a lil' explanation

Hi everyone, 


This is Laney. I wanted to give y'all a somewhat condensed version of the info I've compiled over the last few weeks regarding Mom's condition. There is A LOT of information available on leukemia on the internet, and it is all very technical and confusing. But, it helps me to try to understand what is happening to Mom's body. So, if any of you are interested, here is my attempt at an explanation:


Mom has been diagnosed with CML with an ALL blast crisis. This means that she has the chronic myelogenous form of leukemia, but it progressed to the blast phase (the final phase), which then transformed into an aggressive acute lymphocytic leukemia (ALL) by the time she arrived at the hospital. The doctors quickly got her ALL under control and stopped the blast phase with chemotherapy and a wonder drug called Gleevec. All of her blast cells have disappeared. Her white blood cell count is also down. They are now attempting to push her CML back into the chronic phase so that she will respond well to treatment and experience less symptoms. Once the treatment (chemotherapy) successfully sends her disease into remission, I believe she will need a bone marrow transplant to completely cure her of the CML. However, I do need Dr. Tan (her hematology oncologist) to confirm this. Please read the following info below for more details.


Many thanks to all who are supporting my family and amazing mother. She will beat this stinkin' cancer with the strength that builds from all of your love and encouragement! 


Much love, 
Laney

Overview

Leukemia is a form of cancer that begins in the blood-forming cells of the bone marrow — the soft, inner part of the bones. Leukemia, which literally means "white blood" in Greek, occurs when there is an excess of abnormal white blood cells in the blood. Known as leukocytes, these cells are so plentiful in some patients that the blood actually has a whitish tinge.

Under normal circumstances, the blood-forming (hematopoietic) cells of the bone marrow make leukocytes to defend the body against infectious organisms, such as viruses and bacteria. If some leukocytes are damaged and remain in an immature form, they become poor infection fighters that multiply excessively and do not die off as they should.

These damaged leukemic cells accumulate and lessen the production of oxygen-carrying red blood cells (erythrocytes), blood-clotting cells (platelets), and normal leukocytes. If untreated, these leukemic cells overwhelm the bone marrow, enter the bloodstream, and eventually invade other parts of the body, such as the lymph nodes, spleen, liver, and central nervous system (brain, spinal cord). In this way, the behavior of leukemia is different than that of other cancers, which usually begin in major organs and ultimately spread to the bone marrow.

There are more than a dozen varieties of leukemia, but the following 4 types are the most common:

• Acute myelogenous leukemia (AML)
• Chronic myelogenous leukemia (CML)
• Acute lymphocytic leukemia (ALL)
• Chronic lymphocytic leukemia (CLL)

Acute leukemias usually develop suddenly, whereas some chronic types may exist for years before they are diagnosed.

Types
Leukemia is classified by how quickly it progresses. Acute leukemia is fast-growing and can overrun the body within a few weeks or months. By contrast, chronic leukemia is slow-growing and progressively worsens over years.

Acute versus Chronic Leukemia
The blood-forming (hematopoietic) cells of acute leukemia remain in an immature state, so they reproduce and accumulate very rapidly. Therefore, acute leukemia needs to be treated immediately, otherwise the disease may be fatal within a few months. Fortunately, some subtypes of acute leukemia respond very well to available therapies and they are curable. Children often develop acute forms of leukemia, which are managed differently from leukemia in adults.
In chronic leukemia, the blood-forming cells eventually mature, or differentiate, but they are not "normal." They remain in the bloodstream much longer than normal white blood cells, and they are unable to combat infection well.


Chronic Myelogenous Leukemia (CML)
Chronic myelogenous leukemia (CML) is known as a myeloproliferative disorder—that is, it is a disease in which bone marrow cells proliferate (multiply) outside of the bone marrow tissue.
CML is easy to diagnose, since it has a genetic peculiarity, or marker, that is readily identifiable under a microscope. About 95% of CML patients have a genetic translocation between chromosomes 9 and 22 in their leukemic cells. This abnormality, which is known as the Philadelphia chromosome (Ph1), is named after the city in which it was discovered. The Philadelphia chromosome causes uncontrolled reproduction and proliferation of all types of white blood cells and platelets (blood clotting factors). Sadly, CML is not yet curable by standard methods of chemotherapy or immunotherapy.
CML tends to occur in middle- and retirement-aged people (the median age is 67 years). It occasionally affects people in their 20s, but it is rare in the very young; only 2% to 3% of childhood leukemias are CML. Early disease often is without symptoms (asymptomatic) and is discovered accidentally. Individuals with more advanced cases of CML may appear sickly and experience fevers, easy bruising, and bone pain. Laboratory and physical findings include enlarged spleen (splenomegaly), a high white blood cell count, and absent or low amounts of the white blood cell enzyme alkaline phosphatase.
Like other forms of leukemia, CML is not "staged". Rather, this unstable disease is categorized according to the three phases of its development: chronic, accelerated, and blast.

• Chronic phase—Patients in this initial phase have fewer than 5% blast cells and promyelocytes (immature granulocytes) in their blood and bone marrow. This phase is marked by increasing overproduction of granulocytes. Individuals generally experience only mild symptoms, and they respond well to conventional treatment.
• Accelerated phase—Patients in this progressive phase have more than 5%, but fewer than 30% blast cells. Their leukemic cells exhibit more chromosomal abnormalities besides the Philadelphia chromosome, and so more abnormal cells are produced. Noticeable symptoms such as fever, poor appetite, weight loss occur, and patients may not respond as well to therapy.
• Blast phase (acute phase, blast crisis)—Patients in this final phase have more than 30% blast cells in their blood and bone marrow samples. The blast cells frequently invade other tissues and organs outside of the bone marrow. During this phase, the disease transforms into an aggressive, acute leukemia (70% acute myelogenous leukemia, 30% acute lymphocytic leukemia). 

Acute Lymphocytic Leukemia (ALL)
Acute lymphocytic leukemia (ALL)—also known as acute lymphoblastic leukemia—is a malignant disease caused by the abnormal growth and development of early nongranular white blood cells, or lymphocytes. The leukemia originates in the blast cells of the bone marrow (B-cells), thymus (T-cells), and lymph nodes. ALL occurs predominantly in children, peaking at 4 years of age.
ALL often is diagnosed after a patient experiences a 4- to 6-week period of illness. Initial symptoms may include a nonspecific infection (e.g., respiratory infection) that persists or recurs despite antibiotic therapy. During this period, the person may start to experience aching bone pain in the back, limbs, and/or joints. Walking difficulties may be seen in some children who have extreme swelling of the large joints. But the symptoms that most often suggest referral for a blood count (measure of the number of blood cells within the blood) are a purplish-brown rash or the onset of excessive bruising.