These arc also divided into two types, depending upon the type of white blood cells involved.
1. Chronic lymphocytic Leukemia (CLL).
2. Chronic myeloid Leukemia (CML).
Symptoms
· Tiredness
· Loss of weight
· Loss of appetite
· Fever
· Pain in abdomen due to enlarged spleen
· Occasional bleeding from any source
Diagnosis: This is established by the same methods as they are for acute Leukemias.
Treatment:
Surgery: It has no role in the cure of the disease. Sometimes painful enlarged spleen is surgically removed.
Radiation: Radiation over the spleen, reduces its size and also lessens the number of Leukemia cells in the blood.
Chemotherapy: It lessens the symptoms. Busulphan is the drug of choice. Many patients have remission of symptoms for long periods.
Bone Marrow Transplantation in Leukemias
Bone marrow transplant is the treatment of choice for Leukemia patients of younger age group. The results are good, provided a suitable donor of the bone marrow is available. A sibling is preferable for this purpose. The technique is simple, but great experience is necessary.
Cells from a normal marrow can be given intravenously to a patient who has been specially prepared. These cells go to the marrow and produce enough white and red blood cells and also platelets to restore blood normality in about 3 weeks. It takes longer, months or even years, for the normal bone marrow to stabilize. Bone marrow transplantation thus offers the possibility of replacing diseased with healthy blood tissue.
Supportive Therapy in Leukemias
This is very necessary particularly in the acute forms of Leukemia.
Anaemia is treated with transfusions of red cell concentrate to maintain an adequate haemoglobin level, preferably above 10 gms per cent. Bleeding is due mainly to diminished platelet count in the blood (thrombocytopaenia) and is exacerbated by infection. Platelet transfusions are required. Platelet transfusion may also be given in anticipation of bleeding in a Leukemia patient with low platelet count in the blood. Infection is a serious and frequent problem. An infection can arise very rapidly within hours and it is necessary to act quickly when it occurs.
Unexplained fever over 38°C, lasting more than 6 hours, should be regarded as due to infection until proved otherwise.
Appropriate antibiotic is given intravenously to control the infection. If it fails to control fever and there is marked diminution of polymorph white cells, then a transfusion of white cells of the blood is given, with very good results.
Prognosis
Control of the disease and symptomatic improvement for a number of years is achieved in most patients, but ultimately an aggressive, untreatable disease develops.
Early Detection
Signs & Symptoms
· Loss of weight in an adult without any visible cause.
· Loss of appetite.
· Low-grade fever.
· Pain or discomfort in abdomen due to a mass in the left upper abdomen.
· Occasional bleeding from any source.
· Anaemia.
Investigations
· High TLC with immature white blood cells.
· Bone marrow biopsy examination.