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Leukemia

Definition


Disease: Leukemia Leukemia
Category: Blood diseases & tumors

Disease Definition:

Cancer of the body's blood-forming tissues, including the bone marrow and lymphatic system is called leukemia. Usually, leukemia starts in the white blood cells.

 

The white blood cells grow and divide in an orderly way, as the body needs them. They are strong fighters of infection. However, the bone marrow produces numerous abnormal white blood cells in leukemia, which don't function properly. Leukemia has four main types and many subtypes. Only some of these types are common in children. Leukemia isn't just a children's disease.

 

A diagnosis of leukemia could be quite concerning, and its treatment could be complex, depending on the type of leukemia among other factors. However, certain strategies and resources could make all of this easier for the patient.
 

Work Group:


Symptoms, Causes

Symptoms:

The signs and symptoms of leukemia vary depending on the type, however, some of its common signs and symptoms may include:

 

  • Fever or chills
  • Frequent infections
  • Shortness of breath when being physically active, for instance when climbing the stairs
  • Excessive sweating, particularly at night
  • Swollen lymph nodes, enlarged spleen or liver
  • Persistent fatigue and weakness
  • Bone tenderness or pain
  • Easy bruising or bleeding
  • Loss of weight or appetite
  • Tiny red spots in the skin (petechiae)

 

The number of abnormal blood cells and where they are collected will determine the severity of signs and symptoms. Because the early symptoms of leukemia could resemble the flu and other common illnesses, it could be easily overlooked.
 

Causes:

Leukemia is classified in two ways:

 

PROGRESSION SPEED:

Chronic leukemia:

More mature blood cells are involved in this type of leukemia. These blood cells could function normally for a period of time and they replicate or accumulate more slowly. Some forms of chronic leukemia may go unnoticed or undiagnosed for years because initially, they may not produce any symptoms.

Acute leukemia:

The abnormal blood cells are immature blood cells (blasts) in acute leukemia. The disease worsens quickly because they multiply rapidly and can't carry out their normal work. Aggressive and timely treatment is required for acute leukemia.

 

TYPES OF CELLS AFFECTED:

Myelogenous leukemia:

The myeloid cells are affected in this type of leukemia. The myeloid cell line includes cells that later develop into platelet-producing cells, white blood cells and red blood cells.

Lymphocytic leukemia:

The lymphoid cells or lymphocytes, which form lymphoid or lymphatic tissue, are affected in this type of leukemia. This tissue is found in several places throughout the body, including the tonsils, lymph nodes and spleen, and is the main component of the immune system.

 

MAJOR TYPES:

Some of the major types of leukemia are:

ALL (acute lymphocytic leukemia):

This type accounts for about 75% of all childhood leukemias. It is the most common type of leukemia in young children.

AML (acute myelogenous leukemia):

Also called acute nonlymphocytic leukemia, this type occurs in children and adults. It is also the most common type of leukemia.

CML (chronic myelogenous leukemia):

Adults are usually affected by this type of leukemia. A chromosome abnormality called the Philadelphia chromosome that creates an abnormal gene called BCR-ABL is associated with this type of leukemia. An abnormal protein called tyrosine kinase is produces by the BCR-ABL gene, which is believed to cause leukemia cells to grow and develop. Before entering a phase in which the leukemia cells grow more quickly, a person with CML could have few or no symptoms for months or years.

CLL (chronic lymphocytic leukemia):

This type almost never affects children. It is more common in Jewish people of Russian or Eastern European descent. In case someone has CLL, which is quite common in adults, they could feel well for years without treatment.

Other chronic myeloid disorders:

By creating too few or too many myeloid cells, this group of diseases causes chronic leukemia, just like CML. Myelodysplastic syndromes and myeloproliferative disorders, such as polycythemia vera, essential thrombocythemia and myelofibrosis are some of the chronic myeloid disorders. Acute myeloid leukemia could be caused by these conditions.

 

Hairy cell leukemia and chronic myelomonocytic leukemia are some of the rarer types of leukemia.

 

The exact cause of leukemia is still not known. However, a combination of genetic and environmental factors seems to cause it.

