Acute Leukemia Essay

Scenario: John is a 4 year-old boy who was admitted for chemotherapy following diagnosis of acute lymphoblastic leukemia (ALL).  He had a white blood cell count of 250,000.  Clinical presentation included loss of appetite, easily bruised, gum bleeding, and fatigue.  Physical examination revealed marked splenomegaly, pale skin color, temperature of 102°F, and upper abdomen tenderness along with nonspecific arthralgia.

Leukemia is cancerous disease that starts in blood-forming tissue such as the bone marrow and causes large numbers of blood cells to be produced and enter the blood-stream (National Cancer Institute, 2008, para. 1). It is one of many complicated cancer diseases that affect all ages and have very negative outcomes if not treated properly, and on time. Within the disease are several different types that affect according to how quickly the disease develops and attacks the body. It could be classified as chronic leukemia, which has a slow progress of getting worse or acute leukemia which usually gets worse quickly. The types of leukemia also can be grouped based on the white blood cell that is affected (National Cancer Institute , 2008, p. 1).

DK is a 51-year old male patient presenting with Acute Myeloid Leukemia AML. Two weeks ago while vacationing in Ocean City with his family, DK visited the local hospital with the symptoms of swollen leg, difficulty walking, pain, and fever. Bloodwork was performed at the local clinic and revealed anemia and low cell counts indicating possible leukemia. Patient returned to Baltimore and was admitted to Johns Hopkins Hospital 1 week ago. His current symptoms are swelling of lower legs, fever, low blood Oxygen level, anemia.

Leukemia broadly describes conditions that affect erythropoiesis in the bone marrow, lymphatic system, and spleen. As with all other cancers, leukemia begins from the mutation of DNA in certain cells. Classifications of leukemias are based on the age of onset and the leukocyte involved (Lewis et al. 2014, 665). The most common leukemia is chronic lymphocytic leukemia (CLL), accounting for approximately 30% of cases in the United States (Copstead and Banasik 2013, 222). The normal function of the bone marrow, spleen, and liver becomes interrupted by the invasion of malignant lymphocytes (B cells); since the B cells are functionally inactive, a patient becomes more susceptible to infections. The sluggish progression of CLL unfortunately leads to late diagnoses and poor prognosis (Lewis et al. 2014, 665). Patients that become symptomatic in later stages will experience fatigue, weight loss, anorexia, and an increased susceptibility to infection, due to abnormal antibody production. Patient specific factors such as age, disease progression, and medication side effects will determine the course of treatment (Copstead and Banasik 2013, 223). The fragile state of patients with CLL requires continuous examination of drug therapy and interventions to prevent further complications.

Leukemia is a type of cancer that sadly causes around 25,000 deaths in the U.S. each year. The area that it affects is the blood and the bone marrow and like most or all of the types of cancer in the world if not taken control of early it will most likely kill you.

The body is made up of hundreds of millions of living cells. Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person’s life, normal cells divide faster to allow the person to grow. After the person becomes an adult, most cells divide only to replace worn-out or dying cells or to repair injuries. Cancer begins when cells in a part of the body start to grow out of control. There are many kinds of cancer, but they all start because of out-of-control growth of abnormal cell (American Cancer Society, 2010).

The number of older individuals undergoing HSCT for malignant disease has risen considerably over the years. Between 2007- 2013, 22% of allogeneic transplants and 44% of autologous transplants were in patients older than 60 years of age1. The rise of HSCT in this age group can be attributed to the use of reduced intensity conditioning (RIC) regimen and advances in post-HSCT supportive care2,3. HSCT is a potential curative treatment for a number of malignant hematologic diseases such as myelodysplastic syndrome (MDS), leukemia, lymphoma and myeloma which tend to more commonly affect the elderly population. For instance, according to the SEER database, the median age of diagnosis of acute myeloid leukemia (AML) and MDS are 67 and 70 years respectively. Despite these findings, the number of patients over the age of 65 undergoing allogeneic HSCT remains low4. An evaluation of the NIH clinical trial registry revealed that 90% of HSCT clinical trials excluded older individuals (>75 years), 75% based on chronologic age, 39% based on performance status in the elderly and 39% based on organ function in the elderly5. Inadequate accrual remains a problem even for trials that allow older patients, mostly due to physician reluctance, comorbidities and performance status6.

