Tracking Your Progress
Because all leukemia therapies produce individual responses based on factors such as the type of leukemia, patient's age, nutritional status, and the presence of other diseases, monthly blood testing to monitor progress is recommended. Patients treated for leukemia should work closely with their physician to follow the results of blood and other tests to determine the best treatment course.
The following tests are valuable:
- Cholesterol levels: low cholesterol returned to normal physiological levels with response to treatment in AML and CML (Baroni S et al 1994; Baroni S et al 1996; Moschovi M et al 2004).
- Total lipid profiles: monitoring of lipids such as serum albumin and body mass index can play a role in assessing response to treatment as these lipids are low at leukemia diagnosis (Fiorenza AM et al 2000; Moschovi M et al 2004).
- Cortisol levels: increased levels in AML, CML, and CLL are associated with immune dysfunction (Everaus H 1992; Everaus H et al 1997; Singh JN et al 1989). Monitoring cortisol levels in cancer patients may be useful in observing the psychological impact of the disease and associated treatment on the individual (Cohen L et al 2001).
- DHEA levels: abnormal levels may be associated with immune cell dysfunction (Uozumi K et al 1996). Baseline levels can be determined by radioimmunoassay before DHEA supplementation, shown to correct impaired immune function in animal models (Catalina F et al 2003; Inserra P et al 1998).
- Coagulation profile: blood-clotting parameters are usually abnormal in leukemia. Tests may show low levels of platelets, increased prothrombin time (PT), partial thromboplastin time (PTT), and/or decreased fibrinogen (Barton JC et al 1986). Response to therapy is often accompanied by normalization of these blood tests with increased fibrinogen and decreased PTT (Anders O et al 1988; Higuchi T et al 1997).
- Hemoglobin levels: anemia is common in patients with leukemia, and this can be monitored by periodically measuring hemoglobin status. Hemoglobin levels less than 11g/dL are typically seen with leukemia (Quirt I et al 2001).
- Cytokine panel: tests in patients with leukemia typically reveal that blood levels of pro-inflammatory cytokines, such as interkeukin-6 (IL-6), interleukin-8 (IL-8), interleukin-1 beta (IL-1ß), and tumor necrosis factor-alpha (TNF-a) are elevated.
- Genetic profile: p53 (Lian F et al 1999; Melo MB et al 2002; Nakano Y et al 2000) and Bcr-Abl tyrosine kinase (Patlak M 2002).
- Blood smears: assessments of blood cell shape and size show the presence of leukemia cells by highlighting irregularities in cell shape and structure.
- Bone marrow tests: samples taken by aspiration can detect leukemic cells in bone marrow and monitor treatment effectiveness.
- X-rays: leukemia progression can be monitored by X-rays to detect disease spread to the lymph nodes, lungs, bone, and joints. Magnetic resonance imaging (MRI) can detect brain metastases (Vera P et al 1999).
- Abdominal sonography: this is a diagnostic imaging method used to monitor the effect of treatment through detection of enlarged spleen (splenomegaly) and abdominal lymph nodes (Bessmel'tsev SS et al 1991).
- Physical examinations play a very important role in monitoring the response to treatment and checking for relapse following leukemia remission, including the presence of enlarged lymph nodes or an enlarged spleen (Saven A et al 1998).