Saturday, October 22, 2011

New Lab Testing news for Leukemia

I want to inform Cancer patients of new testing being used and discussed in aiding in their diagnosis of their disease.   Please go this site to learn about new genetic testing.  An educated patient can be empowered to learn that research and testing can bring progress to healing.

Chronic Lymphocytic Leukemia

A lymphocyte has mainly one purpose in the blood system is to provide immunity to certain infections. Lymphocytes make of about 25-33 percent of all white cells in your body.  They are found in the circulatory system and concentrated in lymphoid tissue areas such as spleen, tonsil and lymph nodes.  These places are where the immune response will occur.  B lymphocytes and T lymphocytes are the two primary types. B cells differentiates into a plasma cell which will secrete an immunoglobulin.  B cells mature in the bone marrow,but T cells mature in the thymus.  T cells multiply quickly and become cytotoxic cells or memory cells.  They are used in Cancer treatment to destroy cancer cells.



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Friday, October 21, 2011


Mesothelioma is a cancer that is very uncommon. Abestos is the cause for this cancer. It is a type of cancer that affects the mesothelium ,tissue lining, around different organs.  If it is found in the lungs then it is called pleural mesothelioma.  Peritoneal mesothelioma refers to the abdomen or stomach.  Finally, pericardium mesothelioma refers to the lining around the heart.

A physician needs to determine what is causing the abnormal symptoms one is experiencing in order to give a correct diagnosis. They must obtain a tissue sample for a pathologist to view.  To obtain a tissue sample a physician may do a needle aspiration or surgically remove tissue from the organs.

After visual inspection, the biopsy is processed and inserted into a mold with hot paraffin wax. When this wax cools, the specimen is locked in place and protected from contamination. Thin slices of this wax are then cut and placed under a microscope for inspection. To improve visibility of the cell tissue, various types of dye may be applied.
After this preparation process is completed, the histologist views the specimen with the help of a microscope. The histologist will be looking for unique characteristics of cancer cells in order to verify a cancer diagnosis. Different types of cancer exhibit unique cellular characteristics that usually allow for diagnosis of an exact cancer type.
So how does the histologist and pathologist determine the difference between sarcomatoid  and epithileal mesothelioma cell?  They use a immunochemical stain that take advantage of the antibody/antigen binding properties to alter the color of the cell in which binding occurs.

If you have any of the following symptoms and know that you have been exposed to abestos then you need to be seen as soon as possible.  They symptoms are difficulty breathing, chest pain, cough, weight loss and fever.

Types of Leukemia


The word "acute" means a rapid release of immature lymphocytes from the bone marrow. Above is a picture of blood cells of a person with ALL.  Notice that they are much larger than a normal lymphocyte.  The purple center is the nucleus .  The more condensed the nucleus is in a cell the more mature the cell.  As you can see in the picture the nucleus does not appear condensed and therefore is an immature cell.

The lab tests performed to determine your diagnosis will be: 

Cytochemistry, Cytogenetics, PCR, FISH, and Immunocytochemistry.

A combination of cytomorphological features and cytochemical staining reactions in the diagnoses of the different types of acute leukemia removes much of the subjective difficulty of diagnosis. The number of cytochemical stains used may be limited, and in our experience the PAS, combined NCE and ANE reactions, and either SB or Px staining will yield as much diagnostic information as needed in most cases. With regard to the prognostic implications, it would appear at the present time that the amount of ANE staining in the cytoplasm of blasts is inversely proportional to the chances of remission induction and length of survival in cases of acute leukemia. However, further studies must be carried out to verify this finding before using the information to compliment other prognostic variables, such as age of patient, previous therapy, cytokinetics,

Cells are harvested from two or more unstimulated cultures.  Twenty metaphase spreads are fully analyzed and two karyotypes are prepared.  If abnormalities are found, at least two karyotypes are prepared for each abnormal clone.

