function. Normally, the bone marrow contains stem cells that produce red blood cells, white blood cells, and platelets. When leukemia cells increase in the bone marrow, they interfere with the production of these blood cells, causing symptoms that lead patients to seek medical attention as follows:
- Red blood cells: fatigue, dizziness, fainting, easy tiredness, palpitations, weight loss, hair loss
- White blood cells: low-grade or high fever, frequent infections, fatigue
- Platelets: easy bleeding, including difficulty stopping bleeding when injured, petechiae or bruising on the body
- Symptoms outside the bone marrow: loss of appetite, weight loss, palpable enlarging lumps on the body, sometimes enlarged liver or spleen
These health problems lead to consultation with specialists for diagnosis through complete blood count tests to detect abnormalities in red blood cells, white blood cells, and platelets, as well as bone marrow aspiration to confirm diagnosis and collect bone marrow samples for decision-making and prognosis before starting treatment from bone marrow fluid and tissue.
Often, patients refuse bone marrow aspiration due to confusion with lumbar puncture and concerns about life after the procedure, causing missed opportunities for curative treatment. Bone marrow aspiration is different from lumbar puncture, does not affect walking, and does not lead to paralysis later. The procedure takes 20-30 minutes and can be performed at any age, especially in the elderly, as leukemia is more common in this group as mentioned. Patients can return home to recover if there are no other indications for hospitalization.
Before starting treatment, a medical team must evaluate the type of leukemia, age, existing comorbidities, overall health of the patient, and treatment limitations of each method before recommending the appropriate treatment to the patient and family, including:
Chemotherapy
This is the standard treatment for acute leukemia (chronic leukemia is mainly treated with oral medication) to destroy abnormal rapidly dividing cancer cells and promote the production of normal blood cells to replace them in the bone marrow. Multiple forms of chemotherapy are usually used together, including oral, intravenous, and intrathecal injections. The key principle is to use multiple chemotherapy drugs together to
increase treatment efficacy and reduce side effects from excessive use of any single chemotherapy drug. Consideration is based on the type and severity of leukemia as well as the patient’s performance status. Side effects of chemotherapy are most evident in rapidly dividing cells in affected organs, such as vomiting, diarrhea, mouth ulcers from damaged gastrointestinal mucosa, fatigue, low-grade fever, increased risk of various infections, petechiae on the body due to bone marrow cell destruction or suppression, and hair loss from damage to hair follicle cells.
Targeted Therapy
Also known as “targeted drugs,” these medications specifically act on cancer cells without damaging normal cells or with minimal damage, enhancing treatment efficacy and reducing side effects from normal cell destruction (usually used in combination with chemotherapy). This is considered the standard treatment for chronic leukemia.
Immunotherapy treatment targets cancer cells without damaging normal cells or with minimal damage, increasing treatment efficacy and reducing side effects from normal cell destruction (usually used with chemotherapy). This is considered the standard treatment for chronic leukemia.
Stem Cell Transplantation
or bone marrow transplantation starts by collecting stem cells for blood cell production from the patient’s own blood or bone marrow, relatives, or compatible donors, and transplanting them to the patient after achieving remission to reduce the chance of relapse. This procedure is not used if the patient does not respond to chemotherapy to achieve remission because chemotherapy is required to destroy the existing bone marrow cells before transplanting stem cells to the patient.
As mentioned, during treatment, side effects must be evaluated in all aspects. Supportive care may include blood and platelet transfusions and symptomatic medications to reduce side effects such as antiemetics and white blood cell stimulants. Treatment response is assessed periodically before proceeding to the next treatment phase.
In cases where remission is achieved, doctors will schedule follow-up visits and blood tests periodically during the first year as appropriate. If results are normal, follow-ups will be scheduled every 3-6 months for at least 5 years, after which the patient is considered cured. The chance of relapse decreases over time, but after 5 years, ongoing monitoring and screening for other comorbidities and cancers are recommended as appropriate.
Adhering to hygiene and cleanliness principles to prevent secondary infections after treatment is essential, especially currently with ongoing respiratory infections. Wearing masks, avoiding crowded or poorly ventilated places helps reduce the risk of respiratory infections. Choosing nutritious and thoroughly cooked food, maintaining cleanliness in food preparation, washing vegetables and fruits thoroughly reduce the risk of gastrointestinal infections. Drinking plenty of clean water and collaborative evaluation and treatment planning between the medical team, patients, and families are key to successful treatment.
Dr. Sirawit Samanwongkit
Meesuk Center, Phyathai 3 Hospital
Consultation by Specialist Nurse 08 1937 6906
