This article has been reviewed and approved by Dr Niti Raizada for authenticity and medical correctness on 10 May 2020

All about Leukemia

Leukemia is a cancer of the tissues in your bone marrow that produce blood cells. Your blood has different types of cells like the white blood cells, red blood cells, an blood platelets. All these have specific functions to perform.

White blood cells help to fight infections, while the red blood cells carry oxygen to different parts of the body. Blood platelets help your blood to clot when you have cuts or injuries that cause bleeding. All these cells are present in your blood in the required numbers.

In blood cancers or leukemia, there is an increase in the number of certain blood cells and a decrease in the count of other blood cells.

Blood cancers affect persons of all age groups, from infants to the elderly. Some are more common in children, while others are common in adults.

The main treatment for leukemia includes chemotherapy and biologic therapies. It helps to keep the disease under check for longer periods.

For a complete cure, you may need a bone marrow transplant (BMT) or stem cell transplant. In a BMT, your cancer specialist will help replace the diseased bone marrow with healthy marrow from a donor. The donor may be related, unrelated, or self.

Type of leukemias

There are different types according to the blood cell affected and how quickly cancer progresses. 

Lymphocytic leukemias are cancers of white blood cells called lymphocytes. Here, there is an increase in the count of these cells. The number of abnormal cells is also high.

Myeloid leukemias are cancers of white blood cells, and it’s precursors other than lymphocytes or red blood cells or blood platelets. There is an increase in the count of myeloid cells like neutrophils. The number of abnormal cells is high here also.

Acute leukemias are fast-growing blood cancers. Chronic leukemias are slow-growing blood cancers. 

Some of the common types of leukemias and their features are ...

Acute Lymphoblastic Leukemia (ALL)

It usually affects children below fourteen years. This type responds very well to treatment. Chemotherapy is the most common treatment option. A BMT will help to cure the condition permanently. CAR-T Cell therapy is a new form of treatment that your doctor may suggest if there is a relapse.

Acute Myeloid Leukemia (AML)

While it usually affects those above sixty years, it can happen in other age groups also. Men are more at risk than women. Chemotherapy is the most common treatment. 

Some cases may need Biologic therapy based on some molecular markers. A BMT will be needed if there is a relapse. 

Chronic Lymphocytic Leukemia (CLL)

This type usually affects the old. Treatment is needed only when symptoms are severe.

Chronic Myeloid Leukemia (CML)

It is more common in adults than children. Men are more at risk than women. The disease often progresses very slowly. Oral therapies work well for this type. It generally has very good survival rates.

Causes of leukemia

Your bone marrow has cells called stem cells that form different blood cells as and when necessary. In blood cancers, some of these stem cells divide more faster than usual. It results in a huge increase in the number of certain blood cells.

But what exactly causes these cells to multiply uncontrollably is not very clear. Experts believe that mutations or changes to genes that control cell division are the reason. 

A few things may increase your risk of having blood cancer such as 

  • Your gender- If you are a male, you are more likely to develop blood cancers than women 
  • Your age- Some blood cancers like CLL, CML are more likely in those above the age of sixty. ALL is more common in children while adults are at risk of AML.
  • Having some blood disorders- Your risk is higher If you have blood disorders like polycythemia vera
  • Exposure to chemicals- Those working for a long time with pesticides and some other chemicals are slightly more at risk 
  • Smoking- Smokers have a higher risk of getting AML
  • Exposure to radiation- If you have exposure to atomic or electromagnetic radiations, your risk is more
  • Family history- Having an immediate family member with blood cancer increases your risk

 

You should understand that you may not develop blood cancers, even if you have these risk factors. Similarly, you may have the disease without having any of these risk factors.

Symptoms of blood cancer

The symptoms vary based on age and gender.

Some of the common signs are

  • Severe bleeding even with small cuts or injuries
  • A tendency to have bruises very easily
  • Feeling tired with little effort
  • Poor appetite
  • Pain in the abdomen especially around the spleen, liver, etc
  • Enlargement of the liver, spleen, etc
  • Swelling of the lymph nodes in the neck, armpits, and groin
  • Recurrent sore throat and other respiratory infections
  • Difficulty in breathing
  • Losing weight without trying
  • Pain in the bone and joint
  • Unexplained fever 

 

Most of these signs resemble that of other diseases. Hence it is difficult to diagnose blood cancers with symptoms alone. You will need a proper diagnosis to confirm blood cancer.

