Ionizing radiation, organic solvents, pesticides and previous use of cytostatics in the treatment of malignancy can damage human DNA and trigger the development of a vicious blood disease.
Acute leukemias or blood cancers are malignant diseases of the blood cells and bone marrow. There are two basic types of this disease: acute myeloid and acute lymphoblastic leukemia. They are characterized by uncontrolled proliferation of immature cells of the so-called lymphoid or myeloid lineage, increase in the number of white blood cells in the blood and organs, and very rapid progression. The exact cause of leukemia is currently unknown. Some factors such as ionizing radiation, organic solvents, pesticides, some viruses and previous use of cytostatics in the treatment of other malignancies can damage our hereditary material, ie DNA, and trigger the development of leukemia.
Dr Nada Suvajdžić Vuković (Photo: personal archive)
Acute leukemias can be caused by high fever, profuse sweating and poor general condition.
As Professor Dr. Nada Suvajdžić Vuković, from the Clinic for Hematology of the Clinical Center of Serbia, points out, acute myelodic leukemia is a type of acute leukemia that mainly occurs in adults, while it is rare in children. Acute leukemias can manifest non-specifically – high fever, profuse sweating and poor general condition. By invading the bone marrow, leukemic cells suppress the normal elements of the bone marrow, which leads to anemia, infections and bleeding. Some patients have enlarged lymph nodes, liver and spleen.
– Acute myelodic leukemia is a rare disease. It is diagnosed annually in Serbia in about 150 people. The incidence of this leukemia increases with age, which is explained by the accumulation of gene mutations during life. The average age at diagnosis is 70 years. In addition to medical history and clinical examination, the examination includes a blood count and a blood smear examination. Anemia, thrombocytopenia and an increased number of white blood cells are most often registered in the blood picture. Less often, patients may have a normal or low white blood cell count. Examination of blood smears registers leukemia cells. Then, the analysis of the bone marrow is performed, which includes cytological examination, immunophenotyping and molecular cytogenetic tests – emphasizes Dr. Suvajdžić Vuković.
Guidelines for the treatment of acute myelodic leukemia recommend genetic testing to identify gene mutations.
– In the diagnosis of acute myelodic leukemia, we are guided by international recommendations that include the identification of gene mutations. Molecular-genetic characteristics are the most important prognostic factor on the basis of which acute leukemias are classified into the group of good, medium or bad prognosis. The treatment of patients depends on the prognostic group – explains Dr. Suvajdžić Vuković and adds that the treatment of acute myelodic leukemia is standardized and based on internationally accepted recommendations. The basis of treatment is chemotherapy, that is, a combination of cytostatics for at least six months. The goal of initial treatment is to normalize the blood picture and bone marrow, which we call remission.
– Remission is achieved in about 75 percent of younger patients and about 40-50 percent older than 50 years. In patients in remission, treatment is continued with “strengthening” chemotherapy to reduce the risk of recurrence. In patients with high-risk leukemia, the only way to stop the disease is to transplant the hematopoietic stem cell from a matching related or unrelated donor (allogeneic transplantation). Treatment of acute leukemia requires special accommodation conditions and intensive support with antibiotics, drugs against fungal infections and transfusions of blood components. Considering that this is a rare disease whose treatment is specific and expensive, the treatment is carried out in centers where appropriate staff and equipment are concentrated – our interlocutor adds.
In addition to chemotherapy, is any other type of therapy available to patients in Serbia? Dr. Suvajdžić Vuković states that for patients with acute promyelocytic leukemia, one of the subtypes of acute myeloid leukemia, there is one drug available that, together with cytostatic therapy, enables the cure of 80% of patients. For other types of acute myelodic leukemia, new drugs have recently been registered in the world, which are currently not available to our patients.
– The treatment of acute myelodic leukemia in Serbia is getting better every year, but we lack innovative drugs and better accommodation conditions for modern treatment. At the moment, sterile blocks exist only in transplant centers. In the diagnosis and treatment of acute myelodic leukemia, teamwork of doctors, molecular biologists, transfusiologists, microbiologists, anesthesiologists, radiologists, radiotherapists, psychologists and educational medical technicians is necessary – said Dr. Suvajdžić Vuković.
Given that acute myeloid leukemia is one of the most malignant human diseases, that treatment is expensive, long-lasting and accompanied by serious complications, in addition to family support, the support of state institutions and patient associations is necessary. The association, along with hematologists, has the task of raising public awareness about acute myeloid leukemia. In addition, it is very important to help patients during a coronary virus pandemic.
– The treatment of patients with acute leukemia took place despite the difficulties during the kovid 19 pandemic, in accordance with the recommendations of the Ministry of Health and the European Association of Hematologists. Newly diagnosed patients were hospitalized without delay and treated with respect for maximum protection measures. At the moment, the following is being carried out: testing of patients before entering the ward, accommodation in the isolation unit for suspects on kovid 19 and maximum personal protection of health workers – concludes Dr. Suvajdžić Vuković.