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                                                                                                  Blood cancer


Question.  What is blood cancer? How does blood cancer present?

Answer.  Blood is composed of different types of cells like white blood cells, red blood cells and platelets.  In blood cancer White blood cells start dividing fast and suppress normal cells and their function. Blood cancers involving white blood cells is mainly of two types lymphoid or myeloid. Both blood cancers can be either acute or chronic type.  In acute type patient usually develops symptoms of fever and infections, while in chronic type usually patients are nearly asymptomatic until later stages. Many a times these blood cancers are picked up only in blood investigations done for or some other reason.

There is another subtype known as lymphoma. This is not exactly a type of blood cancer but in this lymph nodes in the body swell up.

Question.  One of my relatives is diagnosed with acute lymphoid leukaemia,  how does the treatment progress?

Answer.  In this type of leukaemia usually a chemotherapy is started known as induction for a month following which patient is discharged and readmitted for another cycle of induction.  During induction patient needs good nursing care and prevention of infection. After induction chemotherapy immunity goes down, so patients are prone for infections. Patients may also require blood transfusions for platelet transfusion during this time.  After the course of induction chemotherapy a maintenance chemotherapy is followed for 2 years. Treatment is largely based on the choice of chemotherapy protocol chosen by the oncologist.


Question.  How does treatment of acute myeloid leukaemia differ from acute lymphoid leukaemia?

Answer.  An important difference is that in myeloid leukaemia we do not give steroid while steroid is an important treatment component in lymphoid leukaemia.  Another important difference from a patient’s perspective is that there is no maintenance phase with oral tablets in acute myeloid leukaemia. We give induction chemotherapy which is just 7 days following which admission needs to be continued for supportive care like blood transfusion and infection treatment. After a gap of one month consolidation of 2 to 3 cycles over three months is usually given. After this treatment the patient is kept on regular follow up with blood investigations only.


Question.  My doctor has offered  bone marrow transplant to me? Is it compulsory? Is it dangerous?

Answer.  In today's world we send certain Genetic tests to find out if the leukaemia is aggressive or not and also to assess the chances of recurrence. If it is a highly aggressive leukemia or one with high chances of recurrence then we  offer bone marrow transplantation. Bone marrow transplantation is also offered in relapse cases.

There are multiple misconceptions regarding bone marrow transplantation. It does not involve surgery for removal of bone or bone marrow from one patient to another. There is pre transplant investigation for finding out patient’s match. Complete match improves the chances of successful transplantation.

Donor is given 13 injections to increase stem cells in the blood and then blood is filtered for these stem cells. When stem cells are filtered out of donor they are kept in the fridge. The patient then receives another set of chemotherapy following which these stem cells are given via injection.

Transplantation has no risks for the donor. However the recipient may develop certain complications because of chemotherapy or because of the foreign stem cells in the patient.  Sometimes when the matching is not complete these complications can be life threatening.

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