Myeloid Leukemia Definitions, Symptoms & Management

Myeloid leukemia which is cancer of the blood or bone marrow with a characteristic increase in white blood cells can have a good prognosis if certain conditions are managed effectively.

Good nutrition is very important as far as the patient’s therapy is concerned. This especially is very significant for children. When the child is being treated for myeloid leukemia, the child’s weight and height are measured constantly and compared with children of the same age category. This enables the child’s medical management team to make best decisions for him or her when it comes to issues of nutritional needs.

It cannot be overemphasized that good nutrition is an important part of the treatment of myeloid leukemia therefore establishing good prognosis. Good nutrition provides fuel for our bodies to repair and replace damaged cells. If the patient is well nourished during the cause of the disease, he will tolerate treatment better, possibly have fewer side-effects, maintain and gain weight, recover faster from treatment and consequently have more energy.

Major side effects of myeloid leukemia during chemotherapy are nausea and vomiting. This is however largely expressed in children. Taking steps to reduce these side effects will go a long way to improve the prognosis of myeloid leukemia.As simple as it might sound, eating and avoiding certain foods can help reduce these side effects in myeloid leukemia. The patient undergoing chemotherapy and experiencing severe bouts of nausea and vomiting can try the following:

1. Eat low fat foods because these can smell less and hence patient becomes less sensitive to it.

2. Eat small but frequent foods.

3. Avoid drinking hot liquids or a lot of liquids accompanying meals as these can trigger nausea.

4. Eat cold foods because these tent to smell less and hence patient especially children becomes less sensitive.

5. Avoid eating overtly sweet, high-fat, strong smelling and spicy foods until the nausea goes away.

6. Sip liquids more slowly through a straw.

7. Drink small amounts of liquid often throughout the day.

8. Eat dry crackers or toast more importantly before moving.

It should also be mentioned that medications such as antiemetic can be used to these side effects of myeloid leukemia.

During the treatment of myeloid leukemia, certain procedures such as needle penetrations, finger pricks, lumbar punctures, bone marrow aspirations etc will be very unpleasant to the patient. Adequate management of this pain as a result of the invasive procedures might sharpen the prognosis of the patient to his favor. Considering their adverse side effects, medications are not the only ways to relieve pain. Imagery and relaxation are very common techniques to reduce uneasiness and pain.

This involves a series of exercises that focus on relaxation, meditation, muscle tension and breathing. Deep breathing helps to manage pain by relaxing the body. Maximum results are achieved when you slowly breathe in through your nose and out through your mouth, making sure that each breath lasts for at least five seconds. You can use imagery by picturing the activities that happened on your wedding day or blowing of a balloon for children.

Treatment Of Myeloid Leukemia Prognosis

Treatment of myeloid leukemia consists mainly of chemotherapy and is divided into the induction and the post remission sometimes called the consolidation therapies. The main aim of the induction therapy is to achieve complete remission by limiting the amount of leukemic cells to an amount that is not detectable. However the goal of the post remission therapy is to eliminate any residual undetectable disease and to achieve total curation.

The main drugs used in chemotherapy include cytarabine and antracycline etc. Induction chemotherapy is commonly known as “7+3” or “3+7 because cytarabine is administered as a continuous intravenous infusion for seven consecutive days while anthracycline is given for three consecutive days. About 70% of patients achieve remission with this regime. However other alternative induction protocols including high-dose cytarabine alone may be used. Considering the possibility of toxic effects of therapy such as myelosuppresion and increased risk of infections etc, induction therapy may not be suitable for the elderly.

Consequently palliative care or less intensive chemotherapy may be employed. The M3 subtype of acute myeloid leukemia is mostly treated with the drug ATRA (all-trans-retinoic acid) in addition to the induction chemotherapy. This should be carried out carefully to prevent the occurrence of disseminated intravascular coagulation (DIC), complicating the treatment of myeloid leukemia when promyelocytes release the contents of their granules into the peripheral circulation.

The main aim of the induction phase is to reach a complete remission. Complete remission in patient with myeloid leukemia, however does not mean an absolute removal of the disease; rather it signifies the disease cannot be detected with available diagnostic methods. Complete remission can be achieved in about 50%-75% of newly diagnosed adults which is however based on certain prognostic factors. The duration of remission depends on the prognostic features of the original leukemia. In a general view all remissions will not be effective without additional consolidation therapies.

A specific type of post remission therapy for myeloid leukemia is based on the patient’s prognostic factors and general health. For a good prognosis a patient with myeloid leukemia will undergo an additional 3-5 course of intensive chemotherapy. For patients with a high risk tendency, allogenic stem cell transplantation is usually recommended on the grounds that the patient is able to tolerate a transplant and has a suitable donor. The best post remission therapy for immediate-risk acute myeloid leukemia depends on the specific situation, including the age and overall health of the patient, the personal values of the patient and whether or not there is an available suitable stem cell donor.

Despite a well planned out therapy, most often than not only 20%-30% of patients enjoy long term disease free survival. For patients with relapsed acute myeloid leukemia, the only proven curative measure is stem cell transplantation. Patients with relapsed myeloid leukemia who are not qualified for stem cell transplantation may be offered treatment in a clinical trial, as conventional treatment options are limited. Under investigation include cytotoxic drugs such as clofarabine as well as targeted therapies such as farnesyl transferase inhibitors, decitabine and inhibitors of multidrug-resistance protein.

