blood cancer symptoms (Leukemia (cancer of the blood)

Leukemia (cancer of the blood)



Symptoms of leukemia
First common signs of blood tumor, information about the initial signs of carcinoma and fulminant blood malignancy, in adults and children (children), and in men and women.

The symptoms of leukemia (a type of blood cancer) begin to appear when the number of cancer cells (abnormal) in the blood grows and the bone marrow can not make the normal cells of the blood that the body needs. Leukemia is an overproduction of abnormal cells that "get stuck" early in the maturation process. These leukemic cells are not functional and are not capable of doing the work of healthy mature blood cells.

Having few normal cells in the blood, be it white blood cells, red blood cells, or platelets, can cause a series of symptoms. In acute leukemia, the symptoms appear and get worse quickly.

The signs and symptoms of leukemia are: fatigue, malaise, loss of appetite, weight loss, fever, anemia, shortness of breath, paleness, palpitations (rapid heartbeat), weakness, dizziness, generalized bruising, frequent nosebleeds or severe, bleeding from the gums, heavy menstrual flow, red spots on the skin (petechiae), frequent infections (pneumonia, cystitis, infection of the gums or around the anus, cold sores), vomiting, headache, sore throat, sweating night vision, pain in the bones and joints, enlarged lymph nodes (in the neck, armpits, groin, or above the clavicle), abdominal discomfort or fullness, vision problems, eye sores, and swelling the testicles.

symptoms of leukemia
There are other rarer symptoms of leukemia:
- Chloroma (granulocytic sarcoma), a group of leukemia cells under the skin or in other parts of the body, similar to a tumor.
- Changes in the skin:
* Skin leukemia: occurs when the leukemia cells enter the skin. The sores or patches can be any size and are usually pink or cinnamon.
* Leukocytoclastic vasculitis: resembles an allergic reaction on the skin. Ulcers usually appear on the extremities (hands and feet).
* Sweet syndrome (acute febrile neutrophilic dermatosis): with fever and painful sores that can appear anywhere on the body.

Acute leukemia

Acute leukemia can cause a drop in normal white blood cells (a condition called neutropenia), which will cause problems to fight infections (being frequent mouth and throat, skin, lungs, urinary tract, bladder, or the area around the year). It can also cause a drop in red blood cells (anemia), so that the person can feel very tired, lack air or show a pale appearance, because less oxygen reaches the tissues. If it causes a marked decrease in platelets (thrombocytopenia), it can cause unusual bleeding, bruising easily, nosebleeds, heavy menstrual bleeding, or small purple or red spots on the skin (called petechiae), especially on the arms and legs .

Other symptoms of acute leukemia may include: fever, chills, unexplained weight loss, frequent infections, pain or fullness below the ribs, malaise, sore throat, swollen gums, night sweats, headache, vomiting, vision problems, pain in bones or joints (especially in the hip or sternum), and painless swelling of the lymph nodes.

When acute leukemia is diagnosed, there is usually already a large and growing number of leukemic cells. Signs and symptoms may have been present less than three months, or even just a few days.

Acute leukemia types include acute lymphocytic leukemia and acute myeloid leukemia.


Chronic leukemia

In the early stages of chronic leukemia, leukemia cells can function almost normally and do not cause symptoms. The disease is often discovered during a routine blood test. When the symptoms appear, they are usually mild at first and gradually get worse. Symptoms of chronic leukemia may include: persistent fatigue, weakness, malaise, loss of appetite, unexplained weight loss, excessive sweating (especially at night), painless swelling of the lymph nodes, and enlargement of the liver or spleen .

People with acute leukemia are more likely to experience the first symptoms of the disease than those with chronic forms of this cancer. In many cases, people with chronic leukemia have no initial symptoms, so it is often common to discover the disease in a routine checkup.

Often, these symptoms are not caused by leukemia but may be due to other health problems such as the flu or an infection. Tests are needed to make a diagnosis. You should see your doctor if you present any signs or symptoms of those indicated in a persistent way.

What is leukemia?

Leukemia is a cancer that begins in the stem cells that make up the blood in the bone marrow. It usually affects white blood cells. However, other blood cells may also be involved.

leukemia
Leukemia cells
Stem cells are basic cells that develop into different types of cells that have different functions. Blood stem cells develop into lymphoid stem cells or myeloid stem cells. Lymphoid stem cells develop into lymphocytes, a type of white blood cell. Lymphocytes produce antibodies to help fight infections. Myeloid stem cells become red blood cells, granulocytes, monocytes and platelets. Red blood cells carry oxygen to all tissues of the body. Granulocytes and monocytes are a type of white blood cells that destroy bacteria and help fight infections. Platelets form clots in damaged blood vessels to stop bleeding.

