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Chronic Myelogenous Leukemia
Leukemia is a general term for cancer of the blood (white blood cells). Blood is made in the bone marrow, a spongy material inside the bones. Blood is made up of:
· Red blood cell which containhaemoglobin to carry oxygen around the body
· White blood cells which fight infections
· Platelets which help to prevent and stop bleeding
The bone marrow produces two main types of white blood cells: neutrophils and lymphocytes, which work together to fight infections.
Chronic myeloid leukemia (CML) is a cancer of the neutrophils. Production of white blood cells normally takes place in an orderly and controlled manner, but in leukemia, the process gets out of control, resulting in too manywhite cells. Over a period of time, the bone marrow progressively becomes replaced by the ‘bad cells’ at the expense of the normal white cells, red cells and platelets. The disease usually progresses very slowly, hence the term “chronic’.
Chronic myeloid leukemia can occur at any age, but it more commonly affects middle-aged and older people.
There are three other types of leukemia: chronic lymphocytic leukemia (CLL), acute myeloblastic leukemia (AML) and acute lymphoblastic leukemia (ALL).
Chronic myeloid leukemia (CML)
What Is Leukemia?
Leukemia is cancer that starts in the tissue that forms blood. To understand cancer, it helps to know how normal blood cells form.
Normal Blood Cells
Most blood cells develop from cells in the bone marrow called stem cells. Bone marrow is the soft material in the center of most bones. Stem cells mature into different kinds of blood cells. Each kind has a special job:
White blood cells help fight infection. There are several types of white blood cells.
Red blood cells carry oxygen to tissue
Platelets help form blood clots that control bleeding
White blood cells, red blood cells, and platelets are made from stem cells as the body needs them. When cells grow old or get damaged, they die, and new cells take their place.
The picture below shows how stem cells can mature into different types of white blood cells. First, a stem cell matures into either a myeloid stem cell or a lymphoid stem cell:
- A myeloid stem cell matures into a myeloid blast. The blast can form a red blood cell, platelets, or one of several types of white blood cells.
- A lymphoid stem cell matures into a lymphoid blast. The blast can form one of several types of white blood cells, such as B cells or T cells.
Most blood cells mature in the bone marrow and then move into the blood vessels. Blood flowing through the blood vessels and heart is called the peripheral blood.
Leukemia Cells
In a person with leukemia, the bone marrow makes abnormal white blood cells. The abnormal cells are leukemia cells.
Unlike normal blood cells, leukemia cells don’t die when they should. They may crowd out normal white blood cells, red blood cells, and platelets. This makes it hard for normal blood cells to do their work.
Types of Leukemia
The types of leukemia can be grouped based on how quickly the disease develops and gets worse. Leukemia is either chronic (which usually gets worse slowly) or acute (which usually gets worse quickly):
• Chronic leukemia: Early in the disease, the leukemia cells can still do some of the work of normal white blood cells. People may not have any symptoms at first. Doctors often find chronic leukemia during a routine checkup—before there are any symptoms.
Slowly, chronic leukemia gets worse. As the number of leukemia cells in the blood increases, people get symptoms, such as swollen lymph nodes or infections. When symptoms do appear, they are usually mild at first and get worse gradually.
- Acute leukemia: The leukemia cells can’t do any of the work of normal white blood cells. The number of leukemia cells increases rapidly. Acute leukemia usually worsens quickly.
The types of leukemia also can be grouped based on the type of white blood cell that is affected. Leukemia can start in lymphoid cells or myeloid cells. Leukemia that affects lymphoid cells is called lymphoid, lymphocytic, or lymphoblastic leukemia. Leukemia that affects myeloid cells is called myeloid, myelogenous, or myeloblastic leukemia.
Thus there are four common types of leukemia:
- Chronic lymphocytic leukemia (CLL): CLL affects lymphoid cells and usually grows slowly. It accounts for most new cases of leukemia each year. Most often, people diagnosed with the disease are over age 55. It almost never affects children.
- Chronic myeloid leukemia (CML): CML affects myeloid cells and usually grows slowly at first. It mainly affects adults.