Acute leukemia:

When one or a few white blood cells have a lost or damaged DNA sequence, acute leukemia occurs. Even though these cells maintain the ability to multiply, but they remain immature in what is known as a blast form. These cells accumulate and begin to interfere with functions of vital organs because they don't mature and die as normal cells do, and eventually, they overwhelm the production of healthy cells.

Chronic leukemia:

More mature blood cells are involved in chronic leukemia. The progression of the disease will be slower because they replicate and accumulate more slowly, however, it could still be fatal. Exactly why this process begins is still not known.

 

Infection, anemia and excessive bleeding could eventually be caused due to shortage of normal blood cells. The function of the bone marrow could be impaired and other organs infiltrated because of too many abnormal white blood cells. Usually, bleeding or infection is the cause of death.

 

A person’s risk of developing certain types of leukemia could be increased due to these factors:

Genetics:

In the development of leukemia, genetics seem to play a role. An increased risk of leukemia is linked with certain genetic diseases, such as Down syndrome.

Exposure to radiation and certain chemicals:

People have an increased risk of developing leukemia in case they've been exposed to very high levels of radiation, such as survivors of an atomic bomb blast or a nuclear reactor accident. An increased risk of certain kinds of leukemia is also associated with exposure to certain chemicals, such as benzene, which is found in unleaded gasoline and tobacco smoke and used by the chemical industry.

Cancer therapy:

People have a slightly greater risk of developing certain types of leukemia many years later in case they've had certain types of chemotherapy and radiation therapy for other cancers.

 

Many people with leukemia don't have any of these risk factors, and most people with known risk factors don't get leukemia.
 

Complications

Complications:

None

Treatments:

Leukemia is not a solid tumor that the doctor can surgically remove, unlike other types of cancer. Leukemia treatment is complex. Some of the factors that treatment for leukemia depends on include:

 

  • The patient’s age
  • His/her overall health
  • The type of leukemia they have
  • Whether it has spread to other parts of the body or not.

 

Some of the therapies that are used to fight leukemia may include:

Kinase inhibitors:

For most people with CML, the first line of therapy will be the drug imatinib mesylate, which is a type of cancer drug. This drug has proved effective in treating the early stages of chronic myelogenous leukemia. It has been specifically developed to inhibit the BCR-ABL protein. People who can't take or who've become resistant to imatinib could benefit from two other drugs that have been approved by the FDA, which are nilotinib and dasatinib.

Chemotherapy:

Chemical agents are used in this form of therapy to kill leukemia cells. The major form of treatment for leukemia is chemotherapy. A person may receive a single drug or a combination of one or more drugs, depending on the type of leukemia. These drugs could be either injected directly into a vein, or they may be taken orally as a pill.

Radiation therapy:

X-rays or other high-energy rays are used in radiation therapy to damage leukemia cells and to stop their growth. Radiation could be directed either at the patient’s whole body, or at a specific area of the body where there is a collection of leukemia cells.

Biological therapy:

Substances that bolster the immune system's response to cancer are used in biological therapy, which is also called immunotherapy.

Other drug therapy:

To treat a certain subtype of AML called promyelocytic leukemia, arsenic trioxide and all-trans retinoic acid (ATRA), which are anti-cancer drugs, could be used either alone or in combination with chemotherapy. Leukemia cells with a specific gene mutation will mature and die due to these drugs.

Stem cell transplant:

Stem cell transplant is quite similar to bone marrow transplant; however, the cells in stem cell transplant are collected from stem cells that circulate in the bloodstream (peripheral blood). The patient’s own healthy cells could be used for transplant (autologous transplant), or they could be the cells of a compatible donor (allogeneic transplant). Because of the shortened recovery time and possible decreased risk of infection, this method is used more frequently than bone marrow.

Bone marrow transplant:

The leukemic bone marrow will be replaced with leukemia-free marrow in this process. The leukemia-producing bone marrow will be destroyed in this treatment by receiving high doses of chemotherapy or radiation therapy. Then, this marrow will be replaced by bone marrow from a compatible donor. In some cases, a person may be able to use their own bone marrow for transplant (autologous transplant). This is possible if they go into remission and then save healthy bone marrow for a future transplant in case leukemia returns.

Supportive care: 

A person will probably need medications to control pain and side effects, no matter what kind of cancer therapy they choose.
 

Prognosis:

Not available

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