Bone marrow is soft fatty spongy tissue inside our body. The bone marrow of skull bone, hips, breast and spine contains stem cells. These cells mature and produce blood cells of the body including,

1. White  blood cells (leukocytes)
2. Red blood cells (erythrocytes)
3. Platelets

Visit following link to read more about blood cells,

http://leukemia-symptoms.thehealthinfo.net/2010/10/what-is-bone-marrow-bone-marrow-cancer-bone-marrow-test/

Types of bone marrow transplant

Mainly there are three types of bone marrow transplantation,

Autologous Bone Marrow Transplantation

Auto means “self” . This BMT is used in conjunction with chemotherapy or radiation therapy treatment. Firstly, before applying high dose of chemotherapy or radiotherapy, stem cells are removed from affected bone marrow.  Then after finishing treatment, stem cells  are put back in body. This is also called “rescue” transplant.

Allogeneic Bone Marrow Transplantation

“Allo” means “others”. The person from which stem cells are removed is called donor. In Allogeneic bone marrow transplant, the genetic makeup of donor’s bone marrow must match the patient’s own genetic makeup as perfectly as possible. There are special blood tests for this which show whether the bone marrow of donor matches the patient’s  bone marrow or not.

Umbilical Cord Blood Transplantation

In this transplantation stem cells are removed immediately from the umbilical cord of infant , after birth. For the transplant purpose, these stem cells are stored. Umbilical cord  blood cells are less mature. So there is less concern that they will not match.

Procedure of Bone Marrow Transplantation

It consists of following steps,

Before BMT, chemotherapy or possibly radiotherapy is needed if leukemia is not in remission. Leukemia or cancerous cells should be at lowest possible level for effectiveness of BMT. This treatment takes several days.

Peripheral blood cell harvest is a procedure used to collect stem cells from donor. An injection of growth factor is given to patient over a 10 days period. This function controls and helps the bone marrow to make large number of stem cells and to make blood cells at faster rate. Then donor can recover from transplant more quickly. This harvesting of blood cells takes 3-4 hours .

In process of harvesting patient lie down on a bed and will have two blood bags, which are connected to each of his arms. Blood then moves from one arm to other via a machine called “cell separator.”  This machine separates out the stem cells from other blood cells. This separator will only pick stem cells and other blood cells are returned to body blood stream through blood bag which is connected to other arm.

Problems which may occur during or after transplantation

Complications of bone marrow transplant  depend  on many things including,

1. The disease which is under treatment.
2. Intensity of radiotherapy and chemotherapy.
3. Age of patient.
4. Matching level of genetic makeup with donor.
5. The type of bone marrow transplant.

These are major problems that may occur after bone marrow transplant.

Graft-Versus Host Disease:  When patient receive bone marrow cells from a donor, it may cause complications. This happens when donors blood cells attack your body tissues. Medicines are  provided by doctor to control this problem. It is mild but in some cases it can be serious.

Graft-Failure: It is very rare. In this problem, the new blood cells fed into the blood may not be able to make enough blood cells. If patient suffer from graft-failure then another transplant my be required.

Helplessness: It is also a common feeling among the bone marrow transplant patients, they have feeling of angriness .

Side Effects Of Bone Marrow Transplantation

- Level of blood cells will be very low.

- It may cause infections due to low level of white blood cells.

- May cause anemia, due to low level of hemoglobin.

- Bleeding due to low level of platelets.

- Fever

- Tiredness

- Patient may be too week, sleep more than normal.

- May cause headache.

- May cause nausea.

- May cause sore mouth.

Goal of Radiation therapy (Radiotherapy)

Basic goal of Radiation therapy are,

1. To cure a disease like leukemia cancer.
2. To destroy abnormal tissues.
3. To control the disease symptoms, mainly to get relief from pain.
4. To shrink the tumor before the surgery so that it can be removed easily.
5. Radiation therapy is also used after surgery to destroy remaining tumors.

