Leukemia is a general term that includes 4 main types. Two of them are chronic, namely chronic myeloid and chronic lymphocytic leukemia. 2 of them acute, namely acute lymphoblastic and acute myeloid leukemia. In medicine, one of the most important questions that need answering is what the outcome of such a patient is. This is referred to as “prognosis”, and the interpretation of the term differs between diseases. Prognosis usually includes the percentages of a complete cure, and those of death or long-term disability.
In cancers, only a few patients have a complete cure, defined as the elimination of all cancer traces, especially because cancer is a genetic disease. It is imprinted in your diseased cell genes. All treatment modalities aim at a “remission”, which is the elimination of all detectable cancer. If surgery is the method of treatment, we aim at the removal of a considerable portion or the totality of the tumor. Then, chemotherapy will do the rest for individual cells. In leukemias, however, things get a little more complex. The main cause of symptoms in leukemia is the change of blood components, whether by an increase or fall.
Therefore, to answer this question, we have to divide it according to the type of leukemia and then according to the severity of the disease, age and overall status of the patient, and whether this is the first time this patient has had leukemia or not. What is certain is that overall, leukemia patients nowadays have a much higher chance of survival than those who presented with the disease 10 years ago. The main difference between the cure rates of acute and chronic leukemias is their origin. Acute leukemias develop in immature cells of the bone marrow and develop a form of deformed cell that can easily be targeted by chemotherapy. Chronic leukemias, on the other hand, occur in more mature cells and are even detected during screening by an elevated number of a specific cell type usually present in the bone marrow. It is safe to say that, generally speaking, acute leukemias have higher rates of complete cure than chronic leukemias.
The question of cure, however, is misplaced in many cases. Medicine doesn’t always aim at a cure but at an improved quality of life for the patient which involves many parameters. For example, some cancers can theoretically be eliminated by a high enough dose of chemotherapy. But this high dose can cause more harm than good and even long-term disabilities for the patient, some can cause other types of cancers as well. A stark example of this is what we mentioned in our article of acute myeloid leukemia in the elderly who take a smaller dose of chemotherapy or a weaker chemotherapy regimen, which is less likely to bring remission, but this is still the best option to spare them the severe side effects of high-dose chemotherapy, which is more likely to be tolerated by the younger stratum of patients.
How can a genetic disease be treated?
Cancer originates within you, in your blueprint, and it doesn’t go away completely except if we remove the genes themselves or the cells containing them. Both of those options are done in blood cancers. Chemotherapy can be used to induce the cells carrying the genes to “kill themselves” and to remove the genetic defect. In chronic myeloid leukemia, this gene is well known, and it is called the BCR/ABL fusion gene. It is caused by a translocated genetic material between two clusters of genes called chromosomes. The main treatment of this type of cancer is a group of drugs called tyrosine kinase inhibitors or TKIs. The most famous and commonly used is imatinib. Surgery can’t be used in blood cancer, but we can remove the cells carrying the genes by another radical means called stem cell transplantation. Just like when we imagine burning down our houses when we see spiders roaming. A form of stem cell transplantation involves high-dose chemotherapy and/or radiotherapy to eliminate all cancer cells in the bone marrow, then implanting new ones. Another form may include other drugs or radiotherapy alone, which won’t kill all cells but will kill enough that the new bone marrow will take over and cure cancer.
Both of the above methods are not perfect and relapses of the cancer can occur, but they present the best effort and hope that we have in fighting cancer, and most research regarding leukemia involves perfecting both of these methods to ensure that we decrease the side effects and rejection rates of stem cell transplantation -which form most of its failures- and create new drugs to overcome the resistance of some cancers.