Leukaemia (Blood cancer)

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What is Leukaemia (Blood cancer) ?

Leukemia is a cancer that starts from the early version of white blood cells s in the bone marrow (the soft inner part of the bones, where new blood cells are made). This is also the commonest form of cancer in children.
The term "acute" means that the leukemia can progress quickly, and if not treated, would probably be fatal within a few months.

Types of leukemia
There are 4 main types of leukemia:

  • Acute myeloid (or myelogenous) leukemia (AML)

  • Chronic myeloid (or myelogenous) leukemia (CML)

  • Acute lymphocytic (or lymphoblastic) leukemia (ALL)

  • Chronic lymphocytic leukemia (CLL)



Signs and symptoms

Signs and symptoms of Acute Leukemia include the following:

  • Fever

  • Decreased neutrophil count

  • Signs and symptoms of anemia, such as pallor, fatigue, dizziness, palpitations, cardiac flow murmur, and dyspnea with even mild exertion

  • Bleeding (eg, from thrombocytopenia due to marrow replacement)

  • Disseminated intravascular coagulation (DIC) at diagnosis (about 10% of cases)

  • Palpable lymphadenopathy

  • Symptoms related to a large mediastinal mass (eg, shortness of breath), particularly with T-cell ALL

  • Bone pain (severe and often atypical)

  • Left upper quadrant fullness in abdobmen and early satiety due to splenomegaly (about 10-20% of cases)

  • Symptoms of leukostasis (eg, respiratory distress, altered mental status)

  • Renal failure in patients with a high tumor burden

  • Infections, including pneumonia

  • Petechiae (particularly on lower extremities) and ecchymoses

  • Signs relating to organ infiltration with leukemic cells and lymphadenopathy

  • Rashes from skin infiltration with leukemia.



Diagnosis

Laboratory tests and other studies used in the workup for ALL include the following:

  • Complete blood count with differential
  • Coagulation studies
  • Peripheral blood smear
  • Chemistry profile, including lactic dehydrogenase, uric acid, liver function studies, and BUN/creatinine
  • Appropriate cultures (in particular, blood cultures) in patients with fever or other signs of infection
  • Chest x-ray
  • Electrocardiography
  • Bone marrow aspiration and biopsy (definitive for confirming leukemia)
  • Immunohistochemistry
  • Flow cytometry
  • Cytogenetics
  • Polymerase chain reaction
  • Gene expression profiling


Management

Treatment may include the following:

  • Induction chemotherapy (eg, standard 4- or 5-drug regimen)
  • Consolidation chemotherapy
  • Maintenance chemotherapy
  • Intrathecal chemotherapy for central nervous system (CNS) prophylaxis
  • Supportive care (eg, blood products, antibiotics, growth factors)

Special considerations apply to the treatment of the following:

  • Mature B-cell ALL
  • Ph+ ALL
  • ALL in older children and younger adults
  • Relapsed ALL
  • ALL in patients with hyperuricemia or at high risk for tumor lysis syndrome
  • Chronic Myeloid Leukemia.

Prevention

There is no known way to prevent most types of Leukaemia, however we can reduce the risk by:

  • Avoiding high doses of radiation.
  • Intake of proper Nutrition & staying physically active.
  • Reducing exposure to chemicals like benzene.
  • Quitting Smoking and tobacco.


Targeted therapy, drugs that target specific parts of cancer cells and tend to have fewer or less severe side effects than chemotherapy; examples include imatinib (Gleevec), dasatinib (Sprycel), blinatumomab (Blincyto), ponatinib (Iclusig), and nilotinib (Tasigna), which attack cells with the Philadelphia chromosome.
Radiation therapy, the use of high-energy radiation to kill cancer cells; this is not used often for ALL, but may be used to treat leukemia in the brain or bone, for example, or before a stem cell transplant.
A bone marrow transplant, which involves use of high doses of chemotherapy and possibly radiation followed by a transplant of bone-forming stem cells; stem cells usually come from a donor, or less likely, from your own bone marrow or peripheral blood. If you cannot tolerate high doses of chemotherapy and radiation, lower doses may be used with a "mini-transplant."

Outcome

The cure rates in leukemia are rising constantly. Patients are encouraged to be optimistic and stick to the treatment protocol advised by the physician for best results.