Chronic Leukemia

What is Chronic Leukemia?

This is also known as chronic granulocytic anaemia, chronic myeloid leukaemia or chronic myelocytic leukemia. These names are mentioned, for a patient with the disorder may have heard of these various terms.

It means that there is a malignant change in the bone marrow involving the granulocyte type of white blood cells.

The disease is rare in children and the very old. Most cases occur in those in the 30-60-years age group, and the sexes are affected equally. There are certain known causes. As with acute leukaemia, these include exposure to nuclear explosions, and in patients receiving radiotherapy for other disorders (most commonly for ankylosing spondylitis, a chronic painful and crippling back disorder). It is also seen in patients who were X-rayed repeatedly as a check for artificial pneumothorax, which was widely used for treatment of certain chest diseases in the past.

Chronic Leukemia Symptoms

The most common symptoms include fatigue and lassitude, feeling listless and weak, “off-color,” and abdominal swelling or frank pain due to enlargement of the spleen. There may be loss of weight, the symptoms of anaemia (see anaemia) or purpura (bruising).

Sometimes the disease is found by chance when a blood test is being carried out for some other purpose. Almost always there is enlargement of the spleen and this may be massive. Sometimes the lymph glands may be involved; this is not a good sign. Sometimes the skin and bones may be involved as well. The blood picture usually confirms the diagnosis and white-cell counts of 100 or more are common. (The normal figure is between 4.0 and 11.0 x 10 9/L.) All forms of developing white cells are seen, from the very immature to the well-developed. Often the platelet count is also raised.

Chronic Leukemia Treatment

At present the medication of choice is one called busulphan, given orally. Gradually the white-cell count drops. When this reaches the relatively normal figure of 10.0, maintenance doses are given.

Gradually this may be replaced with other forms of drug therapy, similar to those used for acute leukaemia. Busulphan has virtually replaced other forms of treatment that were popular in the past, including radiotherapy and other forms of chemotherapy.

A wide range of drugs has been used with varying degrees of success in leukaemia. Long-term, most fail, for the disease is often a fatal one. Many drugs, which appear to be promising at first, later prove to be less effective. Marrow transplants have been tried, and these also have proved successful in some patients, but often relapses have taken place as time advances. Patients with this disease will be under the care of experts in the field, and ideally attached to major public hospitals where the full range of facilities, at that time, will be made available. In short, despite our advances with modern drugs, technology, transplants and success in the field of acute cases, the outlook for older persons with leukaemia is still not good. Other aspects of the disease must be treated as supportive measures.

Antibiotics will be given to check any infection. Anaemia will be treated, and may require repeated blood transfusions. Platelets may be needed for the clotting abnormalities. With the early stages of treatment there is often a rise in the level of uric acid in the blood, and the drug al-allopurinol is often ordered. Otherwise, bouts of acute gout may complicate the picture as well as making life one of abject misery for the unfortunate patient.

Therapy has vastly improved the quality of life for these patients, but, sad to relate, it has not materially augmented the total life span. The disease is inevitably fatal. However, it is now possible for many to live relatively symptom-free lives for the two to three years that usually occur from the time of diagnosis to the time of death.