What is the difference between acute and chronic leukaemias?

Almost everybody knows that there is disease called leukaemia, but only few other than medical professionals and those who has someone with leukaemia knows that leukaemia can be acute and chronic. So, you might wonder, ‘’what is the difference between acute and chronic leukaemias’’. Well this classification is done according to how fast the disease has evolved with time (Kumar P et.al,2009). Therefore, in acute leukaemia the disease progress very rapidly and the patient begins to have symptoms very fast. In chronic leukaemia the changes occurs very slowly. Therefore, it takes a long time for the patient to develop symptoms. In such patients the test results may show the leukaemic changes but the patient may not have single symptom.

Acute leukaemia is more common among young patients and most of them had good outcome if the treatment started quickly. But, it is hard to treat it when it occurs in an elderly patient. On the other hand chronic leukaemia is more common among elderly patients and it is responsible for very few deaths as the disease advances so slowly and most of the time the patient dies due to old age.

Detailed classification and pathogenesis of leukaemia are described in my previous post, Types of Leukaemia. May be you may find some more interesting information about leukaemia there. 

References : Kumar P and Clark M, 2009. Clinical Medicine. 7th ed.

Treatment of Chronic Lymphocytic Leukaemia

According to Kumar and Clark (2009) thirty percent of patients don’t require any interventions as they are asymptomatic and quiet healthy. The method of treatment depends on the following factors.

·         Stage of the disease – if it is early stage no treatment will be given but the patient will be followed up regularly. Treatment is started immediately in advanced disease.

·         Age of the patient

·         Other illnesses in the patient

·         Toxicity to treatment

The treatment helps to improve symptoms. Aggressive treatment has promised to give an increased survival rate. Patients with following features of advanced diseases are indicated for treatment.

·         Marrow failure

·         Recurrent infections

·         Massive Hepatosplenomegally

·         Fever

·         Night sweats

·         Loss of weight

·         Haemolysis

The treatment methods available in chronic lymphocytic leukaemia can be divided in two main categories. They are,

1.      Supportive treatment

2.      Specific treatment

Supportive Treatment

The following drugs/treatment methods are used.

·         Steroids – for anaemia

·         Splenectomy

·         Chemotherapy and transfusion for thrombocytopenia

·         Antibiotics for ongoing infections and also as prophylaxis because these people are more prone to get recurrent infections because they are immunosuppressed.

·         Allopurinol for hyperuricaemia.

Specific Treatment

Following drugs are used.

·         Chlorambucil

·         Purine analogues

·         Combination therapy with rituximab

·         Allogenic stem cell transplantation

References: Kumar P and Clark M, 2009. Clinical Medicine. 7th ed.

What are the Investigations done to diagnose Chronic Lymphocytic Leukaemia?

Following are the investigations carried out in diagnosing.

·         Full blood cout

·         Blood film

·         Bone marrow

·         Immunophenotyping

·         FISH

·         Coomb’s test

·         Immunoglobulins

Symptoms of Chronic Leukaemia

As I mentioned in my previous post, most of the patients with chronic leukaemia are asymptomatic. But some may have the following symptoms.

·         Recurrent infections – this is due to reduction of functioning leukocytes. Now you may wonder how does it happen when there is more than enough white cells to fight infections. It is because those white cells do not work properly.

·         Symptoms of anaemia – these includes fatigability and low exercise tolerance. Their eyes also will be pale if you inspect under their eye lids.

·         Lymph node enlargement – These enlarged lymph nodes are painless.

·         Abdominal discomfort – As with chronic myeloid leukaemia, chronic lymphocytic leukaemia also can lead to spleen enlargement, which is felt by the patient as abdominal discomfort. It you palpate the abdomen carefully; you will feel the enlarged organ.

·         Fever – this is due to infections.

·         Liver enlargement – apart from the spleen liver can also get enlarged.

References : Kumar P and Clark M, 2009. Clinical Medicine. 7th ed.

Chronic Lymphocytic Leukaemia

Chronic lymphocytic leukaemia is also most commonly seen among older age group people. Therefore, the risk increases as you go older. According to Kumar and Clark (2009)The mean age of presentation is 65and 67 years. The type of lymphocytes that are proliferating are B lymphocytes. As in chronic myeloid leukaemia, this also evolves slowly and therefore, the symptoms are seen at very last stages. The disease can be diagnosed accidently, when a full blood count was done for some other reason.

Once the disease has been diagnosed the patient normally has a chance of survival for 10 years. But, many patients die of old age before there are killed by the disease itself.

References : Kumar P and Clark M, 2009. Clinical Medicine. 7th ed.

Stem Cell Transplantation in Acute Myeloid Leukaemia

Seventy percent of the chronic myeloid leukaemic patients can be cured with stem cell transplantations. As I described in my earliest posts, stem cells are cells that proliferate and give rise to all the other blood cells. Earlier stem cell transplantation was widely used but now it has reduced due to the success rate of therapy with imatinib.

Compared to treatment with imatinib, stem cell transplantation has a risk of death due to graft versus host reaction or due to opportunistic infections. Therefore, your physician will weigh the risks upon benefits and decide the most suitable treatment.

You are more likely to have problems with stem cell transplantation, if you belong to any of the following categories.

·         Older age

·         Time of transplantation is delayed even if the disease was diagnosed earlier.

The histocompatibility with the donor is poor.

References : Kumar P and Clark M, 2009. Clinical Medicine. 7th ed.

Treatment of Chronic Myeloid Leukaemia

This is most commonly seen in adult age group (40-60 years). As with all chronic leukaemia, chronic myeloid leukaemia also progress slowly. The possible out comes of a non treated disease are,

·         Blast crisis

·         Myelofibrosis

·         Death – within 3-4 years

Patients with chronic myeloid leukaemia are treated with “imatinib” Ninety five percent of the patients responds very well to this drug and therefore has a good reputation in treatment of chronic myeloid leukaemia. It can be continued for the rest of the life, and good news is that its side effects are also mild and most patients can tolerate them very well. Some of such side effects are listed below.

·         Nausea

·         Headache

·         Rashes

·         Cytopenia

Very few people may develop resistant to imatinib and those patients are treated with second generation tyrosine kinase inhibitors, dasatinib, and nilotinib.

The next method of treatment is Stem cell transplantation, which I will describe in my next post.

References : Kumar P and Clark M, 2009. Clinical Medicine. 7th ed.