Awareness Is The Greatest Agent To Change

Symptoms

The signs and symptoms of AML are common to other, less serious illness. There is usually a short history of 5-7 days before symptoms become more severe. Symptoms resemble those mentioned above for ALL except that lymph node, spleen, liver enlargement is less common and bleeding , fever is more prominent. In addition AML can present as mass of tumour cell in any part of body (myeloid sarcoma).

Treatment

Most AML patients, particularly patients with high WBC counts, need treatment soon after diagnosis because of rapid disease progression. After diagnosis, initial aim is to get disease under control or in remission. Long term goal is to cure the disease.

• Chemotherapy
• Chemotherapy followed by BMT
• Exact choice depends upon many factors like age, type of disease etc.

CLL is the most common leukemia of the west and second most common in India. It is usually diagnosed on routine blood test (CBC) in otherwise healthy patient, where there is increase in a specific type of cell(Lymphocyte). Most of the CLL patients do not require treatment, which is initiated only when CLL becomes symptomatic.

Most common indications to start treatment are :

• Weakness, Fever
• Large Lymph Nodes
• Large Spleen
• Rapidly Increasing Lymphocyte Count
• Anaemia or Low Platelet Count
• Even if treatment is required, it is effective and long term disease control can be achieved.

Major Advances in Leukemia

• Cure of Childhood Acute Lymphoblastic Leukemia (ALL)
  ALL was fatal for every child who was diagnosed in the 1960s, but today, after new combinations of drugs were developed and aggressive treatment of the brain and spinal fluid were incorporated, approximately 80 percent of children with the disease are cured. Even in relapsed ALL CAR T cell therapy and Antibody therapy (Blinatumomab) has revolutionized treatment.
• Targeted Therapy ("smart" drugs) for Chronic Myelogenous Leukemia (CML)
  In the 1950s the only treatment for CML was radiation of the spleen, granting patients about 30 months of survival. The identification of the mutation in the BCR-ABL caused by a specific chromosomal translocation (when a piece of one chromosome breaks off and attaches to another) led to the development of imatinib, a gene-targeting drug that is the paradigm of a new generation of "smart" drugs. Imatinib is the first drug that has been designed to be so specific that it targets and corrects only the molecular defect that leads to CML (unlike chemotherapy, which targets all rapidly dividing cells, both diseased and normal), sparing patients most of the toxic side-effects that usually come with chemotherapy. Treated with this non-toxic oral drug, more than 75 percent of patients diagnosed with CML now achieve a durable complete cytogenetic remission. This development introduced a new way to think about treating cancer patients. With the disease in long-term remission (inactive, but not necessarily cured) many CML patients can now expect a normal life span.  Small number of patients who relapse on this therapy can be offered second line treatment like Nilotinib , Desatinib.
• Targeted Therapy for Acute Promyelocytic Leukemia (APL) APL was once described as the most malignant (rapidly worsening) form of acute leukemia. Leukemia cells contain molecules that disrupt normal function of the hemostatic system (which controls the flow of blood) and, as a result of initial treatments that triggered the release of these molecules, many APL patients bled to death before the chemotherapy they were given had a chance to work. A simple and effective therapy for this process was established in the 1980s that allowed chemotherapy drugs to kill the leukemia cells without initiating the deadly reaction. In combination with chemotherapy, targeted treatment has significantly improved survival in patients with APL and raised remission rates to about 85 percent. Today, the treatment of APL has become a model for treating cancer with targeted therapy
• Improved Survival in Acute Myeloid Leukemia (AML)
  More than 13,000 new cases of AML will be diagnosed in this year. Without treatment, AML can progress quickly and become fatal in just a few months. However, over the past 30 years, new targeted therapies and aggressive chemotherapy have dramatically increased the rate of patients who stay in remission for years or are cured. Today, the initial remission rate is approximately 80 percent.

