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Leukemia: Bloody disease
By Henrylito D. Tacio

April 08, 2005 - "LEUKEMIA is a blood disease that strikes thousands of people each year," says the Mayo Foundation for Medical Education and Research, in Rochester, Minnesota, which I happened to visit last year when I went to the United States. "It's one of the more common cancers, but it is one of the more deadly."

Medical experts call leukemia as cancers of the blood cells. The term "leukemia" is derived from the Greek words for "white" and "blood." It is often considered a disease of children, yet it actually affects far more adults.

But before probing deeper, however, let's be acquainted first what blood is and how it is produced.

Our blood is made up red blood cells (RBCs) or erythrocytes, which carry oxygen; white blood cells (WBCs) or leukocytes, which fight infection; and platelets, which help clotting. All these suspended in a watery, straw-colored fluid called plasma, which contains dissolved proteins, sugars, fats, salts, and minerals.

Blood cells develop in bone marrow, the spongy tissue in the center of our bones. RBCs are the most numerous--there are about five million of them in one cubic millimeter of blood--and have the longest life span of about 120 days. WBCs are fewer (about 7,500/cu mm) and have shorter life spans. Platelets number somewhere in between RBCs and WBCs (about 250,000/cu mm), and survive in the blood for about nine days.

Normally, blood cells are produce in the bone marrow in an orderly, controlled manner. However, with leukemia the body produces large numbers of abnormal WBCs. "These cells never mature properly or function normally," says the Mayo Clinic. "And, they don't die off like normal cells do."

As these abnormal blood cells accumulate, they interfere with production of normal cells in the bone marrow. Too few RBCs can lead to anemia, a condition causing paleness and fatigue. Too few normal WBCs, and you can't fight off infection. And a lack of normal platelets can lead to bleeding.

Since medical experts don't understand yet what causes leukemia, the disease is largely unpreventable. It is no respecter; it strikes both sexes equally and can occur at any age. But recent studies have shown that the following factors can increase a person's risk of leukemia:

* Advanced age. The risk of genetic mutations increases with age. More than half of people who develop leukemia are over age 60.

* Cancer therapy. People who've had certain types of chemotherapy and radiation therapy for other cancers have a slightly elevated risk of developing leukemia.

* Genetics. There's evidence that at least part of the risk for leukemia may be inherited. Some genetic disorders, such as Down syndrome, are also associated with increased risk.

* Environmental hazards. Smoking, exposure to intense radiation and long-term exposure to benzene (found in unleaded gasoline) are linked to greater risk. Leukemia is not a single disease. In fact, it has four main types and many subtypes. They're, however, grouped in two ways. The first is by type of white blood cells affected. When leukemia affects lymphocytes, it's called lymphocytic leukemia. When myeloid cells are affected, it's called myelogenous leukemia.

The second grouping is by how fast they progress: either acute or chronic. In acute leukemia, the leukemia cells multiply rapidly, and the disease worsens in weeks or months. In chronic leukemia, abnormal blood cells replicate or accumulate more slowly and can function normally for a period of time.

There are four major types of leukemia. The first one is called acute lymphocytic leukemia, the most common cancer in children, accounting for 25 percent of all cancers in children under age 15. It most often affects children between the ages three and five but can also affect adolescents and, less commonly, adults, according to The Merck Manual of Medical Information.

Then, there's acute myelogenous leukemia, which affects people of all ages but mostly adults. Exposure to large doses of radiation and use of some cancer chemotherapy drugs increase the likelihood of developing this type of leukemia.

The third one is known as chronic lymphocytic leukemia. More than three-fourths of the people who have this type are over age 60; it affects men two to three times more often than women. Chronic myelogenous leukemia, the fourth type, may affect people of any age and of either sex but is uncommon in children under 10 years old.

The signs and symptoms for each type differ, but in general include: persistent fatigue, weakness; shortness of breath when physically active; swollen lymph nodes, enlarged liver or spleen; easy bruising; prolonged bleeding from minor cuts, slow-healing cuts; nosebleeds, swollen or bleeding gums; frequent infections; weight loss; excessive sweating; and fever.

In order for a doctor to confirm or rule out leukemia, an individual must undergo blood or bone marrow tests. Other more specialized tests may also be necessary. A complete blood cell count can provide the first evidence that a person has leukemia. Very immature blood cells are seen in blood samples examined under a microscope. Also, a bone marrow biopsy is almost always performed to confirm the diagnosis and determine the type of leukemia.

For comments and feedback, write me at [email protected]

Cell Therapeutics' Gamble

By Brian Gorman
June 15, 2005

No one ever said being a biotech company was easy. Biotechnology companies are known for pursuing opportunities that the big boys ignore. That kind of moxie can translate into a drug with no competition and, hence, considerable sales. Sometimes, though, even an approved drug is more trouble than it's worth. Cell Therapeutics (Nasdaq: CTIC) has learned that lesson, but the company still faces some tough times ahead.

The Seattle-based company announced Tuesday that it will sell its only approved drug to Cephalon (Nasdaq: CEPH). Cell Therapeutics unloaded Trisenox, a treatment for a rare form of leukemia, for $70 million in cash, plus up to an additional $100 million based on certain sales and regulatory milestones.

Given the economics of Trisenox, the deal makes some sense. From 2000 until the present, Cell Therapeutics spent $100 million on the medicine, while sales have been just $67 million, according to an interview with the firm's CEO James Bianco in the Seattle Post-Intelligencer. Trisenox sales have continued to grow, but not enough to reverse the company's losses, which amounted to $39.1 million in the first quarter.

With Trisenox off its books, the firm now hopes to focus on getting approval for Xyotax, a form of the widely used cancer drug paclitaxel, which has been modified to improve its water-solubility, lowering its toxicity.

Unfortunately, the Trisenox sale is not likely to provide much breathing room; $30 million from the deal will go to investor PharmaBio Development. Based on the remaining proceeds (excluding potential future payments), and cash and equivalents at the end of the first quarter, Cell Therapeutics will have roughly a year's worth of cash if it achieves its hoped-for $8 million monthly burn rate.

An NDA submission for Xyotax is expected in the first half of 2006, meaning that Cell Therapeutics will probably need to raise cash while it awaits FDA approval. Without an approved drug on the market or the certainty of FDA clearance, the firm won't have an easy time finding investors.

Fool contributor Brian Gorman is a freelance writer in Chicago. He does not own shares of any companies mentioned in this article

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