Leukemia (or leukemia) is a malignant cancer of the hematopoiesis. It is characterized by an increase in white blood cells that are immature and do not perform their normal function. These blood cells are found in the bone marrow, blood and sometimes in other organs. The form and success of the treatment depends on the specific type of leukemia, the patient’s overall health and the stage of the disease.
Contents: Leukemia – types, causes, symptoms and treatment
What is leukemia?
The main types of leukemi
Causes of leukemia
Leukemia – symptoms
Symptoms of leukemia in children
Diagnosis of leukemia
Leukemia treatment
Chemotherapy
Steroid therapy
Radiotherapy
Transplantation of hematopoietic cell
Leukemia prognosis
Early diagnosis and psychological support
In leukemia, a disorder of hematopoiesis occurs , when the stem cells begin to produce a large amount of one type of blood cell, which, however, does not mature sufficiently.
What is leukemia?
To understand the essence of this disease, it is good to know that blood consists of blood cells and plasma, and among its most important functions is the distribution of oxygen and nutrients in the body. All types of blood cells originate in the bone marrow, which produces three basic types of cells:
- Red blood cells (erythrocytes)– contain the protein hemoglobin that carries oxygen to the tissues of the body.
- White blood cells (leukocytes)– divided into monocytes, granulocytes and lymphocytes, each type having an important role in defense against infections.
- Platelets (thrombocytes)– these are important for blood clotting.
The complete formation of blood cells is precisely controlled in the body – for the correct ratio and number of blood cells. Any abnormal cell proliferation will therefore disrupt this balance and affect overall physical health.
All types of blood cells arise in the bone marrow from so-called stem cells . In leukemia, a disorder of hematopoiesis occurs , when the stem cells begin to produce a large amount of one type of blood cell, which, however, does not mature sufficiently. Such blood cells then do not fulfill their function, they gradually fill the bone marrow and are washed out into the blood. Leukemic cells can collect in various organs. The bone marrow is no longer able to produce enough normal blood cells and the balance of hematopoiesis is disturbed, explains MUDr. Lenka Bambasová , clinical oncologist from EUC Clinic České Budějovice.
The main types of leukemia
Leukemia is divided into many types according to the type of multiplied blood cells. For the purposes of our article, a division into 4 main types will suffice:
- Acute myeloid leukemia (AML)– occurs more often in older people, but it can also affect younger people. Blasts stop maturing in the body and it is flooded with affected white blood cells. This type of leukemia is divided into many subtypes, according to which treatment and chances of survival depend.
- Chronic myeloid leukemia (CML)– accounts for about a quarter of cases in patients between 45 and 55 years of age. It has 3 stages, which depend on the form of treatment and the probability of its success. In the first stage, there is no need for drastic treatment, in the second stage, the disease is often treatable, but the form of treatment is very invasive. In the last stage, treatment options are very limited.
- Acute lymphoblastic leukemia (ALL)– most often affects children, especially between the ages of 2 and 5. Diseased white blood cells suppress healthy ones, which impairs blood formation. Especially in pediatric patients, the success rate of this form of treatment is higher than 80%.
- Chronic lymphatic or lymphocytic leukemia (CLL)– the most widespread form, which usually affects people over 50 years of age. The interesting thing is that it appears exclusively in Caucasians, much more often in men. This type of leukemia is still incurable.
Now let’s explain some of the terms mentioned. Myeloid is the name for leukemia affecting the production of monocytes or granulocytes. Lymphatic leukemia affects the production of lymphocytes. Acute forms have a rapid course and, if not treated, quickly lead to the death of the patient. One of the earliest cells of the developmental series – blasts – is significantly multiplied here. Chronic forms have a slow and gradual course, the patient can live for several years without treatment before the disease is detected. In chronic leukemia, more mature cells are multiplied, but they still do not perform their normal function.
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Causes of leukemia
In most cases, the cause is unknown. However, it is likely that it is due to the action of many factors that lead to a disturbance in the normal maturation of bone marrow cells. It then turns into an uncontrollable process .
