Treating Leukemia with Bone Marrow Transplant

Leukemia is a cancer of the blood-forming cells. When leukemia develops, the body produces large numbers of abnormal blood cells that appear and behave differently from normal blood cells. To better understand what happens when you have leukemia, it is helpful first to know about normal blood

Normal Blood

The blood has two components: a liquid part called plasma, and a cellular part or the blood cells. There are three major types of blood cells: red blood cells (RBCs), white blood cells (WBCs), and platelets. All these cells are produced in the bone marrow (soft tissue inside the bones).

• The role of the RBCs is to carry oxygen throughout the body to different tissues. The percentage of RBCs in the blood is called the hematocrit. The part of the RBC that carries oxygen is a protein called hemoglobin. Anemia occurs when there is a decrease in the number of RBCs in the body and is detected by a low hemoglobin level or a low hematocrit. A normal hemoglobin level ranges between 12 and 16 g/dl ( or a hematocrit of 40-50%). Most people will have some symptoms when the hemoglobin is less than 8. This is why blood transfusions are frequently ordered when the hemoglobin is less than 8.

• The role of the WBCs is to defend the body against infections. The neutrophils (one subtype of WBCs) kill most regular bacteria. Lymphocytes are responsible for killing viruses and constitute an important part of the immune system. Infections are therefore more likely to occur when the WBCs is low. Normal WBC count is 3,000 to 9,000/mm3. The Absolute Neutrophil Count (ANC) is used to measure the amount of neutrophils you have to fight infections. A patient's ANC is computed by multiplying the total number of WBCs by the percentage of neutrophils. Serious infections are more likely to occur when your ANC falls below 500. A patient's WBC will generally fall within the first week after starting chemotherapy. However, most people recover their WBC count between days 21 to 28 after starting chemotherapy.

• Platelets are the cells that help control bleeding. The normal platelet count is 150,000- 300,000/mm3. The risk of bleeding increases when the platelet count is less than 10,000-20,000. Platelets transfusion are usually administered when the platelet count is lower than 10-20,000/mm3. The risk of bleeding increases if you have taken aspirin, Motrin or other anti-inflammatory drugs, but Tylenol has no effect on platelets.

Types of Leukemia

Leukemias are classified by the type of cell affected and by the rate of cell growth. Leukemia may be either acute or chronic. Acute leukemia involves a rapid growth of very immature blood cells and is a life-threatening condition requiring immediate treatment. Chronic leukemia involves the growth of more mature blood cells, and usually, does not require immediate treatment. However, some chronic leukemias, such as chronic myeloid leukemia, do progress to a form of acute leukemia. Myelodysplastic Syndrome (MDS) or pre-leukemia is a condition in which the bone marrow does not produce enough normal blood cells, and precedes the development of acute leukemia.

The most common types of leukemia are:

• Acute lymphocytic leukemia (ALL); the most common type of leukemia in children

• Acute myeloid leukemia (AML); the most common type of acute leukemia in adults

• Chronic lymphocytic leukemia (CLL); the most common type of leukemia in adults

• Chronic myeloid leukemia (CML)

During the last four decades, the prognosis of leukemia has changed dramatically. Now, most patients can live successfully managing their symptoms and some patients can be cured.

Treating Leukemia With Chemotherapy

Currently, the most effective treatment for leukemia is chemotherapy, which may involve one or a combination of anticancer drugs that destroy cancer cells. Each type of leukemia is sensitive to different combinations of chemotherapy. A "chemotherapy course" is the period of time from the start of the chemotherapy until the blood cell counts are back to normal. There are several different phases of the chemotherapy treatments for leukemia:

• induction chemotherapy

• consolidation chemotherapy

Bone Marrow Transplantation for Leukemia

Bone Marrow Transplantation (BMT) is a form of treatment for leukemia patients. This treatment consists of destroying leukemic bone marrow cells using higher doses of chemotherapy (and in some cases, radiotherapy) and/or immune suppressive medications to permit to the donor's immune system to fight the leukemia. Because high-dose chemotherapy severely damages the bone marrow's ability to produce cells, healthy bone marrow cells are provided intravenously to stimulate new bone marrow growth.

Acute Lymphocytic Leukemia Treatment

For patients with acute lymphocytic leukemia, additional phases are needed. These include:

• Intrathecal (IT) Chemotherapy: chemotherapy is infused into the spinal canal through a spinal tap or a lumbar puncture to prevent central nervous system leukemia.

• Maintenance Chemotherapy.

Several courses of a different combination of drugs are administered for up to two years. The short term goal of chemotherapy is to achieve a complete remission (CR), which means that no evidence of leukemia can be found in the blood and bone marrow. The long-term goal is to maintain this CR state.

Other Leukemia Treatment Options

• Targeted Therapy: with small molecules (tyrosine kinase inhibitors) for CML, such as Gleevec (Imatinib Mesylate)

• Monoclonal Antibody Therapy for AML, for example Myelotarg (Gemtuzimab-Ozogamycin)

• Biological Therapy like Interferon alfa for CML and all trans-retinoic acid (ATRA) for acute promyelocytic leukemia.

Clinical Trials

Our participation in national, international and institutional clinical assures that we offer patients the newest knowledge in stem cell biology and transplant immunology.  We also collaborate in research and clinical and basic science through a number of national and international organizations. Learn more

National awards & recognition

Awards

• Winship is a National Cancer Institute - Designated Cancer Center
• US News & World Report “America’s Best Hospitals"
• Accredited by the American College of Surgeons Commission on Cancer
• Joint Commission on Accreditation of Healthcare Organizations
• Blue Cross Distinction - Center for Complex and Rare Cancers
• OptumHealth Center of Excellence for Bone Marrow Transplant
• Foundation for the Accreditation of Cell Therapy (FACT) Accredited
• Center of Excellence of the Myelodysplastic Syndromes Foundation.