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The Treatment of Leukemia and Bone Marrow Cancer, Hematopoietic Stem Cell Transplantation (HSCT) 2022.06.21

The Treatment of Leukemia and Bone Marrow Cancer,
Hematopoietic Stem Cell Transplantation (HSCT)



There are types of blood cancer: acute myeloid leukemia, acute lymphoblastic leukemia, chronic myeloid leukemia, chronic lymphoblastic leukemia, malignant lymphoma (non-Hodgkin’s lymphoma and Hodgkin’s lymphoma), multiple myeloma, etc. The cause is not found clearly, but it is assumed to be genetic factors, occupational exposure such as radiation, chemicals, etc. and usage of medicines such as chemotherapy. However, it is still hard to tell the exact cause of each patient.

The production of hematopoietic stem cell:
Composed of RBC (Red Blood Cell), WBC (White Blood Cell), platelet and plasma.





The blood is produced from the hematopoietic stem cell in the bone marrow which is composed of RBC (Red Blood Cell), WBC (White Blood Cell), platelet and plasma. RBC carries oxygen in the body and provides it to the cells. WBC consists of neutrophils, eosinophils, basophils and lymphocyte, and it fights against the bacteria or virus that invaded in our body as an immune system.


Leukemia has various symptoms such as lowered immune function, chronic fatigue, enlarged liver/spleen, etc.

Leukemia is cancer of the blood cells that abnormal blood cells increase excessively and suppress the production of normal WBC, RBC and platelets. When the leukemia goes severe, there can be symptoms such as enlarged liver/spleen, swollen lymph nodes/gums and bone pain. There can be fatigue, weight loss, fever, night sweat, enlarged spleen, etc. in case of chronic leukemia. Usually when enlarged lymph nodes of neck, axilla and inguinal area are touchable, patients visit the hospital. They have symptoms such as fever, loss of weight and night sweat as well. The symptoms of multiple myeloma are hypercalcemia, anemia and decreased renal function. Also, osteolytic lesion may cause bone pain and fracture even by small bump.


Bone marrow aspiration and biopsy



Bone marrow aspiration is collecting bone marrow inside the bone by a long needle after local anesthesia of upper hip. The sample is sent to the laboratory for microscopic observation, chromosome test, gene test and cell marker test. They are very significant for accurate diagnosis, but also useful to make a treatment plan predicting prognosis in the future.


Targeted therapy, the basic step of blood cancer treatment
Hematopoietic stem cell transplantation is recommended when the recurrence risk is high

Chemotherapy
In order to treat acute leukemia, we bring the neutrophil down to the lowest, perform the chemotherapy and make ‘complete remission’ which appears normal in the blood or bone marrow test. After chemotherapy, it takes about a month to recover the bone marrow, so supportive therapy such as preventive antibiotics about inflammation, transfusion of RBCs or platelets are necessary.

Targeted Therapy
Chronic lymphoblastic leukemia was mostly considered to a chronic disease. However, it has been regarded as curable cancer by oral pills as targeted drug such as Glivec (Imatinib) came out. The 2nd generation drugs, for instance, Sprycel(Dasatinib) and Tasigna(Nilotinib) are used to the first-line regimen as well.

Hematopoietic Stem Cell Transplantation
Hematopoietic stem cell transplantation is performed to patients who still have high-risk of recurrence even after anticancer therapy. If the patient with high risk of recurrence of acute leukemia is capable of tough treatment, allogeneic hematopoietic stem cell transplantation that matches HLA(Human Leukocyte Antigens) with the patient such as siblings or other donors can be considered.


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