Stages of Diagnosis
The first step taken after hearing ancestry and medical background of patients who are suspected of leukemia, is a comprehensive physical examination. This examination is a body check for both the disease symptoms that can be seen in leukemia (anemia, abnormal bleeding findings, growth of lymph nodes, liver and spleen enlargement) and infection as well as any other disease that can be seen along with leukemia. After physical examination, the numerical value of the blood cells (leukocyte, platelet, erytrocyte) through blood counts and presence of abnormality of blood cells through peripheral blood distribution are examined. Full biochemistry analysis, viral serology, coagulation and infection analysis are performed in our hospital. When leukemia is suspected based on the findings, the bone marrow sample is taken for accurate diagnosis. Leukemia is diagnosed when the sample exposed to stains changes color when viewed under the microscope. Typing is made by histochemical staining and flow cytometry is run at Düzen Laborataories Group which is an internationally accredited lab. Cytogenetic and molecular analysis (FISH,PCR) are studied by Prof. Dr. Muhterem Bahçe in Genlab Genetic Diseases Diagnosis Center. Brain spinal cord fluid is taken for the anaylysis of the central nervous system eclipse and after analyzed under the microscope, cytologic assessment is completed done in the pathology and cytology laboratories in Ankara University.
All newly diagnosed patients are assessed with abdominal USG at ALFAMED Medical Projection. When further inspection is necessary, assessment is made with computed tomography at İntegra Medical Projection Center. During the diagnosis process and ongoing treatment, patients go through cardiology monitor by Prof. Dr. Vedat Okutan, eye examination by Prof. Dr. Fatih Mehmet Mutlu, and dental examination and treatment by Dr. Kürşat Alanya at Ankara Dental Tooth Treatment Center in suitable intervals.
Stages of Treatment
Patients that are diagnosed with Acute Lymphoblastic Leukemia and Myeloblastic Leukemia are treated with BFM chemotherapy protocol. In this protocol, patients undergo intensive treatment for 6 to 9 months. This treatment consists of chemotherapy taken orally or intravenously. During this period, patients receive in-patient and also outpatient treatment on a daily basis. During outpatient treatment, the patient can stay at home if he/she lives in Ankara or if registered with LÖSEV, he/she can stay at the house called “Home” which provides service to prevent the family be aggrieved and continue his treatment. The intensive treatment is followed by maintenance treatment and during this period the patient takes oral treatment, thus can be treated in his/her hometown. He/She is monitored by blood counts every fifteen days and monthly hospital controls. The treatment of acute lymphoblastic leukemia lasts approximately 2 years for girls and 3 years for boys. Onko Ankara Oncology Center gives cranial radiotherapy to patients who should take prophylactic cranial radiotherapy in accordance with the treatment protocol.
In acute myeloblastic leukemia; a 6 to 9 months intensive treatment is followed by maintenance treatment and patients are monitored at monthly controls. The treatment takes one and a half years for both types. Other types of leukemias are treated with chemotherapy protocols that are suitable according to the type of leukemia. Patients are assessed according to their own risk groups and are directed to Bone Marrow Transplantation Centers when neccessary.
Monitoring After Treatment
After the treatment is over, patients are monitored monthly during the first year, bimonthly during the second year, quarterly during the third year, every six months during the forth year and annually after the fifth year. Every patient is assessed by of endocrinological growth and development, sexual development, by their hormone levels and also cardiologicaly at intervals with echocardiography and MUGA.