According to the Department of Health (DOH), leukemia is among the top 5 killer-cancers in the country. To raise the profile of this “silent killer,” the department has designated September as “Leukemia Awareness Month,” coinciding with the “Blood Cancer Awareness Month” which is also celebrated internationally September of each year.

The Philippine Cancer Society, for their “2015 Philippine Cancer Facts & Estimates” report, has said that around 4.5 individuals per 100,000 Filipinos will develop the disease. The same report estimated that around 4,270 new cases were diagnosed for the year, plus 3,386 leukemia-caused deaths in 2015.

Of the different types of leukemias, lymphoid leukemia is highest in Filipino children and those over 70 years of age. The survival rate of Metro Manila children with acute lymphoid leukemia is only 34%. This figure is lower than those of developed countries like the US (86%). The 5-year survival rate of adults with leukemia in Metro Manila is only 5.2%. Again, this is lower than those from developed countries like the US (48.4%).

Access to appropriate and effective treatment is said to play a major role in these figures.

What is Leukemia?

Leukemia is a type of blood cancer involving the overproduction of abnormal or non-functioning white blood cells.

White blood cells (WBC’s), which are the mainstays of the immune system, are produced in the bone marrow—the spongy tissue found inside the bone. WBC’s protect the body from diseases and infections, attacking bacteria, viruses and other pathogens that pose a threat to health. In the case of leukemia, there is a preponderance of abnormal white blood cells that do not function as an effective line of defense.   

Aberrant WBC’s cells emerge from a sudden mutation in the genes of normal white blood cells. The genes involved are usually those that regulate cell reproduction, resulting in rapid and uncontrolled cell division. Healthy white blood cells normally stop dividing when a predetermined level is reached. They also die at a predetermined time and are replaced by new healthy WBC’s. Abnormal WBC’s are problematic because they have longer lifespans than normal white blood cells, and they keep on producing more and more abnormal WBC daughter cells.

An accumulation of defective white blood cells results, and this glut impinges on the bone marrow’s ability to produce two other vital components of blood: red blood cells (RBC’s) and blood platelets. Regular production of RBC’s and platelets is essential for maintaining good health. Red blood cells deliver life-giving oxygen to the different parts of the body, while blood platelets regulate blood clots. When there is an overproduction of WBC’s, the production, and therefore the functions, of these two blood components are impaired. In fact, one of the symptoms of leukemia is bleeding, which suggests a serious disruption in the platelets’ blood-clotting operations.

Risk Factors

Men are more at risk for leukemia than women. And, although the condition has been known to hit at any stage in life, the chances for developing it increases with age.

While ascertaining the exact cause of leukemia remains elusive, there are several factors that put certain individuals at risk for the disease:

• Chemical exposure—Certain chemicals—like benzene, which is a common industrial chemical found in gasoline, plastics, lubricants, dyes, detergents and pesticides—are linked to an increased risk of leukemia.

• Existing genetic abnormalities—Persons with congenital conditions like Down Syndrome and Bloom Syndrome have a higher risk of developing the condition.

• Family history—If other members of the family have been diagnosed with the disease, this increases one’s chances of developing the same.

• Cancer treatment—Chemotherapy or radiation treatments, used to combat other types of cancers, could, in turn, increase one’s risk.

• Smoking—Cigarettes have been linked to a host of health hazards, and one of them is acute myelogenous leukemia.

That being said, close associations with these risk factors do not automatically mean developing the disease. But on the other hand, having none of the risk factors is no guarantee that one will never develop the disease.

Types of Leukemia

Leukemia is classified according to the rate of progression and the type of white blood cell involved.

Leukemia, according to the rate of progression, has two types:

1. Acute leukemia—is a rapidly developing condition. The cells divide rapidly so the disease escalates very quickly. For acute leukemia, aggressive treatment is required.

2. Chronic leukemia—is characterized by mature blood cells that divide and replicate more slowly. These cells could initially function like a normal WBC. As a result, chronic leukemia could remain undiagnosed for years.

Leukemia, according to the type of white blood cell involved, also has two types:

1. Lymphocytic leukemia—affects the lymphoid cells. The symptoms include swollen lymph nodes in the neck, armpits and groin.

2. Myelogenous leukemia—affects myeloid cells, which are immature white blood cells.   

The 4 Main Types of Leukemia

1. Acute lymphocytic leukemia (ALL) – This is the most common type of leukemia affecting young children. ALL still does affect adults. But when this happens, the affected adults usually have a worse prognosis than children suffering from the same condition.

2. Acute myelogenous leukemia (AML) – This is the most common type of acute leukemia in adults. It is a rapidly-developing condition. AML can quickly spread to different parts of the body like spleen, liver and brain.

3. Chronic lymphocytic leukemia (CLL)– Many people with the condition will not have any symptoms for years. This being the case, chronic leukemias tend to be harder to manage than acute ones.

