Temiye: Delay in appropriate treatment of Leukemia could be dangerous

Prof. Edamisan Temiye is a consultant paediatric haematologist and oncologist at Lagos University Teaching Hospital (LUTH). He is a specialist in the treatment of childhood cancers. In this interview with GERALDINE AKUTU, he talks about managing leukaemia.

Leukaemia and the symptoms
Leukaemia is a group of cancers arising from blood-forming cells in the bone marrow (the soft inner parts of certain bones) following some changes in the maturing blood cells. Once this change occurs, (usually due to genetic alteration called mutation), the cells fail to mature further and start dividing without stopping. They also fail to die when they should, thereby accumulating in the marrow, crowding out normal cells and subsequently spilling into the blood stream. From the blood, they can get to other parts of the body such as the lymph nodes, spleen, liver, the brain and testicles among others. From there, they establish themselves and continue to divide rapidly, consequently interfering with the normal functions of those organs. Often, the cells involved in leukaemia are the white blood cells, but sometimes, the other blood cells are also involved.

Leukaemia symptoms are often vague and not specific. They may be overlooked initially, as these symptoms resemble those of other common illnesses, such as malaria and the flu, but they are manifestations of failure of bone marrow to produce normal cells and those are due to disturbances of where the cancer cells spread

Failure of the marrow to produce normal numbers of functional white blood cells (required to fight infections) lead to recurrent fevers. This may be very serious and may quickly lead to death.

Failure of the marrow to produce adequate amount of red blood cells leads to recurrent anaemia, presenting as persistent fatigue, weakness and sometimes heart failure. The person is short of blood and requires blood transfusion almost every two to four weeks.

Failure of the marrow to produce adequate amount of platelets (needed to prevent bleeding) lead to excessive bleeding from minor cuts and bruises. Often, bleeding occurs without obvious injury. Such bleeding occur from the gums on brushing the teeth, nose bleeding; small tiny bleeding into the skin are called petechiae, bigger bleeding can occur into the skin or other vital organs in the body and may lead to death.

Presence of leukaemia cells in the brain may lead to headache, convulsion and coma. Presence of leukaemia cells in the liver and spleen lead to their enlargement; enlargement of the testes and lymph nodes among others may also be due to presence of these cells in those organs.

Bone pain and tenderness are often due to the abnormal expansion in the bone marrow caused by these cells.

At what age can a child get leukaemia?
Leukemia can occur at any age. It has been diagnosed in children as young as one month of age. This disease also occurs throughout life. However, in children, most leukaemia occurs between the ages of two to five. Also, the type of leukaemia seen in children is quite different from those seen in adults. In children, the acute leukaemias are more common. These run a rapid course and death often occurs within three to six months, if treatment is not given. Adults often have the types called chronic leukaemias and a sufferer can live productive life for some years without treatment after diagnosis is made.

Can leukaemia be prevented?
Most children and adults with leukaemias have no known risk factors. So, there is no sure way at this time, to prevent leukaemias from developing, especially in children. However, the risk of developing some leukemias in adults can be reduced by some lifestyle changes, such as, not smoking or quitting smoking and avoidance of exposure to such chemicals as benzene.

Generally, exposure to radiation is linked to the development of leukaemia. This is one of the reasons why doctors want to be sure a woman is not pregnant before sending her for X-ray, so that the growing foetus could be protected from being exposed to radiation.

Some medications used to treat cancer are also known to increase the chances of developing cancers, including leukaemias some years after the initial cancer treatment. It is important that those that have been treated for cancer before engage in life-long follow-up with their doctors in order to detect such complications as early as possible.

What’s the difference between chronic and acute leukaemia?
Chronic leukaemias occur, when the developing white blood cells that constitute the leukaemia are more mature and the progression of the disease is slower. In chronic leukaemias, the individual can live in relatively stable state for some years before succumbing to the disease. This is the commoner type in adult. Acute leukaemias occur, when the cell development is arrested at a very early stage. The course of the disease is very rapid and the individual succumbs to the disease process within weeks or months of diagnosis. Indeed, chronic leukaemias often transform to this rapid stage just before death occurs. The acute type of leukemias is the more common in children.

What are the different types of leukaemia?
Leukaemias are named after the cell lines they arise from, the common ones are:

Acute lymphocytic leukaemia- from lymphoid cells
Acute Myelogenous leukaemia – from myeloid cells
We can also have the chronic types of these two groups. Please note that the myelogenous type can also be sub divided into various groups. Cell typing has also helped us to classify the lymphoid type into various sub groups.

Is there need for parents to get a second opinion on leukaemia?
It is the inalienable right of an individual or the parents of a child to seek for a second opinion in every disease state, including the leukaemias.

However, this should not be turned into a “shopping for opinion” from everywhere and every person. Second opinion should be sought from experts, who are sufficiently equipped to give a sound verdict, where doubts occur. An attending physician should not shy away from assisting a parent or an individual requesting a second opinion in a disease condition. In acute leukaemias, for example, delay in starting appropriate treatment could be deleterious to final outcome.