Types of Radiation therapy (Radiotherapy)

Mainly, there are three types of Radiation therapy,

1. Radical Radiation therapy
2. Prophylactic Radiation therapy
3. Palliative Radiation therapy

Radical Radiation therapy

This therapy is used to get rid of all types of cancerous cells. Treatment is applied with low level of dosage usually five days a week, for five weeks.

Prophylactic Radiation therapy

This therapy is applied on the surgically operated organs to protect the re-development of cancer and to minimize the spread of cancer cells to other parts of body. The dose is given for five days a week, usually for many weeks.

Palliative Radiation therapy

This treatment is given when the disease reaches a stage where apparently it is not possible to cure it. It is usually given to control further growth of cancer tissues. It is given in single dose over a very short time period.

Method of Radiation therapy
Radiation therapy can be applied in following ways,

External Radiation therapy (Radiotherapy)

In this method, radiation comes from a machine which is outside of the body. It is the most common method. In this technique, machine emits high energy X-rays which are then applied on affected areas. Equipment of this Radiation therapy is advanced, specialized and large in size.

Planning of Treatment Course

This treatment is planned by radiographers. It is based on three factors,

1. Type of cancer (type of leukemia).
2. Size of cancer.
3. Location of cancer.

The total dose of radiation which is required to treat the cancer is carefully calculated and divided into fractions.

Fraction

To minimize the side effects of total dose of radiation, the treatment is further divided into smaller dosage called fraction.
The patient is treated on all possible days in every week. Treatment finishes after the patient has received entries dosage.

Aims of Treatment Session

1. Focus the radiation on the correct side of the cancer cells.
2. Normal tissues should be carefully avoided from radiations to minimize the side effects.

CT scan technology is used to protect normal tissue.  With the help of latest advancement in CT scan, exact location of tumor can be calculated and therapy is applied on right angels with high precision.

Procedure of Treatment

Before first session, the therapist carefully determines the exact direction and position of affected areas, patient lays on a special table and then radiations emit from machine. To ensure that during each treatment beams of radiation is focused on the same point the specialist may use permanent ink or permanent tattoo to make a spot on skin or some technique may also be used. After settlement, therapist goes out in a separate room to protect himself from the repeated exposure of radiation. The therapist observes the entire situation via TV monitor or through window where patient still be able to talk to them.
Each treatment session lasts for few minutes.

Internal Radiation therapy (Radiotherapy)

In this therapy, radiation comes from liquids which are inside the body like blood. Liquid can contain radioactive substance. This substance is absorbed into the blood stream and taken up by both normal and abnormal cells then radioactive substance pin points the cancerous cells and destroys them. They have little side effect on normal tissues in the body but this effect is temporary, sometimes it may become permanent.

Radio Immunotherapy

In this technique radiolabeled antibodies are used to deliver dose of radiation at correct position of cancer.Antibodies are highly specific protein which is developed by body immune system in response to the presence of antigen. Some tumor cells contain specific antigens that cause the body to start the production of tumor-specific antibodies. These types of antibodies can be prepared in a large quantity in the laboratory known as radio labeling. When anti-bodies developed using radio labeling are injected into the body, the antibodies actively find out the cancer cells which are then destroyed by the cell-killing action of radiation.

Role of Drugs in Radiation therapy

Two types of drugs are used in Radiation therapy,
Radiosensitizer: Used to kill cancerous cells.
Radioprotector: Used to protect normal cells

Good things about Radiation therapy

1. Rays do not hurt, even patient don’t feel the radiation penetrating in the body.
2. Rays are not hot.

Side effects of Radiation therapy (Radiotherapy)

1. After starting treatment of external therapy, the area of skin from which the beams of radiation passes, becomes red, sore, itchy, and scary that may turn into painful wounds. Skin usually recovers its original look and feel  in 2-4 weeks after the treatment finishes. Sometimes spots on skin become permanent and the affected part of skin become darker than the surrounding normal skin.
2. Loss of hair.
3. Cerebral oedema, which affects the neurological conditions causing restlessness, headache, hypertension, nausea, low rate of heart pulse and decrease in respiration.
4. Change in taste sensing ability.
5. Sore throat.
6. May cause diarrhea and vomiting
7. May cause sterility in men and women.
8. May lead to tiredness, bruising and bleeding.