Leukemia develops when the blood stem cells in the bone marrow change in their DNA and no longer grow or behave abnormally. These abnormal cells are called leukemia cells. Over time, leukemia cells displace normal blood cells so they can not do their job.

Types of leukemia

Acute leukemia
Acute lymphoblastic leukemia cells
There are many different types of leukemia. They are grouped according to the type of blood stem cells from which they develop. Lymphocytic leukemias (also known as lymphoblastic leukemias) develop from abnormal lymphoid stem cells. Myeloid leukemias develop from abnormal myeloid stem cells.

Leukemias can also be classified according to how quickly the disease develops. Acute and chronic leukemia differ in the number of mature blood cells. Acute leukemias have a greater number of immature cells, while chronic leukemias have a greater number of mature cells. Acute leukemias start suddenly, in a matter of days or weeks. Chronic leukemias develop slowly over months or years. The four main types of leukemia are: acute lymphocytic, acute myelogenous leukemia, chronic lymphocytic and chronic myelogenous.

In adults, chronic lymphocytic and acute myelogenous are the most common leukemias. There are many different subtypes of leukemia.

Acute leukemia

chronic leukemia
Chronic lymphocytic leukemia cells
In acute leukemia, cells in the bone marrow do not mature as they should. These immature (underdeveloped) cells continue to reproduce, accumulate and displace normal cells. Acute leukemia progresses rapidly, so there are more immature cells than mature cells. Immature cells can not carry out the normal functions of blood cells.

Chronic leukemia

In chronic leukemia, the bone marrow cells mature partially and look more normal than the immature cells of acute leukemia. Chronic leukemia usually progresses slowly and allows cancer cells to develop more. These cells survive longer, so they accumulate and displace normal cells. In general, these cells can perform some of the normal functions.

Rare lymphocytic leukemia

There are several rare types of lymphocytic leukemia that share some characteristics with chronic lymphocytic leukemia:
- prolymphocytic leukemia;
- leukemia of large granular lymphocytes;
- large and granular T-cell lymphocytic leukemia;
- aggressive NK cell leukemia;
- adult T cell lymphoma;
- Sézary syndrome (leukemic phase of cutaneous T-cell lymphoma);
- Hairy cell leukemia.

Disorders related to leukemia

polycythemia vera
Polycythemia vera
There are several disorders that are not strictly considered as leukemia but are related to it.

Myeloproliferative disorders

In the myeloproliferative disorders there is an excess of one or more types of blood cells (red blood cells, white blood cells or platelets). Overproduction starts when a single mother cell mutates and reproduces. There are 4 types of myeloproliferative disorders: polycythemia vera or polycythemia vera rubra, idiopathic myelofibrosis, essential thrombocythemia or thrombocytosis and chronic myelogenous leukemia.

Myelodysplastic syndromes

myelodysplastic syndrome
Myelodysplastic syndrome
Myelodysplastic syndromes are a group of diseases in which the bone marrow does not produce enough healthy mature blood cells. Immature cells, called blasts, do not work properly. These cells accumulate in the bone marrow and blood. As a result, there are fewer healthy cells: red blood cells, white blood cells and platelets.

Myelodysplastic / myeloproliferative syndromes

The myelodysplastic / myeloproliferative syndromes have characteristics of both syndromes: myelodysplastic and myeloproliferative disorders. Among them are:
- chronic myelomonocytic leukemia;
- atypical chronic myelogenous leukemia;
- unclassifiable myelodysplastic / myeloproliferative disorder.

Once the type of leukemia or related disorder has been diagnosed, the doctor will also consider the phase or classification of the leukemia, the progression of the disease (how much it has spread), the prognostic factors (special characteristics that may influence in the course of the disease) and survival statistics for the particular type of leukemia or disorder.

Risk factors for leukemia

There is no known or unique cause for leukemia. Most cancers are the result of many risk factors at the same time. However, some people with leukemia do not have identifiable risk factors.

Different types of leukemia have different risk factors. A risk factor can not increase the risk for all types of leukemia. Not all of the risk factors for the different types of leukemia are listed below.


Men are more likely than women to develop leukemia. The risk for the development of most types of leukemia increases with age.

The following factors are known to increase the risk of developing some types of leukemia:
- high radiation doses (such as exposure to atomic bomb explosions or nuclear accidents);
- radiotherapy administered in the past to treat cancer or other health disorders;
- chemotherapy given in the past to treat cancer;
- radiotherapy combined with chemotherapy administered in the past (the combination of treatments increases the risk more than individual treatments);
- exposure to benzene or formaldehyde;
- genetic syndromes (leukemia can develop in children with these syndromes): Down syndrome, Fanconi anemia, ataxia-telangiectasia and Bloom syndrome.

