Leukemia is a cancer of the blood and bone marrow that affects the body’s blood-forming tissues. When someone has leukemia, their bone marrow starts producing abnormal white blood cells, which crowd out the healthy blood cells. This can lead to anemia, bleeding problems, and infections. Leukemia is a serious disease, but with modern treatments, many people can achieve long-term remission or even cure.
What is leukemia?
Leukemia begins when healthy blood stem cells in the bone marrow develop changes or mutations in their DNA. These mutated stem cells produce abnormal white blood cells that don’t function properly. The abnormal cells divide rapidly and overwhelm the healthy cells. There are several main types of leukemia:
- Acute lymphocytic leukemia (ALL)
- Acute myeloid leukemia (AML)
- Chronic lymphocytic leukemia (CLL)
- Chronic myeloid leukemia (CML)
Acute leukemias progress quickly and cause symptoms like fatigue, weight loss, and easy bleeding or bruising. Chronic leukemias tend to progress more slowly at first and often don’t cause obvious symptoms right away.
How is leukemia treated?
Treatment for leukemia typically involves chemotherapy, targeted drugs, radiation therapy, bone marrow transplantation, or immunotherapy. The best treatment approach depends on the type of leukemia, the patient’s age and health status, and other factors. Some key treatments include:
- Chemotherapy: Uses anti-cancer drugs to kill leukemia cells. It can be given intravenously or by mouth.
- Targeted therapy: Drugs that specifically attack abnormalities in leukemia cells while causing less damage to normal cells.
- Radiation: High energy beams used to kill leukemia cells and shrink tumors.
- Stem cell transplant: Replaces a patient’s diseased bone marrow with healthy stem cells to re-establish normal blood cell production.
- Immunotherapy: Drugs that help the immune system recognize and attack leukemia cells.
What happens when leukemia goes into remission?
The goal of leukemia treatment is to get the disease into remission. This means:
- Blood cell counts return to normal levels
- Immature blasts in the bone marrow decrease to less than 5%
- No signs or symptoms of the disease
Achieving remission can take weeks or months. The length of remission varies: it may last a few months, a few years, or be indefinite. Even in remission, a small number of leukemia cells likely remain in the body, and relapse is possible over time if these cells grow out of control again.
What is the terminal phase of leukemia?
The terminal phase of leukemia occurs when treatments can no longer control the disease. This is known as end-stage or refractory leukemia. As the cancer advances, it causes the following:
- Severe suppression of blood cell counts
- High risk of bleeding, anemia, and infection
- Vital organ damage from lack of oxygen and nutrients
- Buildup of leukemia cells in organs like the liver, spleen, and lymph nodes
- Dangerously high white blood cell count
- Recurring fevers and night sweats
- Fatigue, weakness, and shortness of breath
- Loss of appetite and weight loss
- Swelling in the legs, feet, or abdomen
In the final weeks to months, the patient requires transfusions, antibiotics, and other supportive care to try to reduce discomfort. Hospice services are often enlisted during this time. Death usually occurs due to infection, bleeding, or organ failure.
What happens in the last days of life?
In the very last days and hours of life, people with terminal leukemia experience some common symptoms and changes. These may include:
- Increased drowsiness and sleep: The patient becomes harder to rouse or interact with and sleeps more and more. This reflects the body’s shutting down.
- Confusion or restlessness: Toxins building up and reduced oxygen to the brain can lead to confusion and agitation.
- Loss of appetite: The body loses interest in food and drink.
- Difficulty swallowing: Weakness in the throat muscles makes swallowing difficult.
- Changes in breathing: Breathing can alternate between rapid and shallow breathing to slower, irregular patterns.
- Coolness in extremities: As circulation slows, the hands, feet, arms, and legs become cool to the touch.
- Loss of bladder or bowel control: Loss of brain signals to these areas can lead to loss of control.
- Withdrawal from surroundings: The person becomes increasingly unresponsive to voices or touch.
- Transition to unconsciousness: In the final hours, the patient slips into unconsciousness before death.
Providing comfort, pain management, and emotional support are the priorities during this time. Saying goodbye and being present at the bedside are meaningful for the patient and loved ones.
What is the life expectancy for someone with terminal leukemia?
Life expectancy depends on many factors, including:
- Type of leukemia (acute forms have shorter survival times)
- Patient’s age and overall health
- How advanced or aggressive the cancer is
- How well the patient responds to treatments
On average, data on median survival times for terminal leukemia includes:
- Acute myeloid leukemia: 2 to 3 months
- Acute lymphocytic leukemia: 3 to 6 months
- Chronic lymphocytic leukemia: 18 to 24 months
- Chronic myeloid leukemia: 6 to 18 months
Of course, each patient’s disease course is unique. With palliative care and symptom management, quality of life can still be preserved as much as possible.
Conclusion
Reaching the terminal phase of leukemia means the cancer is no longer responding to treatment. This leads to disrupted blood cell production, organ damage, and eventually the shutting down of bodily functions. In the final weeks to days of life, providing comfort care and emotional support are key. Clear communication about prognosis and options can help patients and families make informed choices about end-of-life care.
While leukemia is a serious illness, the prognosis is improving in many cases thanks to advances in treatments like targeted therapies, immunotherapies, and stem cell transplants. Current research offers hope that for many leukemia patients, long-term remission or cure is possible.