Leukemia is type of cancer which is caused by abnormal production of blood cells in bone marrow. Abnormal production means that bone marrow produces immature cells which can not perform regular functions. In Acute Myelogenous Leukemia, immature cells are produced at more rapid speed. Another problem with these immature cells is that these cells tend to remain in the body for longer time than normal cells. Normal blood cells die after about 120 days and new healthy cells replace old cells but leukemic cells do not die easily. With passage of time, AML cells replace most of the health cells in body.  AML require immediate treatment than chronic type of leukemia cancer because growth of leukemic cells is very fast in Acute Myeloid Leukemia.

Why this type of cancer is called Acute Myeloid Leukemia? All blood cells in bone marrow are produced from two types of basic cells including Myeloid and Lymphoid cells. Blood cells in our body consist of tree main types including white blood cells, red blood cells and platelets. Of these three types, white blood cells are further categorized into five sub type. Few of these types are produced from myeloid cells and few are produced from lymphoid source. Red cells and platelets are grown up form of myeloid cells. Myelogenous leukemia starts with a problem in myeloid source. Main reason for leukemia is abnormal production of white cells. But as red cells and platelets are also produced from myeloid sources, AML may also start to produce immature red cells and platelets.

Acute Myelogenous Leukemia symptoms

As in all types of leukemia cancer, body loses normal blood cells, mostly white cells. So the few symptoms are common in all types of leukemia. Acute Myelogenous Leukemia symptoms are following,

-         Spleen size may increase in AML

-         In other types of leukemia, swelling of lymph nodes is usually seen. But it is not common symptom in Acute Myeloid Leukemia.

-         Swelling in gums may be seen in some patients

-         Sudden and unexplained bruising

-         Solid looking tumor outside bone marrow.

-         Shortness of breath

-         In AML, as body also loses red blood cells. Red cells contain hemoglobin and are responsible for oxygen transportation in body. Lack of red cells lead to anemia and other such diseases.

Acute Myeloid Leukemia Diagnosis

Diagnosis of AML is done using following techniques,

-         Complete blood count test is taken. Increased count of white cells and white cells blast indicates possibility of leukemia. AML may also result in lack of red cells and platelets.

-         Optical microscopy and flow cytometry is used to examine bone marrow to find out leukemic cells. This technique is used to distinguish leukemia from other types of leukemia cancer. It is also used to find out sub type of AML.

AML Treatment

Treatment of Acute Myelogenous is usually done using chemotherapy and stem cells transplant. Chemotherapy is done in two phases, induction and consolidation.

The goal of induction phase is to achieve a phase where leukemic cells fall below detectable level. Consolidation therapy is then applied to kill all remaining immature cells. If induction therapy fails then stem cells transplantation option is used to treat AML. Stem cells transplantation is also used if the patient re-develops AML after successful induction therapy.

Chronic Lymphocytic Leukemia

Chronic Lymphocytic Leukemia is the most common type of leukemia cancer. Chronic Lymphocytic is abbreviated as CLL. It is also called Chronic Lymphoid Leukemia as it originates in lymphoid lineages. This type of leukemia is mostly seen in adult, generally in people around 50 years old. Technically it may appear in people of all age groups including children. Children may inherit this disease from their parent.

The word “Chronic” refers to the fact that this type of leukemia does not become fatal quickly. It is not necessary to treat CLL at early stages. In fact, CLL is monitored for long time (may be for years), and treated only if it starts to show any damage to body. CLL does not cause damage to body in quick time.