When a patient tests negative in the 20 cell cytogenetics test for the Ph chromosome as well as the 500 cell FISH
test for the BCR-ABL fusion gene, there is still residual CML disease left in the body, sometimes a million
leukemic cells or more.  Polymerase chain reaction (PCR) test measures this low level disease by being able to
detect 1 leukemic cell in a million or more normal cells by amplifying one leukemic cell into many copies.  The
PCR test is a molecular test and the results is the molecular response of a patient.
•        Qualitative PCR gives a positive or negative value for the presence of disease.
•        Quantitative PCR (Q-PCR) gives the level of disease positivity in numbers.
•        Nested PCR can sometimes be more sensitive than the above as it uses double primers and repeats the
experiment so that errors are corrected.
Most doctors will recommend a quantitative PCR to measure residual disease.  This can be recommended right
from diagnosis or after other tests show negative, it really depends on the doctor.  However, it is the most
important tool, nowadays, to follow low disease load.  You follow the disease by PCR numbers in the same way you
tracked the Ph chromosome when the disease load was high by other tests.  Do remember, that absolute PCR
values cannot be compared to FISH and Cytogenetics values and also not between different PCR labs as it will be
A PCR report looks like the one above.  Quant BCR-ABL means a quantitative PCR was done to look for BCR-
ABL transcripts.  In layman terms, it is looking for leukemic cells carrying the BCR-ABL signature.  In the Q-
PCR experiment, a control is used and in most labs, that is ABL.  A control correlates to the number of normal
cells.  Therefore, when you see the result of 0.6%BCR-ABL/ABL, it means the percentage ratio of bad cells to
total cells.
•        One PCR test, by itself, has little meaning.  The PCR trend is important.  Ideally, the PCR numbers should
be going down with time as the disease is controlled by therapy.
•        There are two types of molecular response.  A major molecular response (MMR) when the PCR value of a
patient has decreased 1000-fold or 3-log from diagnosis and complete molecular response (CMR) when the patient
tests negative for leukemia from the PCR tests.
•        If there is a 10-fold or 1-log increase in PCR numbers, usually, doctors will first recommend a re-test and
many patients have reported a re-test showing the rise to be a fluke.  If the re-test and subsequent tests show a
rising PCR trend, most doctors will recommend ABL point mutations testing to see if resistance to therapy is
being developed.  These are special tests done only in a handful of laboratories around the world and it is usually
done from a blood draw.
•        The goal of Gleevec therapy is to reach a 1000-fold or 3-log reduction from diagnosis PCR values as this
gives only a 0.5% risk of relapse per year.  Many patients do not have diagnosis PCR values so a PCR lab has a
diagnosis PCR baseline from newly diagnosed patients and you can correlate your PCR value to that.
•        A PCR test can be done from either the blood or marrow.  However, recent medical studies have shown that
the two may not show absolute correlation so doctors recommend PCR testing from the blood only, to keep the
source constant and because recommendations are to do a PCR every 3 months and a bone marrow aspiration
every 3 months is considered invasive.
So, what are the questions to ask the doctor when you get a report as above?
•        CML experts recommend a PCR sensitivity of 1 in 100,000 cells as the minimum so ask the doctor if the
PCR lab is able to detect 1 leukemic cell in 100,000 cells.
•        If you do not have a diagnosis PCR value, ask the doctor what log reduction is 0.6% from the lab baseline.
If it is 3-log and below, you are in good molecular response.
•        Watch the PCR trend over time and if you find that with your current dose of Gleevec, your PCR is not
going down any further after some time and you do not have a 3-log reduction, discuss with the doctor options of
raising Gleevec dose or his advice on what to do next.
For a schedule of recommended PCR monitoring, see the article below from ASH 2005 from Dr. Deininger of


 It is a test can identify specific chromosomal and genetic abnormalities - leukemia, lymphomas, hematopoietic malignancies, some solid tumors.

Immunocytochemistry uses the same principle, employing antibodies to produce distinct color changes in the cell sample that allow the pathologist to identify the type of leukemia present.


Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid (intrathecal chemotherapy), an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Intrathecal chemotherapy may be used to treat adult ALL that has spread, or may spread, to the brain and spinal cord. When used to prevent cancer from spreading to the brain and spinal cord, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis. Intrathecal chemotherapy is given in addition to chemotherapy by mouth or vein.

See Drugs Approved for Acute Lymphoblastic Leukemia for more information.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. External radiation therapy may be used to treat adult ALL that has spread, or may spread, to the brain and spinal cord. When used this way, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis.
Chemotherapy with stem cell transplant
Stem cell transplant is a method of giving chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.
See Drugs Approved for Acute Lymphoblastic Leukemia for more information.
Targeted therapy
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.
Targeted therapy drugs called tyrosine kinase inhibitors are used to treat some types of adult ALL. These drugs block the enzyme, tyrosine kinase, that causes stem cells to develop into more white blood cells (blasts) than the body needs. Two of the drugs used are imatinib mesylate (Gleevec) and dasatinib.
See Drugs Approved for Acute Lymphoblastic Leukemia for more information.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
Biologic therapy
Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the
Options are:  chemotherapy, radiation, or bone marrow transplant

Thursday, October 20, 2011


What Is the Cause of Leukemia?

Cancer invades the tissues that form the blood cells which includes the bone marrow and the lymphatic system.   In the picture above which are viewed from a microscope are abnormal cells.  The second  image is a diagram of all blood cell types in the human body.

Leukemia usually begins with the white cells.  We have white cells to defend our bodies against infection .   Normal white cells divide in systematic way.  When white cells are become abnormal they divide rapidly.  

A blood specimen is drawn for a lab tech to analyze through a lab instrument.  When the result is printed and she will look at the result.  The instrument should flag abnormalities.  If the white count is elevated , then the lab tech should prepare a manual differential.  This is done by placing a drop of blood on a slide and spread drop with a quick push across with another slide at a 45 degree angle.  After the smear is made then it is stained so it can be viewed under the microscope.  100 cells are viewed and categorized according to type and maturity stage of that cell.  If there are many abnormalities it will be sent to the pathologist for viewing and reporting.   He may recommend a bone marrow biopsy.  The bone marrow is the place in your bone where cells are made.

Symptoms of leukemia are the following:
  1.  Fever and night sweats
  2. Your spleen may be enlarged and abdomen may be swollen and painful
  3. Infections do not go away
  4. Tired and weak
  5. Losing weight and you do not feel hungry is one I see a lot.