diagnosis and treatment of leukaemia
The regimes followed in the treatment of leukaemia vary depending on the patient’s type of leukaemia.
However, the current standard treatment for leukaemia is still chemotherapy.
Bone marrow transplantation also plays a very important role, be it autologous (from the patient) or allogeneic (from a donor), depending on the case.
Haematopoietic progenitor transplantation or bone marrow transplantation is employed for neoplastic diseases (malignant tumours) and diseases of bone marrow function (blood cell producer) diseases. The objective of this procedure is to restore the function of the bone marrow so that it can produce blood cells normally.
New drugs and new therapeutic strategies are being developed, not only to destroy the neoplastic cells but also to inhibit their growth and promote their differentiation.
For example, retinoic acid derivatives, the new monoclonal antibodies combined with chemotherapy or gene therapy.
A bone marrow study needs to be performed through biopsy. This examination should include a genetic study in which the presence of the Philadelphia chromosome is demonstrated.
The cytochemical reaction of granulocyte alkaline phosphatase is also performed. This reaction enables physicians to differentiate the leucocytosis caused by chronic myeloid leukaemia from those caused by other conditions, mainly serious infections.
When faced with suspected chronic lymphoproliferative syndrome, it is essential that a bone marrow test be performed using biopsy.
The study should be completed with a scanner to determine the extent of the disease in the lymph nodes, liver and spleen. It is also essential that a cytogenetic study of the bone marrow be performed due to its prognostic value.
With these data, a study is conducted on the extent of the disease, dividing patients into three groups: low risk, intermediate risk and high risk.
This condition is frequently suspected from the clinical symptoms (haemorrhaging, intense pallor, infections, high fever, etc.). The confirmation of the diagnosis is performed using blood tests and bone marrow aspiration.
Currently, flow cytometry, cytogenetic and molecular biology analyses are essential for the correct diagnosis of each subtype of acute leukaemia.
The treatment for acute leukaemia is still chemotherapy. The regimes vary depending on the type of acute leukaemia. Bone marrow transplantation also plays a very important role, be it autologous (from the patient) or allogeneic (from a donor), depending on the case.
New drugs and new therapeutic strategies are currently being developed, not only to destroy the neoplastic cells but also to inhibit their growth and promote their differentiation. These drugs and strategies include retinoic acid derivatives, new monoclonal antibodies combined with chemotherapy and gene therapy.
For lymphocytic leukaemia, the importance of correct staging lies in the fact that each stage of the disease will be treated in its own way. Cases with better prognoses might not need treatment.
To date, fludarabine and other purine analogue derivatives have has excellent results. We also use new biological therapies, such as monoclonal antibodies.
The treatment of chronic myeloid leukaemia depends on the phase in which the disease is found. Initially, oral chemotherapy and immunotherapy are performed in an attempt to control the considerable leucocytosis.
Patients in the acceleration phase or transformation phase to an acute leukaemia should undergo more aggressive treatments.
Once the disease has been controlled, the treatment will depend on the patient’s age:
- Younger patients with donated bone marrow can undergo bone marrow transplantation, the only curative treatment.
- In elderly patients or those who do not have a bone marrow donor, autologous bone marrow transplantation may be assessed.