Diagnosis of leukemia

If you have any of the symptoms of leukemia, you will have a thorough physical exam and a blood test.

Physical examination- During the physical examination, your doctor will look for signs of blood cancer. You may have swollen lymph nodes in the neck, armpits, groin, etc. The doctor will also feel your abdomen to look for enlargement of the liver, spleen, etc.

 

Blood tests-  If you have leukemia, you will have a higher number of white blood cells in your blood. If the number of lymphocytes is more, you have lymphocytic leukemia. A higher number of other white blood cells (myeloid series) points to myeloid leukemia. Also there can be low Hemoglobin and low platelets.

 

Bone marrow test-  Your doctor will make you do this test to examine your bone marrow very closely under a microscope. During this test, your doctor will insert a special needle into your hip bone and take a sample of the bone marrow. He or she will then look at it with a microscope to detect the type and extent of your cancer. It helps the doctor to decide on the best course of treatment for you.

Treatment for leukemia

Your treatment will depend on the type of leukemia you have. Your age, general health, the severity of symptoms, etc. also play a role. 

Chemotherapy

It is the most common treatment for leukemia. The procedure uses combinations of medicines to destroy cancer cells in your blood. You will have the medicines through your mouth or as injections through your veins. You will have the treatment in cycles with a few days of rest in between. 

Targeted therapy 

This treatment uses medicines that target and destroy cancer cells without much harm to healthy cells. Thus the side effects are very few. The medications target the cancer cells with the help of some markers. The treatment is suitable only for certain types of cancers like Chronic Myeloid Leukemia or Chronic Lymphocytic Leukemia.

Immunotherapy

It aims to increase the immunity of your body to help destroy cancer cells with the help of some biologic agents. These include monoclonal antibodies, vaccines, etc. As your immunity increases, it becomes easy for your body to identify and destroy cancer cells.

Radiation therapy 

You will have this treatment if your leukemia has spread to other organs like the brain. It uses high-energy rays or particles to destroy cancer cells.

Bone marrow transplant/ Stem Cell Transplant

If other treatments do not, help you will have bone marrow or stem cell transplant. In this treatment, your doctor will replace your diseased bone marrow producing cancerous cells with a healthy one. The healthy bone marrow will come from a donor whose bone marrow matches yours.

You will have chemotherapy and radiation before the procedure to destroy the faulty bone marrow. The doctor will then introduce the healthy bone marrow through a large blood vessel into your bloodstream. Once in the blood, the bone marrow moves and occupies the marrow space of large bones. Then it starts producing healthy white blood cells without any abnormalities.

Bone marrow transplant can be of various types:

  1. Autologous Stem Cell Transplant – It uses healthy stem cells from your own body.
  2. Allogenic Stem Cell Transplant – where the healthy blood stem cells from a donor replaces the diseased cells in your body.The donor can be related(preferred option) or unrelated. A Haplo Identical transplant uses stem cells from a half matched donor who is typically a family member. 
  3. Umblical Cord Blood Transplant uses stem cells from the umbilical cord of the new born babies

Leukemia treatment in India
Leukemia treatment in India

References / Additional Reading
This article has been reviewed by Dr Niti Raizada for authenticity and medical correctness on 10 May 2020
Dr Niti Raizada
Dr Niti Raizada
MBBS, MD, DM-Medical Oncology, MRCP
Dr. Niti Raizada is a senior Medical Oncologist with over fifteen years of experience in the field. Dr Niti has special interests in the areas of Thoracic, Gastrointestinal, Breast, Gynaecological Oncology, and Bone Marrow Transplants. She did her MBBS at Gandhi Medical College, Bhopal; MD-General Medicine at G R Medical College, Gwalior, DNB-General Medicine from National Board Of Examination,DM from Adyar Cancer Institute Chennai and Fellowship in Hematology from Hammersmith Hospital and Imperial College,London. She is a member of American Society of Clinical Oncology,USA; Royal College of Physicians,Edinburgh,UK; Member of Pharmacy Committee,Member of DNB teaching program in Medical Oncology and European Society of Medical Oncology (ESMO).
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