Lymphoid cells, a mature form of stems cells, are the origin of the production of leukocytes or white blood cells. Three white cells types including T cells, B cells and NK cells are produced from lymphoid cells. All these types are components of immune system. Our focus is no B-Cells. B-cells are root cause for chronic lymphocytic leukemia. The function of B cells is very important. B cells produce antibodies for immune system. Antibodies detect harmful substances in body like virus and bacteria. Antibodies not only detect harmful objects but also remove these objects. Damage in DNA of B cells causes CLL. As a result of this, excessive production of abnormal B cells takes place. These abnormal B cells fail to produce antibodies, exposing body to harmful substance and diseases.  The growth of these abnormal white cells is not that much rapid. But in long time, these cells may replace most of the normal platelets, white blood cells and red blood cells.

At very early stage, CLL does not show any prominent leukemia symptoms. At initial stage, CLL is only detected in routine CBC which points out increased count of white blood cells.  Normal white cells count is between 4000 and 1000. With the passage of time, CLL shows symptoms like swelling in lymph nodes, swallow spleen and liver. Patient also feels other leukemia symptoms like fatigue, loss of appetite, bruising, and anemia.visit CLL symptoms for more detail on CLL symptoms.

The diagnosis of CLL can be done with CBC, which shows count of white blood cells. B cells count greater than normal in blood, bone marrow or in other tissues indicate chronic lymphocytic leukemia.

Studies have shown that their in no advantage to treat CLL at initial stage.  Patients with CLL are examined time to time and treatment is initiated when CLL starts to turn fatal. It may take more than a decade. When treatment starts, its focus is to treat the symptoms of CLL rather than a complete cure. Treatment options include chemotherapy, radiation therapy, biological therapy and bone marrow transplant.

Leukemia is a fatal a disease. The question is,  at what stage it becomes fatal ? If the leukemia is caused by cells which at very initial production state(less mature), the disease becomes fatal within weeks if left untreated. “ACUTE” refers to the fact that leukemia becomes deadly dangerous in a very short period of time. As it becomes fatal very quickly, it should be treated immediately. Acute lymphocytic leukemia is generally seen in childhood or in old age. Mostly children become the victim of Acute lymphocytic leukemia. Acute Lymphocytic leukemia is abbreviated as “ALL”.

Symptoms of acute lymphocytic leukemia are similar to other leukemia types. These symptoms include anemia (Paleness), fatigue, bruising due to lack of platelets, join pain (due to presence of abnormal cells in bone surface or cavity), weight loss, night sweats, swelling in lymph nodes and limbs.

Acute Lymphocytic Leukemia Treatment

The objective of treatment is to reduce the number of abnormal cells. The goal of all treatments is to minimize the ratio of blast cells to less than 5 % at bone marrow. As abnormal cells spread all over the body, there is no surgical solution to treat leukemia. Available option include followings,

Chemotherapy

Chemotherapy is commonly used in treatment of cancer. It is treatment of diseases using chemicals. Chemotherapy kills abnormal white cells that are root cause of leukemia. Chemotherapy of leukemia consists of three phases. Treatment may take up to 2-3 years.

Radiation Therapy Treatment

In this treatment, high energy radiations are used to kill the tumor cells. This treatment is applied to body parts which are under high attach. It is also used in bone marrow transplant process. Radiation therapy damages the DNA of cells and as result of this, cells die. This may also damage normal body cells, so the treatment should be applied very carefully. Visit following link to read more about Radiation Therapy,

Cancer Treatment with Radiation Therapy

Bone Marrow Transplant

Aggressive chemotherapy may result in damage to bone marrow. As of result of this damage, bone marrow may fail to further produce normal cells.  In this case bone marrow transplant is required. Visit following link to read about bone marrow transplant,

http://leukemia-symptoms.thehealthinfo.net/2010/10/what-is-bone-marrow-bone-marrow-cancer-bone-marrow-test/

Steroids and other such medicines are also used in acute lymphocytic treatment. Often a mixed treatment approach is used to get rid of Leukemia.