Stem cell transplant combined with chemotherapy in high doses is a form of treatment, which gives a human body infected with multiple myeloma a chance at remission, which will last a longer time than other remissions. High doses of chemotherapy are very effective in killing the multiple myeloma cells. However, a side effect of chemotherapy is the destruction of hematopoetic stem cells. Stem cell transplant is to replace these cells, which are very important in the human body. There are two types of stem cell transplants. Allogenic stem cell transplant and autogous stem cell transplant is advisable for patients who chose to undergo this form of treatment to have their stem cells harvested prior to the treatment. This will ensure that after the destruction of the hematopoetic stem cells due to the chemotherapy, the patient has available stem cells that doctors transplant into their body when the need arises. Chemotherapy comes with some side effects some severe and others minor. The slight side effects are nausea and vomiting. The worst-case scenario side effects are organ damage (Jones,

Patients with standard-risk myeloma have a median overall survival (OS) of 6–7 years while those with high-risk disease have a median OS of less than 2–3 years despite tandem autologous stem cell

Many of the clinical signs and symptoms of AML are the result from displacement or interference of dysfunction, immature cells with the normal differentiated blood cells. As explained earlier, in AML, myeloblast are most often not able to differentiate into mature differentiated cells. Even though in some cases they do differentiate, they will more likely differentiate into immature differentiated cells. These immature cells, also called blasts, do not have the ability as the normal cells do. With no ability to function, many of them were just floating in the circulation and died and destroyed at the end of their life span. The rest of the myeloblast that are not able to differentiate are just building up in the place where it is produce, the bone marrow. In either scenario, the circulating normal differentiated cells components, like erythrocytes, monocytes, granulocytes, and megakaryocytes are deficient. This is a condition called pancytopenia.

Leukemia is a cancer that affects the bone marrow. The bon marrow is the soft spongy center of the bone that produces blood cells. Leukemia is found in white blood cells or leukocytes. The white blood cells help to fight ff infections and other diseases. Normally, cells produce in an orderly way, but people that have leukemia the cell production gets out of control. The marrow produces too many immature white blood cells called blasts. They are differently shaped and can’t carry out their usual duties.

“If the ALL has spread to the covering of the brain or spinal cord”, doctors should take this into consideration while deciding the patients treatment (“Acute Lymphocytic Leukemia”3). If patients have certain chromosomal changes chromosomal changes, doctors need to think about that when deciding treatment for a patient (“Acute Lymphocytic Leukemia” 3).

Acute Lymphocytic Leukemia is a scary disease. The term “acute” means the disease can quickly spread and progress quickly and can prove fatal in months if left untreated. “Lymphocytic” simply means that it develops from immature forms of lymphocytes. Also known as Acute Lymphoblastic Leukemia, or ALL for short, it is a type of cancer that starts from the early form of white blood cells called lymphocytes in the bone marrow. ALL is the most common form of cancer in children, though adults can get it as well. For children, treatment results in a good chance of a cure. Adults have a significantly smaller chance of a cure with ALL. ALL generally invades the blood very quickly and has the potential to spread to other body parts such as the spleen,

After their successful work with Acute Lymphoblastic Leukemia, St. Jude Children’s Hospital decided to expand their efforts outwards and focus on another type of leukemia that attacks the lives of children every year. Acute Myeloid Leukemia, a cancer that begins in bone marrow and quickly multiplies and spreads to white blood cells, makes up 20% of all childhood leukemia (Pui 51). The first AML study at St. Jude began in 1986. Before the start of this project, only one child out of every 58 children suffering from this illness survived for a time greater than five years; however, by the end of the first study completed in 1973, the rate of remission had increased to 66%. Although St. Jude was ecstatic that they had brought the rate of remission

     Another option is Bone Marrow Transplantation. In many cases of acute leukemia and cml, doctors give high doses of chemotherapy and radiation, when indicated to destroy all of the patient’s bone marrow, since it is not functioning correctly. Then they give the patient healthy bone marrow from the donor, whose tissue it the same or almost the same as theirs; ideally an identical twin or a sibling. They also might give bone marrow that was removed from the patient earlier and especially treated to remove any leukemia cells. Patients who have a bone marrow transplant bone marrow begins to produce enough