- Acute lymphocytic (lymphoblastic) leukemia (ALL): ALL affects lymphoid cells and grows quickly. ALL is the most common type of leukemia in young children. It also affects adults.
- Acute myeloid leukemia (AML): AML affects myeloid cells and grows quickly. It occurs in both adults and children.
Symptons
Like all blood cells, leukemia cells travel through the body. The symptoms of leukemia depend on the number of leukemia cells and where these cells collect in the body.
People with chronic leukemia may not have symptoms. The doctor may find the disease during a routine blood test.
People with acute leukemia usually go to their doctor because they feel sick. If the brain is affected, they may have headaches, vomiting, confusion, loss of muscle control, or seizures. Leukemia also can affect other parts of the body such as the digestive tract, kidneys, lungs, heart, or testes.
Common symptoms of chronic or acute leukemia may include:
- Swollen lymph nodes that usually don’t hurt (especially lymph nodes in the neck or armpit)
- Fevers or night sweats
- Frequent infections
- Feeling weak or tired
- Bleeding and bruising easily (bleeding gums, purplish patches in the skin, or tiny red spots under the skin)
- Swelling or discomfort in the abdomen (from a swollen spleen or liver)
- Weight loss for no known reason
- Pain in the bones or joints
Most often, these symptoms are not due to cancer. An infection or other health problems may also cause these symptoms. Only a doctor can tell for sure.
Treatment
People with leukemia have many treatment options. The options are watchful waiting, chemotherapy, targeted therapy, biological therapy, radiation therapy, and stem cell transplant. Sometimes a combination of these treatments is used.
The choice of treatment depends mainly on the following:
- The type of leukemia (acute or chronic)
- Your age
- Whether leukemia cells were found in your cerebrospinal fluid
Targeted Therapy
People with chronic myeloid leukemia (CML) and some with acute lymphoblastic leukemia (ACL) may receive drugs called targeted therapy, which are a breakthrough in the treatment of cancer. Imatinib (Glivec) tablets developed by Norvatis, were the first targeted therapy approved for chronic myeloid leukemia as well as a type of stomach cancer called GIST.
Since Glivec was approved in 2001, researchers have hoped that every new cancer therapy would copy its success: a convenient pill that lets patients live for years with relatively few serious side effects. Though experts say few of the new "targeted" therapies come close to that ideal, they do have one thing in common with Glivec: They're all incredibly expensive. With an annual cost of over Sh2.7 Million, and most patients needing to take the drug for a lifetime, this life saving drug is beyond the reach of most people even in developed countries.
GIPAP
Glivec International Patient Assistance Program (GIPAP) was developed by Novartis to provide access to its breakthrough cancer therapy Glive. The Program provides Glivec at no cost to eligible patients in developing countries who meet specific medical and socio-economic guidelines. Novartis is responsible for identifying qualified medical centers and physicians in collaboration with The Max Foundation. Novartis donates and supplies Glivec to qualified treatment centers. GIPAP also provides information and referral assistance to patients, their family members and caregivers. Specifically:
- GIPAP helps patients who are properly diagnosed with Philadelphia chromosome-positive (Ph+) chronic myeloid leukaemia (CML) patients and to patients with c-Kit (CD117) positive unresectable (inoperable) and/or metastatic malignant astrointestinal stromal tumours (GISTs).
- GIPAP helps patients who are not insured, not reimbursed, cannot pay for treatment privately, and are in developing countries that have minimal reimbursement capabilities.
Henzo GIPAP Kenya |
Patient Support Group: Helping Patients and their caregivers cope with the diagnosis of Cancer
Generosity is a contagious emotion. An act of kindness can create a ripple effect well beyond its original scope. The combined efforts of a drug manufacturer who provides free treatment for those most underserved; a physician who dedicates him or herself to their patients, and an organization that holds the patient’s hand, have a tremendous impact on those individuals who are affected by it. |
Gastrointestinal Stromal Tumor (GIST)
Gastrointestinal stromal tumor:
What GIST is
GIST is a rare type of sarcoma found in the digestive system, most often in the wall of the stomach. Some GISTS are benign (not cancerous) but they can become cancerous if not treated. Generally speaking, the larger the GIST, the more likely it is to be cancerous.
