Author: Julien Kolta, Year 12
Leukaemia is a cancer of the blood-forming tissues including the bone marrow and the lymphatic system. There are two ways of classifying leukaemia. The first classification is based on the speed of progression of this malignant tumour. Acute leukaemia is when this abnormal mutation occurs in immature blood cells (blasts). This results in cells not carrying out normal functions and they also multiply rapidly. The other type is chronic leukaemia. Here the mutation occurs in more mature cells and some produce too many cells and some cause too few cells to be produced. These blood cells replicate and accumulate slower and, in fact, can function normally for a period of time. Chronic leukaemia doesn’t produce early symptoms and so can go unnoticed for many years.
The second way to classify leukaemia is by the type of white blood cell affected. Lymphocytic leukaemia affects lymphoid cells (lymphocytes). Lymphoid cells usually form lymphoid/ lymphatic tissue which makes up our immune system. Myelogenous leukaemia affects myeloid cells which produce red blood cells, white blood cells and platelet-producing cells.
Diagnosing leukaemia is also no small feat. To diagnose chronic leukaemia a physical exam can be done, a blood test and a bone marrow test. In the physical exam, a doctor will be looking for pale skin from anaemia, swelling of the lymph nodes and the enlargement of the liver and spleen. Blood tests usually show an abnormal number of red or white blood cells. If you are found to have leukaemia the bone marrow test can be carried out where a sample of the bone marrow is removed from the hipbone. Then, further tests of your leukaemia cells may reveal certain characteristics which could direct your treatment options.
Bone marrow transplant is therefore used to treat leukaemia as the bone marrow doesn’t produce enough healthy blood cells. In such a transplant, the body is infused with healthy blood-forming stem cells into the body of the patient to replace the damaged or diseased bone marrow. It is also sometimes referred to as a stem cell transplant. Bone marrow transplants may use cells from the patient's body (an autologous transplant) or from a donor (an allogeneic transplant).
In more detail, the operation involves giving the patient quite high doses of chemotherapy to kill off any diseased cells due to cancer and any malfunctioning bone marrow. The patient is then injected with new healthy blood-forming stem cells which attach to the bone marrow and should start to form new healthy blood cells.
However, there are many difficulties and risks associated with such an operation. Some risks of the operation include graft-versus-host disease which occurs from allogeneic transplants only or stem cell (graft) failure.
GVHD (graft-versus-host disease) occurs when the donor stem cells that make up your new immune system see your body’s tissues and organs as something foreign and start to attack them. This disease can occur at any time after your transplant however the risk is greater if the stem cells are from an unrelated donor.
Much like leukaemia itself, there are 2 types of this disease: acute and chronic. Acute GVHD usually occurs earlier during the first few months after your transplant and it typically targets the skin, digestive tract or liver. However chronic GVHD develops later and affects many organs. However, pretransplant tests and procedures are carried out to reduce the risks and effects of such diseases.
References:
Mayo clinic -
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