4. Chronic myelogenous leukemia (CML) – CML affects mostly adults. It is a slow-moving subtype. But that said, CML can alter its progression and suddenly become an acute, rapidly-progressing condition.

Symptoms & Signs

The signs and symptoms of leukemia are quite vague, and a patient could mistake them for some other illness. In some cases, like in chronic leukemia, symptoms may not even appear for years.

Here are its most common symptoms:

• Being prone to infection—Since the person’s immune system is compromised, the patient is easily susceptible to infection and often experience unexplained fever, chills and headaches.

• Anemia-related signs—The person persistently feels tired or fatigued. (A good night’s rest doesn’t really help.) He or she could feel weak, look pale and experience shortness of breath. These are telltale signs of low red blood cells in circulation.

• Being prone to bleeding— Patient bruises easily and experience recurring nosebleeds and gum bleeds. Brown, red or purple rash (petechiae) appear under the skin. These are tiny, visible circular patches that indicate the capillaries are bleeding out. Blood may also be found in stool and urine. This set of symptoms means low platelet levels. Platelets, if you remember, are responsible of making blood clot.

• Bone and joint pain—Because of the overproduction of white blood cells in the bone marrow, pain will be experienced in areas like pelvis and breastbone, where there is a concentration of marrow. The pain might cause the person to limp.

• Swollen lymph nodes, liver or spleen—This is again from the overproduction of white blood cells. WBC’s often congregate in the lymph nodes, liver and spleen, causing them to uncomfortably swell. Lymph nodes in the neck, armpit and groin area would be enlarged. Pain or discomfort on the upper left side of the abdomen points to a swollen spleen. Pain on the upper right side of the abdomen indicates an enlarged liver.

• Unexplained weight loss—A swollen liver or spleen might make a patient feel full earlier and thus make him eat less, but even without this being the case, an unexplained weight loss could signal to an underlying condition.

Treatment for Leukemia

According to the United States’ National Cancer Institute, the 5-year survival rate of leukemia patients is at 61.4%, with death rates falling on average 1.5% each year. (The younger the patient, the higher the survival rate.) This trend is expected to continue.

The treatment approach will vary by leukemia subtype, and doctors will discuss with their patients the different treatment options available. Thus far, the most commonly used remedies are:

Chemotherapy

This is the most common doctor recommended treatment. Chemotherapy involves a combination of drugs (like anthracycline, doxorubicin and cytarabine) administered intravenously in order to kill leukemia cells—those rapidly dividing cells in the body.

Chemotherapy is often employed for acute cases of leukemia where a rapid progression of the disease is expected. It generally has three phases: Induction, Consolidation and Maintenance. Induction lasts 4-6 weeks, with the main purpose of destroying the great majority of leukemia cells. The Consolidation phase follows this up and kills off the remaining aberrant cells. Finally, the third phase, Maintenance, which last around 2 years, involves administering low dosages of the chemo drugs in order to prevent the leukemia from coming back.

When later tests reveal that the condition has cleared, the patient is said to be in “remission.”

Radiation

Radiation therapy uses high-energy beams directed at specific parts of the body in order to destroy leukemia cells or stop them from dividing. It’s like getting an X-ray, only the radiation used is much stronger.

The patient lies on a table, and a machine moves around to administer the beam to specific targets of the body. The patient does not see or feel the radiation. The session itself is painless and lasts only a few minutes.

If necessary, radiation and chemotherapy are often used to prepare the patient for the next treatment option: bone marrow transplant.

Stem Cell or Bone Marrow Transplant

The bone marrow is a spongy tissue found that produces the white blood cells, red blood cells and blood platelets. A bone marrow transplant is not a surgery like a heart transplant. It is the act of replacing, via infusion, a faulty bone marrow with one that’s able to produce healthy blood cells.

This is achieved by using “stem cells” either from the patient himself or from a suitable donor. Stem cells are undifferentiated cells that have the ability to develop and mature into any type of cell.

Prior to infusing the stem cells, chemotherapy or radiation is used to destroy the old and unhealthy leukemia cells and bone marrow. The process takes about 5-7 days. After this is done, stem cells are introduced and infused through a tube connected to a major vein in the chest. The stem cells enter the bloodstream and find their way to the marrow and jump start the production of healthy blood cells.

With continuing advances in medicine and our growing understanding of the human body, leukemia patients can look ahead to more effective regimens and remedies.

But the road to recovery starts with an accurate and early diagnosis.

If you or any of your loved ones experiences the signs and symptoms mentioned above, BloodWorks Lab can provide you with the most reliable diagnostic tools. We provide Leukemia/Lymphoma Immunophenotyping by Flow Cytometry that’s vital in diagnosing blood cancers.

We are also proud to be the first laboratory in the Philippines to offer neurological tests like the Anti-NMDA Receptor Antibody Test and the Anti Acetylcholine Receptor (lgG) Antibody Test.

BloodWorks Lab is your one-stop shop for all your blood test needs. Our branches are in Alabang and Katipunan.