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“Leukemia” or “blood cancer” is a disorder originating in the bone marrow.
“Blood” contains three types of blood cells: red blood cells, white blood cells, and platelets. Going into more detail, the blood cells that mature into adults
are able to perform their functions… “Red blood cells carry oxygen from the lungs to the various parts of the body. White blood cells act like soldiers… fighting and defending, while platelets stop bleeding when it occurs.”
Prof. Dr. Surapol Issaragrisil, Senior Director of the Bangkok Hematology Center, Wattanosoth Hospital, explains that normally all three types of blood cells are produced in the factory located in the bone marrow, starting from the very first cell called the stem cell… that is, a cell with the capacity to become all three types of blood cells, and able to divide into new cells that retain all of the same properties.
The question is… “Which cell is leukemia a disease of?”
The answer is… it is a disease of the cell that comes after the stem cell, the one that would develop into white blood cells.
These cells become abnormal, multiplying in enormous numbers, that is, multiplying in a “cancerous” way, multiplying “relentlessly,” multiplying constantly until everything is full of them.
“Now, these cells are the most immature white blood cells, and they do not emerge into the bloodstream… Since they do not come out, they accumulate in the bone marrow, building up more and more.
They then crowd out the production of normal blood cells. As a result… the patient's normal blood cells all decline… red blood cells, white blood cells, and platelets alike.”
When red blood cells decline, problems arise: “anemia, fatigue, paleness.”… When white blood cells decline, it is like having fewer soldiers, leading to illness, infection, and fever… When platelets decline, abnormal bleeding occurs… All of these are symptoms of “acute leukemia.”
Acute leukemia is considered the most severe form of cancer, because it affects the bone marrow, which is the main production factory. Consider other types of cancer:
With those, once chemotherapy is given and it begins to affect blood cell production, the medication has to be stopped. But with leukemia… even before the medication is given, the normal blood cells are already completely depleted.
“With this disease, if not treated correctly, most patients will die within 3 months… 6 months means the condition is very advanced.”
Turning to the treatment methods, Dr. Surapol shared his experience, explaining that we have to administer chemotherapy to kill and destroy the leukemia cells. The problem is that chemotherapy is like poison, and complications can arise.
And most importantly… the medication does not selectively kill only the cancer cells, but kills normal cells as well.
During the first two… three weeks of treatment, the patient is in very poor condition, and treatment must focus on supportive care. But if… the patient is fortunate, after one course of chemotherapy, the disease enters a phase called “remission.”
This means there are fewer than 5 percent “leukemia cells” in the bone marrow, and the normal bone marrow recovers… bounces back, producing normal blood cells… in normal numbers. The main problem of “acute leukemia”
is also that, once we treat it with chemotherapy and the disease enters remission, the disease can still come back.
The physician's duty is therefore… how do we keep the disease in remission so that it does not return?
“Fewer than 5 percent is considered remission, but the problem is that it is not completely gone… some still remains. Killing… destroying cancer cells with chemotherapy reduces them in proportion, for example, from ten thousand… down to a thousand, from a thousand… down to a hundred, from a hundred… down to ten, from ten… down to one.”
To cure leukemia completely, the treatment must… include a stem cell transplant, or hematopoietic stem cell transplant, as part of the regimen… From experience, we first give high-dose chemotherapy to eliminate the leukemia cells, and then introduce the bone marrow or stem cells.
Where can these “stem cells” be found? In most cases they must come from a sibling with the same parents, who has the genetic characteristics relevant to transplantation that match.
The chance of a 100 percent exact match across every marker… is around 25 percent.
The other 75 percent who do not match means no donor can be found. Prof. Dr.
Surapol also explained that bone marrow transplantation helps in the way already described: the high-dose chemotherapy given before the stem cells, together with the stem cells themselves, which contain white blood cells called the donor's lymphocytes.
“When introduced, they destroy the leukemia cells remaining in the patient, which leads to a complete cure.”
As an ongoing improvement over the past, stem cells… previously had to be aspirated
from the bone marrow at the lower back… about 1 liter for an adult. Nowadays, medication can be given to mobilize stem cells from the bone marrow into the blood, making it possible to collect stem cells from the blood.
And the highlight, as mentioned, is that the stem cell donor had to be a sibling with a 100 percent genetic match. If there was no match, one had to search for an altruistic person who had registered as a donor with the Thai Red Cross Society, and finding one took a long time, was costly, and some patients… could not wait.
Now there is a new technology that makes it possible to transplant stem cells from a donor who is only a half match, someone who has the genetic characteristics relevant to transplantation matching by half, for example a father or mother donating to a child, a child donating to a parent, or a half-matched sibling, which can also be used, making it possible to perform transplants in 100 percent of cases.
Everyone can be treated with a stem cell transplant. This has been a popular topic over the past 2-3 years. In our country it began at Siriraj Hospital and Bangkok Hospital, using this new technique… after the stem cells are given, 3-4 days later chemotherapy is administered to destroy the activated cells that would trigger an immune reaction.
This makes the transplantation of “stem cells” or “hematopoietic stem cells” successful.
In summary, “acute leukemia” is a serious disease. The treatment is to administer chemotherapy until the patient enters the phase called… “remission.” After that, a way must be found to prevent the disease from recurring. The best approach, especially for the highest-risk group, is to give high-dose chemotherapy followed by a stem cell transplant.
“The true causes of these diseases are unknown to anyone, but they may be associated with chemicals or electromagnetic fields… Studies comparing patients with healthy people who do not have the disease have found a correlation. For example, those living near high-voltage power lines have a higher chance of developing it, but this is not a direct 100 percent cause.”
As for age, the older one gets, the greater the chance of developing it. As an initial observation, if you have the symptoms mentioned… anemia, fatigue, paleness, fever, or petechiae on the body, these may occur singly, in pairs, or all three at once.
“Abnormal cells that can turn into cancer arise all the time in people.
Normally, the body already has an immune system to handle these abnormal cells that constantly arise. But whenever we are stressed, depressed, or experiencing great suffering, the immune system declines. As a result… the abnormal cells multiply and can develop into disease. We must not be stressed.”
concluded Prof. Dr. Surapol Issaragrisil, Senior Director of the Bangkok Hematology Center.
