Precision targets

by Linley Boniface / 21 February, 2009
Dramatic advances in leukaemia treatment give patients a much brighter outlook.

The popular misconception that leukaemia mainly strikes children was shattered last month when it was announced that -Wellington entrepreneur Lloyd Morrison was taking leave from his role as managing director of investment company Infratil while being treated for the disease.

Shortly afterwards, bowls champion Peter Belliss revealed that he, too, has -leukaemia.

Although leukaemia is the most common form of cancer in children, it is predominantly a -disease of older adults. In 2005 - the most recent year for which figures are -available - only 47 out of the 575 people in New Zealand diagnosed with -leukaemia were children.

A suspected diagnosis of leukaemia is devastating, not least because patients are brought into the hospital system so quickly that they have little time to adjust. Patients may see their GP in the morning, have a blood test shortly afterwards, and be told that afternoon to pack an overnight bag and go to hospital. The following day, they may be told they have leukaemia; the day after that, they may start treatment.

This accelerated pace can seem particularly bewildering to patients who have only minor symptoms, or no symptoms at all. In chronic forms of the disease, about a quarter of cases of leukaemia are picked up by chance. This was the case with Belliss, who had no idea he was ill until he was given a blood test as part of a routine mid-50s check-up.

Rapid diagnosis and treatment are essential in acute forms of leukaemia, which can be fatal within eight weeks if not treated.

But this is not the case with chronic leukaemia, which progresses slowly over many years. Treatment may not be needed immediately or, in some cases, at all.

Although leukaemia remains a frightening disease, advances in treatment over the past decade have been dramatic, perhaps more so than in any other form of cancer. New anti-leukaemia drugs, stem cell transplants and improved care for patients - such as better control of infections - have improved the outlook for sufferers.

The prognosis for children with leukaemia was once uniformly grim. Now, 85-90% of children with the disease go into remission, and 70% of those remain stable long term. Survival rates for adults are also improving significantly, particularly for those under 65.

Leukaemia is a cancer of the bone marrow and white blood cells. Immature white blood cells accumulate in the bone marrow, disrupting the normal balance of cells in the blood. There are fewer red blood cells, which are needed to carry oxygen around the body; fewer platelets, which help stop bleeding; and fewer normal white blood cells, which fight infection.

Depending on the type of leukaemia, symptoms can include weakness and lethargy, shortness of breath when exercising, excessive bleeding - such as nosebleeds, heavy periods or heavy bleeding after an injury or tooth extraction - fevers, night sweats, weight loss and infections.

Acute leukaemia affects immature cells, and chronic leukaemia affects more mature cells. The four most common types are acute lymphoblastic leukaemia (ALL), chronic lymphocytic leukaemia (CLL), acute myeloid leukaemia (AML) and chronic myeloid leukaemia (CML).

ALL is the type most likely to affect children. Overall, the most common type is the slow-moving CLL, which Belliss has. The average age to be diagnosed with CLL is between 60 and 65, and many patients die with the disease, rather than of it.

The most exciting medical advances have been made in the treatment of CML, the rarest of the main types. Treatment has been revolutionised by a drug called Glivec, which blocks or switches off a protein that instructs the body to keep producing abnormal blood cells. New Zealand patients were involved in early trials of Glivec and are in trials of second--generation versions of the drug.

Dr Peter Browett, professor of pathology at the University of Auckland and medical director of the Leukaemia & Blood Foundation, says the average survival rate for people with CML in the pre-Glivec era was about five years. "The prediction is that Glivec will push survival rates way out over 10 years," he says.

Future treatments for leukaemia are expected to involve more targeted drugs like Glivec, which has the added -advantage of being much less toxic than chemotherapy. Browett says there is likely to be a move to antibody-based therapies, as well as further strategies to help the body's own immune system attack -leukaemia cells.

Cancer specialists hope to eventually be able to look at the molecular profile of every individual case of leukaemia so they can design a specific targeted treatment for each patient.

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