Smoking , radioactive radiation, work in the energy industry or contact with certain chemicals are considered risk factors for the development of leukemia . There are also assumptions about the possible share of heredity , although the occurrence of more than one case of leukemia in a family is rather rare.
Sometimes leukemia appears in a patient who has already been treated for another cancer. The development of some CLL and ALL leukemias in adults is related to immune disorders and past viral infections. However, the cause of leukemia is still very unclear, as none of the risk factors occur in a significant part of patients.
Leukemia – symptoms
The leukemic cells gradually crowd out the normal ones. In addition, they tend to be functionally inferior, which explains some clinical symptoms that result from the inability of the bone marrow to form enough functional blood cells . Possible major manifestations include:
- Loss of energy, rapid fatigue and paleness – due to anemia (lack of erythrocytes ).
- Long-term and recurring infections – due to the lack of functional white blood cells ( granulocytes and lymphocytes ).
- Frequent bleeding from the nose and gums, excessive formation of bruises or formation of red dots on the skin (lack of platelets ).
- Enlarged lymph nodes (lymphadenopathy) in the neck, armpits and groin – leukemic cells can accumulate in them, and when they are very swollen, the flow of blood and lymph in the limbs slows down, causing them to swell.
- Abdominal pains – they can be caused by leukemic cells accumulated in the spleen, which subsequently enlarges, and at the same time, the liver can become enlarged ( hepatosplenomegaly ).
- Mild bone and joint pains are common at the edge of the disease.
The following symptoms may also appear:
- fever and night sweats,
- headache ,
- loss of appetite and weight loss.
However, the patient may not have any problems and the disease is discovered accidentally, during a blood count examination for another reason.
Symptoms of leukemia in children
The symptoms of leukemia in children, who most often suffer from the ALL form, are manifested as other diseases of hematopoiesis, i.e. the aforementioned anemia, frequent bleeding from the nose and gums, or reduced immunity .
If you or your child notice the above-mentioned symptoms, definitely do not delay a visit to the doctor . However, the mentioned symptoms are also common to many other diseases, so keep calm and wait for the opinion of a specialist who will perform a blood count examination.
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Diagnosis of leukemia
A blood count in most leukemias will show anemia and a lack of normal white blood cells and platelets, but also the presence of leukemic cells. A bone marrow examination is usually needed for an accurate diagnosis of a specific type of leukemia . In some types of acute leukemia, especially lymphoblastic, it is necessary to repeatedly examine the cerebrospinal fluid (lumbar puncture).
Leukemia treatment
Today, this type of cancer is curable for many patients, but much depends on the type and stage of the disease, which also depends on the treatment. It is always crucial that the treatment is started early and expertly guided by an experienced hematologist , taking into account all the factors that influence the treatment. The course of the disease can be different for each patient, therefore the chosen treatment procedures also differ. Below we will discuss individual options and forms of treatment.
Chemotherapy
Chemotherapy is one of the basic treatment options. It works on the principle of administering cytostatics , which stop cell growth. They are given in the form of tablets or intravenously (more often). They enter the bloodstream and kill tumor cells. However, they also affect other rapidly multiplying cells of the human body, so it is necessary to use them very responsibly.
Cytostatic drugs are administered in special combinations and at intervals so that they can destroy as many leukemic cells as possible while at the same time minimally damaging healthy tissues. The side effects of chemotherapy , which can vary widely in intensity from patient to patient, include the following:
- Significant temporary suppression of normal blood formation – the decrease in white blood cells causes a greatly reduced defense against infections, the lack of platelets and red blood cells can cause increased bleeding.
- Nausea , vomiting and loss of appetite.
- Inflammation of the mucous membranes – manifested by pain and burning in the mouth, abdominal pain and diarrhea.
- Temporary hair loss – is a common side effect of numerous cytostatics and depends mainly on the type of cytostatics used.
The patient must be strictly monitored during the treatment and should see a doctor immediately in case of any complication or, for example, the mentioned bleeding . After chemotherapy treatment, a loss of taste or weakness in the muscles of the limbs may occur for up to several months.