Major Advances in Lymphoma and Lymphoid Malignancies

• Cure of Hodgkin Lymphoma
  Today, many patients survive Hodgkin lymphoma. Advancements in radiation therapy and chemotherapy have helped transform this once fatal disorder into a routinely cured disease. More than 80 percent of patients are cured after primary treatment, and the success of treating Hodgkin lymphoma has created hope for curing other forms of cancer.  Even relapsed Hodgkin Lymphoma have a good chance of cure with newer therapies like stem cell transplant, immunotherapy like Brentuximab, etc.
• Immunotherapy for Non-Hodgkin Lymphoma
  The incidence of non-Hodgkin lymphoma has been increasing since the 1970s, making it the fifth most common cancer. Recent years have seen the development of promising immunotherapy treatments (which stimulate the body's immune system to fight disease) for patients, increasing survival rates. Studies have shown that five-year survival without recurrence of the lymphoma signals a high likelihood of cure. During the 1960s only 31 percent of patients reached that benchmark.Today, that number has more than doubled to 64 percent.
• Improved Therapy and Survival in Multiple Myeloma
  There will be more than 19,000 new cases of multiple myeloma this year, and approximately 34 percent of patients survive five years after diagnosis. Unfortunately, there is not yet a cure; however, thanks to advancements in stem cell transplantation and treatment therapies, patients are living longer, healthier lives than they were 30 years ago. Recent Medicines like Daratumumab , Pomalidomide , Carfilzomib have improved prognosis of even relapsed and refractory Myelomas.

Major Advances in Genetic Diseases

• Effective Prenatal Diagnosis of Abnormal Hemoglobins
  Sickle cell disease and thalassemia are among the most common genetic diseases . Before 1983, there was no national neonatal screening program to detect either disorder. Today, newborns with these diseases greatly benefit from early detection. Those diagnosed with sickle cell disease have a greater rate of survival than children diagnosed later in life.
• Major Advances in AnemiaDevelopment of Diagnostic Techniques to Prevent Stroke in Sickle Cell Disease
  Despite progress in understanding the causes of sickle cell disease, the health of patients with this disease was largely ignored until the 1970s. During the 1980s and 1990s, several studies worked to improve the quality of life for these patients. In 1998, transcranial screening allowed doctors to identify sickle cell patients at risk for stroke and treat them with blood transfusions to prevent stroke.

Major Advances in Anemia

• Cloning of Erythropoietin and Development of Recombinant Epo Clinical Use
  More than 50 years ago, patients suffering from anemia due to chemotherapy, chronic kidney disease, AIDS, or other disorders were dependent on frequent blood transfusions in order to replenish their red blood cells. In between transfusions, when their red blood cell counts dropped, they would suffer from weakness, fatigue, and shortness of breath. In the 1950s and 1960s scientists conclusively showed that a hormone in the body, erythropoietin, was responsible for regulating red cell production. Twenty years later, researchers developed a nearly identical, synthetic version of that hormone, known as epoetin alfa (Epo), that could be mass-produced and administered by injection under the skin. Today, millions of patients worldwide have benefited from Epo, one of the most widely used drugs created through recombinant DNA technology. Epo has allowed them to live active lives without the inconvenience and risk of repeated transfusions.
• Immunotherapy for Aplastic Anemia
  Aplastic anemia is a rare and serious condition that can be traced back to 1888. In the past, severe aplastic anemia was fatal to nearly half of all patients regardless of treatment, but with the development of immunosuppressive therapy combined with other treatments, survival rates have substantially improved, and more than 60 percent of patients experience successful responses to immunotherapy. It is considered as treatment of choice in patients of aplastic anemia who are older than 40 years of age.

Major Advances in Stem Cell Research

• Development of Successful Hematopoietic Stem Cell Transplantation
  Today, hematopoietic stem cell transplantation (HSCT) is an important approach for treating blood and bone marrow disorders, as well as certain types of cancer. The earliest work with HSCT began in the 1950s. By the 1960s this treatment was successfully used in patients with end-stage leukemia. Subsequent research in this area has led to improved transplantation techniques and improved survival rates for a number of diseases. Today it offers only chance of cure to a large number of non cancerous blood disorders like Aplastic anemia , Thalassemia , storage disorders etc.