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 June 14, 2003
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Leukemia is a disorder affecting the production of white blood cells, causing them to reproduce uncontrollably, crowding out existing healthy cells. These abnormal white cells "overpopulate" the bone marrow, often with immature, nonfunctioning blast cells and spill over into the bloodstream.


The term leukemia, which is derived from Greek, literally means "white blood." The bone marrow may become severely impaired and unable to maintain production of sufficient levels of red blood cells and platelets. At the same time, white blood cell production becomes so rapid that these cells do not reach the level of maturity necessary to perform their infection-fighting functions. Leukemic cells infiltrate all the major organs of the body, sometimes causing these organs to malfunction or fail. The kidneys may become impaired. The liver and spleen may become enlarged. Normally, the spleen acts as a filter for the blood, screening out aging red cells and platelets. When the spleen becomes enlarged, it can actually start doing its job too well, removing perfectly healthy red cells and platelets, further reducing the number of these already scarce cells. As leukemia progresses, the entire blood system may become flooded with immature blast cells. If this disease is left untreated, a person with leukemia becomes increasingly susceptible to fatigue, excessive bleeding and infections until, finally, the body becomes virtually defenseless, making every minor injury or infection very serious. Leukemia may be fatal. People may die from internal bleeding which would have been prevented by the platelets. Or, more often, they may die from infections which start with a virus or bacteria that would ordinarily have been wiped out by healthy white blood cells. The exact course leukemia takes, and the speed with which it takes that course, varies with the type and age of the white cells initially affected.


The cause of leukemia in most circumstances is not known. Some cases appear to be genetic in origin. Others may be related to exposure to toxins, chemicals or drugs, or to radiation.


Patients may present with fatigue, fever and recurrent infections, weight loss, night sweats, or bleeding.


Although suspected by medical history or physical examination, leukemia may be diagnosed incidentally when blood tests or radiological studies are performed for other indications. A bone marrow biopsy may be recommended by your physician.


Leukemia is treated mainly with chemotherapy, although radiotherapy and biological therapy can play a part with some forms of the disease. Bone marrow transplantation may be recommended for some types of leukemia, including acute leukemia and CML. The goals of therapy are to relieve symptoms and obtain a remission. Remission is the condition in which leukemia is no longer detected and the bone marrow functions normally. Treatment is usually divided into two phases: Induction. This is the attempt to attain a remission meaning that the bone marrow appears normal. Consolidation. This involves giving the same or different treatment, even when the patient appears to be in remission because of the suspected or assumed presence of residual disease that cannot be detected. Some patients may receive a third phase called maintenance treatment to prolong the remission. Maintenance treatment is more associated with the treatment of ALL (Acute Lymphoblastic Leukemia) than AML (Acute Myelogenous Leukemia).


What are major types of leukemia? Which type is this? Is the bone marrow impaired? What are the principal treatment options? Do you recommend chemotherapy? Is radiation therapy of any value in this case? Will there be a possibility of remission?

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