LEUKEMIA : (PART 4) Diagnosisa and treatment ....سرطان الدم اللوكيمياء .الجذء 4
Diagnosis of leukemia.
Diagnosis is usually based on repeated complete blood counts and a bone marrow examination following observations of the symptoms.
1-Sometimes, blood tests may not show that a person has leukemia, especially in the early stages of the disease or during remission.
2-A lymph node biopsy can be performed to diagnose certain types of leukemia in certain situations.
3-Following diagnosis, blood chemistry tests can be used to determine the degree of liver and kidney damage or the effects of chemotherapy on the person.
4-When concerns arise about other damages due to leukemia, doctors may use an X-ray, MRI, or ultrasound.
5-These can potentially show leukemia's effects on such body parts as bones (X-ray), the brain (MRI), or the kidneys, spleen, and liver (ultrasound).
6-CT scans can be used to check lymph nodes in the chest, though this is uncommon.
--Despite the use of these methods to diagnose whether or not a person has leukemia, many people have not been diagnosed because many of the symptoms are vague, non-specific, and can refer to other diseases. For this reason, the American Cancer Society estimates that at least one-fifth of the people with leukemia have not yet been diagnosed.
Treatment.
Most forms of leukemia are treated with pharmaceutical medication, typically combined into a multi-drug chemotherapy regimen. Some are also treated with radiation therapy. In some cases, a bone marrow transplant is effective.
1-Acute lymphoblastic.
Management of ALL is directed towards control of bone marrow and systemic (whole-body) disease.
Additionally, treatment must prevent leukemic cells from spreading to other sites, particularly the central nervous system (CNS) e.g. monthly lumbar punctures. In general, ALL treatment is divided into several phases:
• Induction chemotherapy to bring about bone marrow remission.
• For adults, standard induction plans include :
1-prednisone.
1- vincristine.
2- anthracycline drug.
3- other drug plans may include L-asparaginase or cyclophosphamide.
4- For children with low-risk ALL, standard therapy usually consists of three drugs (prednisone, L-asparaginase, and vincristine) for the first month of treatment.
• Consolidation therapy or intensification therapy:
- to eliminate any remaining leukemia cells.
- There are many different approaches to consolidation, but it is typically a high-dose, multi-drug treatment that is undertaken for a few months.
• - People with low- to average-risk ALL receive therapy with antimetabolite drugs such as methotrexate and 6-mercaptopurine (6-MP). People who are high-risk receive higher drug doses of these drugs, plus additional drugs.
• CNS prophylaxis (preventive therapy) :
• to stop the cancer from spreading to the brain and nervous system in high-risk people. Standard prophylaxis may include radiation of the head and/or drugs delivered directly into the spine.
• Maintenance treatments with chemotherapeutic drugs to prevent disease recurrence once remission has been achieved. Maintenance therapy usually involves lower drug doses, and may continue for up to three years.
• Alternatively, allogeneic bone marrow transplantation may be appropriate for high-risk or relapsed people.
• Treatment of Chronic lymphocytic leukemia.
Decision to treat.
Hematologists base CLL treatment on both the stage and symptoms of the individual person.
A large group of people with CLL have low-grade disease, which does not benefit from treatment.
Individuals with CLL-related complications or more advanced disease often benefit from treatment.
In general, the indications for treatment are:
• Falling hemoglobin or platelet count.
• Progression to a later stage of disease.
• Painful, disease-related overgrowth of lymph nodes or spleen.
• An increase in the rate.
Treatment approach.
For most people with CLL, it is incurable by present treatments, so treatment is directed towards suppressing the disease for many years, rather than totally and permanently eliminating it.
=The primary chemotherapeutic plan is :
1-combination chemotherapy with (chlorambucil or cyclophosphamide), plus 2- corticosteroid such as (prednisone or prednisolone).
=The use of a corticosteroid has the additional benefit of suppressing some related autoimmune diseases, such as immunohemolytic anemia or immune-mediated thrombocytopenia.
= In resistant cases, single-agent treatments with nucleoside drugs such :
1- fludarabine.
2- pentostatin,.
1- cladribine may be successful.
2- Younger and healthier people may choose allogeneic or autologous bone marrow transplantation in the hope of a permanent cure.
*Treatment of Acute myelogenous.
Many different anti-cancer drugs are effective for the treatment of AML.
Treatments vary somewhat according to the age of the person and according to the specific subtype of AML.
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