Myeloid Leukemia Prognosis Facts

Myeloid leukemia can be managed and sometimes can be treated. This however depends on various factors which are patient dependent.  Prognosis of myeloid leukemia can be long or short this depends on certain factors such as the nature of the leukemia cells.

Patient’s age and race are also key points in determining the myeloid leukemia prognosis. Younger patients and Caucasians invariably have a good prognosis.

Considering subtypes of acute myeloid leukemia, those with M3 have a good prognosis whereas those with M7 have a poor prognosis.

Myeloid leukemia prognosis can also be based on patients respond to therapy. Myelody splastic syndrome or myeloproliferative diseases have a poor prognosis as well as those with elevated levels of lactate dehydrogenase .

One important denominator that determines the prognosis of acute myeloid leukemia is its complications. More severe complications, will give poorer prognosis. Some of the complications include; disseminated intravascular coagulation, megaloblastic anemia, neutrophil nuclear hyper segmentation, neutrophilia and hypokalaemia.

One important factor of determining the prognosis of acute myeloid leukemia is cytogenetic or chromosomal structure of the leukemic cell.

Cure rates in clinical trials have ranged from 20-45%, however it should be noted that clinical trials often include only younger patients and those able to tolerate aggressive therapies. The overall cure rate for all patients with myeloid leukemia including the elderly and those unable to tolerate aggressive therapy is likely lower. Cure rates for promyelocytic leukemia can be as high as 98%

Without treatment, most people with myeloid leukemia die within a few weeks and sometimes may even take months to the period of diagnosis. With the advent of therapy, about 20 -40% of patients survive for at least five years without much relapses. This is because relapses almost always occur within the first five years after initial treatment. However most people who remain leukemia-free after 5 years are considered cured. Most often people who have the poorest prognosis are those older than sixty, those who develop myeloid leukemia after undergoing chemotherapy and radiation therapy for other cancers and those whose cases evolved slowly after a period of months to years of abnormal blood counts.

In cases of chronic myeloid leukemia, there are some prognostic factors which determine the survival of the patient. These are also helpful when choosing treatment. Factors that are linked to shorter survival time are called adverse and they include; accelerated phase or blast phase, swollen spleen, areas of bone damage due to growth of leukemia, increased number of certain types of cells in blood samples and very high or very low platelet counts.

Majority of the factors used above are used in the Sokal system, which gives a score to predict outlook. It takes into account the persons age, the size of the spleen, the numbers of the different kinds of cells, the the percentage of the patients blasts and other factors. The Sokal system has been in use in time past but it is however unclear these days in its ability to predict a person’s outlook.

Living With A Myeloid Leukemia Prognosis

Majority of the signs and symptoms of myeloid leukemia are caused by the replacement of normal cells with leukemic cells. Inadequate amount of normal white blood cell production makes the patient susceptible to infections. Though the leukemic cells themselves are derived from white blood cell precursors, they have no infection-fighting capacity. Low levels of red blood cell count i.e. anemia can cause shortness of breath, fatigue, paleness. In addition lack of platelets can lead to easy bruising or bleeding with minor trauma. The early signs of acute myeloid leukemia most often than not are vague and non specific. This may be similar to the symptoms of influenza or other common diseases. Some of the broad symptoms most often spoken about include weight loss, Loss of appetite, fever, fatigue, anemia and petechiae etc. Others include bone and joint pain and persistent or frequent infections.

Very often noticed in patients with myeloid leukemia is enlargement of spleen but it is mostly mild and asymptomatic. It is worth noting that lymph node swellings are often rare. The skin is involved about 10% of the time in the form of leukemia cutis. Some patients however may experience swelling of the gums due to the infiltration of leukemic cells into the gum tissue. Sometimes the first sign of leukemia may be the development of solid leukemic mass or tumor outside of the bone marrow called a chloroma. In cases of no symptoms, myeloid leukemia may be discovered during the analysis of routine blood test.

Hearing that a relative has myeloid leukemia can be upsetting and scary. Dealing with the sudden change in lifestyle can be overwhelming. It is very imperative to set aside one day at a time to help you manage and adjust to your new reality.  Emphatically, you and your sick patient and your entire family may require help adjusting to new demands of treatment and the obvious side effects of chemotherapy such as hair loss and weight gain. A combination of the family and the health care team can help smooth your relative’s journey through treatment by understanding his worries. You can also help him develop coping strategies that he can use during treatment.

One important factor worth discussing in living with myeloid leukemia is the behavioral changes that happen in patients especially children. Several children who have myeloid leukemia learn to adjust to their situation over time however with the support of adults. A behavioural change in children most importantly depends on the child’s age.

Each age and stage of life brings a different set of challenges; a toddler with myeloid leukemia can behave differently from a school aged child. Anger, crying, fussiness and tantrums etc can be of normal behavior for younger children at certain times. However school-aged children sometimes feel nervous about their disease. Other children may show serious behaviors like becoming withdrawn, not sleeping well, having problems with relationships, becoming very anxious and refusing to take treatment. As far as teenagers are concerned, they feel so frustrated because of their loss of independence. On approaching adulthood, they are faced with new issues, both physically and socially which attempts to affect their care. They are very much sensitive to changes in appearance and irritability.

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