Steroid therapy
Steroids are commonly found in the human body. However, in significantly increased amounts, they help destroy leukemic cells, especially in the ALL form, where they play a completely irreplaceable role. Steroids prednisone and dexamethasone are used here. However, steroids also have a lot of side effects :
- increased appetite – the patient gains weight mainly in the face, waist and shoulders,
- trouble falling asleep
- fluid retention in the body,
- reduced immunity against certain types of infections,
- increased blood pressure,
- high sugar level (steroid diabetes mellitus),
- irritation of the gastric mucosa, possibly the return of a previously suffered stomach ulcer.
During treatment, these side effects tend to be very unpleasant. But it goes away after treatment, just like in the case of chemotherapy. With elevated blood sugar levels, a diabetic diet must be followed. The patient should always report any new problems that develop while taking steroids to the doctor.
Radiotherapy
Radiotherapy uses ionizing radiation, which destroys tumor cells with as little damage as possible to healthy surrounding tissue. It is mainly used in the destruction of leukemic cells that are present in the CNS, i.e. in the brain and spinal cord . Sometimes it can also be used to destroy accumulated leukemic cells in certain parts of the body (eg testicles, eyes or skin).
It is mostly used together with cytostatics administered via lumbar puncture. This kind of treatment is necessary only for some types of leukemia, mainly for the ALL form. Radiotherapy is also a frequent part of preparatory regimens before bone marrow or stem cell transplantation. Side effects here include:
- Reduced ability to reproduce, up to complete infertility – during radiation in the abdominal area.
- Nausea and vomiting – during radiation in the abdominal area .
- A feeling of tiredness and reduced concentration – during radiation in the head area .
- Temporary loss of hair in the irradiated area .
- Red, dry and fragile skin in the irradiated areas.
Transplantation of hematopoietic cells
Today, it plays an important role in the treatment of leukemia. It is used in serious cases , when high doses of cytostatics and radiotherapy are necessary, which would otherwise completely destroy the patient’s hematopoiesis. However, with a hematopoietic cell transplant after this high-dose treatment, blood formation can be restored.
The donor should be a person with the most similar cellular structure , i.e. a sibling or other close relative – ideal donors are identical twins. However, a suitable donor can also be found outside the patient’s family. Transplantation is divided into:
- syngeneic– the donor is the patient’s identical twin,
- allogeneic– the donor is another person (relative or unrelated transplant),
- autologous– the patient is transplanted with his own hematopoietic cells taken before high-dose therapy.
What happens after successful leukemia treatment?
Treatment continues even after cancer cells are no longer detected. Because there are no such sensitive tests, moreover, it has been proven that the cancerous substances multiply again if the treatment is stopped soon after they have subsided.
After sufficient treatment, the patient continues to have regular blood count checks and, at longer intervals, bone marrow checks – for life, with a gradual reduction in the frequency of tests.
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Leukemia prognosis
If acute leukemia is diagnosed in time , the patient has a high chance of survival . The probability of successful treatment is always determined by the doctor, who takes into account the age and general health of the patient, as well as the stage and type of leukemia. In 2018, leukemia was diagnosed in 1,332 people , a total of 919 people died as a result of the disease , but they did not have to be diagnosed.
In the last 20 years or so, the prevalence of leukemia has tripled. However, this does not mean a higher incidence of the disease, on the contrary – the number is growing, as medicine is constantly developing. This results in more frequent diagnosis and subsequent successful treatment.
Early diagnosis and psychological support
Most patients are devastated after being diagnosed with leukemia. Reactions tend to be very individual, which is absolutely natural. As part of the process of coping with an illness, a myriad of feelings come up – one can feel shock, confusion and change one’s mind quickly. The partners, family and loved ones of the patient often need the same support during this process and throughout the treatment as the patients themselves.
However, the most important factor for increasing the chance of survival remains early diagnosis of the disease and initiation of appropriate treatment. Therefore, if you or a loved one suspect leukemia, seek medical help immediately. You can also turn to experts from the EUC clinic.
