Day 48: Leukemia + Back to School

Saturday, October 27, 2007 - When Mady’s pediatrician called me the afternoon we learned about a “problem” with her blood (see the first post in this blog), I was still thinking that she had a virus of some kind. The doctor said a virus was possible, but it also could be (pause) leukemia. I had heard of leukemia, of course, but I really knew nothing about it. I remember asking him “If we had to hope for a virus or leukemia, which one would it be?” After a moment of what I now suppose was stunned silence, he said we’d certainly hope for something viral.

As you might expect, I now know a lot more about this form of cancer. From time to time, I plan to list some of the information that I didn’t know back then…

What are the different types of leukemia?

There are four main types: ALL, AML, CLL, CML. The first two letters of each of their acronyms are based on the combination of two different classifications, Speed of Progression and Types of Cells Affected.

Speed of Progression
The first type of classification is by how fast the leukemia progresses:

Acute leukemia. This is what Mady has. It began with one or a few white blood cells that had a lost or damaged DNA sequence. These cells remained immature in what's known as a “blast” form, but maintained the ability to multiply. Because they didn't mature and then die as normal cells do, they accumulated and began to interfere with functions of vital organs. Eventually, they overwhelmed the production of healthy cells. They multiplied rapidly, so the disease worsened quickly. Acute leukemia requires aggressive treatment, and if left untreated life expectancy is about 3 months. In Mady’s case, Dr. Friedmann estimated that her leukemia started around the beginning of the summer, and without treatment she would have lived just a few more weeks.

Chronic leukemia. This type of leukemia involves more mature blood cells. These blood cells replicate or accumulate more slowly and can function normally for a period of time. Some forms of chronic leukemia produce no signs or symptoms and can go unnoticed or undiagnosed for years. This type most often affects adults.

Types of Cells Affected
The second type of classification is by type of white blood cell affected:

Lymphocytic (aka Lymphoblastic) leukemia. This is also what Mady has. This type of leukemia affects her lymphoid cells or lymphocytes (a type of white blood cell in her bone marrow), which form lymphoid or lymphatic tissue. This tissue is the main component of the immune system and is found in various places throughout Mady’s body, including her lymph nodes, spleen and tonsils.

Myelogenous leukemia. This type of leukemia affects the myeloid cells. The myeloid cell line includes cells that later develop into red blood cells, white blood cells and platelet-producing cells. This type is more common and much more difficult to cure.

How common is Mady's acute lymphocytic leukemia (ALL)?

In 2007 there will be about 44,240 new cases of all types of leukemia in the United States. 13,500 of these will be AML, and Mady is one of about 5,200 people who will be diagnosed with ALL this year.

The average person's lifetime risk of getting ALL is about 1 in 1,000, which is about the same as the lifetime risk of either drowning or dying in a motorcycle accident.

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By the way, Mady finally got to go back to school on Friday. She wore neither wig nor hat, had her two IV picc lines hanging out of her arm, sported her LIVESTRONG and CANCER SUCKS bracelets, and had a great day. Her classmates were very welcoming, and everything went well. After school Mady visited some her favorite teachers with a good friend, then headed to another friend's house for a small Halloween party. Later in the evening we took an oncologist-approved trip into Boston to see the wonderful musical Wicked (during which she reluctantly wore a surgical mask). Whew! Amazingly, she wanted to catch the second half of another friend's sleepover party after the show, but we drew the line there.

This morning Mady was the first one up, and once again making Madycakes (TM) for all of us...