These tumours have a rather complicated name. Gastrointestinal means they start in the digestive system (the gastrointestinal tract). Stromal means they develop from tissues that support the connective tissues controlling the movements of the gut. Tumour means a lump or growth in the body.
About 6 out of 10 of these tumours start in the stomach, but they can begin anywhere in the digestive system, for example in the bowel or foodpipe (oesophagus). Very rarely, they develop outside the gastrointestinal tract.
These tumours are most common occur in people between 50 and 70 years old. We don't really know the cause but a condition called neurofibromatosis (NF) can increase the risk of developing it. In rare cases, GIST can develop in children.
Symptoms of GIST
People with early stage GIST often do not have any symptoms. They may be found when doing tests for other medical conditions. Most GISTs are diagnosed in later stages of the disease when it has already spread to other organs such as the liver. The symptoms of advanced GIST are likely to include
- Pain or discomfort in the tummy (abdomen)
- A feeling of fullness
- Being sick
- Blood in stools or vomit
- Feeling very tired
- A low red blood cell count (anaemia)
Other medical conditions apart from GIST can cause these symptoms. If you have these symptoms you should see your doctor. It may be nothing serious but it is always best to check.
Treatment for GIST
The most common treatment used is surgery and this alone may be a cure for people with small tumours. But larger tumours are less likely to be completely removed. If the GIST has spread to other parts of the body, it is sometimes possible to remove these secondary tumours too. Chemotherapy and radiotherapy don't work well for GIST, so researchers have been looking for other types of treatment.
Glivec (imatinib) is often used to treat GIST that can't be completely removed with surgery. Glivec is a type of biological therapy called a tyrosine kinase inhibitor. This means it blocks a chemical (an enzyme) that the cancer needs in order to grow. Glivec is a tablet. So you can have treatment at home.
Your surgeon removes a sample of your tumour during your operation and sends it to the laboratory. A specialist tests the cells to confirm the diagnosis of GIST, and to see if the cells have a receptor on their surface called CD117. If the cells are CD117 positive, Glivec is likely to work very well. But it can work even for GISTs that are CD117 negative.
Since Glivec was approved in 2001, researchers have hoped that every new cancer therapy would copy its success: a convenient pill that lets patients live for years with relatively few serious side effects. Though experts say few of the new "targeted" therapies come close to that ideal, they do have one thing in common with Glivec: They're all incredibly expensive. With an annual cost of over Sh2.7 Million, and most patients needing to take the drug for a lifetime, this life saving drug is beyond the reach of most people even in developed countries.
GIPAP
Glivec International Patient Assistance Program (GIPAP) was developed by Novartis to provide access to its breakthrough cancer therapy Glive. The Program provides Glivec at no cost to eligible patients in developing countries who meet specific medical and socio-economic guidelines. Novartis is responsible for identifying qualified medical centers and physicians in collaboration with The Max Foundation. Novartis donates and supplies Glivec to qualified treatment centers. GIPAP also provides information and referral assistance to patients, their family members and caregivers. Specifically:
- GIPAP helps patients who are properly diagnosed with Philadelphia chromosome-positive (Ph+) chronic myeloid leukaemia (CML) patients and to patients with c-Kit (CD117) positive unresectable (inoperable) and/or metastatic malignant astrointestinal stromal tumours (GISTs).
- GIPAP helps patients who are not insured, not reimbursed, cannot pay for treatment privately, and are in developing countries that have minimal reimbursement capabilities.
Henzo GIPAP Kenya
|
Patient Support Group: Helping Patients and their caregivers cope with the diagnosis of Cancer
Generosity is a contagious emotion. An act of kindness can create a ripple effect well beyond its original scope. The combined efforts of a drug manufacturer who provides free treatment for those most underserved; a physician who dedicates him or herself to their patients, and an organization that holds the patient’s hand, have a tremendous impact on those individuals who are affected by it. |