Being overweight or obese is a risk factor for leukemia. This means that it has an association with leukemia, but there is not enough evidence to say that it is a known risk.

The following are unknown factors for which there is not enough evidence or the evidence is inconclusive. In other words, it can not be determined with certainty whether these factors are or are not associated with leukemia:
- exposures to agricultural and related products (especially herbicides or pesticides);
- occupational exposure to certain chemicals or radiation in low doses;
- exposure to electromagnetic fields.

There are no specific ways to reduce the risk of leukemia. It is important that anyone who has symptoms consult their doctor as soon as possible. Especially go to the doctor if you have the following symptoms: fatigue, discomfort, loss of appetite, weight loss, bleeding or bruising, and frequent infections.

Diagnosis and tests of leukemia

Diagnostic tests for leukemia are performed when: the symptoms of leukemia are present, the doctor suspects that he may have leukemia after talking to the person and completing a physical examination, and when routine laboratory tests suggest a problem with the blood.

Some of the tests that are used to diagnose leukemia are also initially used to determine the stage you are in (how far you have progressed).

Clinical history and physical examination

The medical history is a record of the current symptoms, risk factors and all medical events and problems that a person has had in the past. The medical history of a person's family can also help the doctor diagnose leukemia.

In the medical history, the doctor will ask you questions about: personal history of exposure to high doses of radiation, genetic syndromes, exposure to benzene, prior chemotherapy or radiotherapy, viral infections, family history of leukemia, and signs and symptoms.

A physical examination allows the doctor to detect any signs of leukemia. During a physical examination, the doctor can:
- measure vital signs to detect fever, shortness of breath and palpitations;
- evaluate the skin to see if there are bruises and paleness;
- feel the areas of the neck, armpits and groin to detect swollen or enlarged lymph nodes;
- Examine the mouth for infection and bleeding, or inflammation of the gums;
- feel the abdomen in search of inflamed organs;
- examine the skeleton to detect sensitivity or pain.

Complete blood analysis

A complete blood test measures the quantity and quality of white blood cells, red blood cells and platelets. Leukemia is suspected when blood cell counts are abnormal and blood cells do not look normal. Abnormal blood cell counts may be due to leukemia or other disorders. Immature white blood cells are not normally seen in the blood, so leukemia is suspected if they are present.

- Acute leukemia: The white blood cell count can be low, normal or high. Blast cells may be present in the blood of people with acute leukemia. Many people with acute leukemia have neutropenia (low neutrophils). About 40% of people with acute leukemia have thrombocytopenia (low platelet count). Most people with acute leukemia have anemia (low number of red blood cells).

- Chronic leukemia: The white blood cell count is high. The platelet count may be low. There may be anemia.

Blood chemistry tests

Blood chemistry tests measure certain chemicals in the blood that show if certain organs are working well, and can also be used to detect abnormalities. They help detect liver or kidney problems caused by the spread of leukemic cells. The following blood levels may be elevated: blood urea nitrogen (BUN), creatinine, phosphate, lactate dehydrogenase (LDH), transaminases such as alanine aminotransferase (ALT) and aspartate transaminase (AST), and
uric acid.

Bleeding and coagulation factors

The tests measure the clotting factors of the blood to see how the body can coagulate the blood. In leukemia abnormal levels of blood clotting factors can occur. They are measured using the following tests: fibrinogen level, prothrombin time (PT) or international normalized ratio (INR), and partial thromboplastin time (PTT).

Cytochemistry

The cytochemistry uses dyes to identify the structures of tissues and cellular components in the blood or in the cells of the bone marrow. Some dyes are attracted by certain substances that are found in some types of leukemic cells. The results of the staining can be seen with a microscope. Cytochemistry helps determine the type of cells that are present.

Flow cytometry

Flow cytometry is a laboratory test that is used to classify, count and examine microscopic particles (such as cells or DNA). The cells are measured by staining with a light-sensitive dye; They are placed in a fluid and pass through a laser beam. The laser causes these cells to emit a light that is measured and analyzed by a computer. Flow cytometry helps determine the types of cells that are present.

Immunohistochemistry

Like flow cytometry, immunohistochemistry (or immunocytochemistry) treats a sample of cells from the blood or bone marrow with special antibodies. Instead of using a laser and a computer, chemicals are added that cause the cell to change color if a certain antibody adheres to it. The color change can only be seen with a microscope. Immunohistochemistry helps determine the types of cells that are present.

Cytogenetics

Cytogenetic techniques in a blood or bone marrow sample help to identify the individual chromosome segments and distinguish them. These cytogenetic techniques show chromosomal abnormalities that help confirm the diagnosis and identify the type of leukemia. The results are also useful for planning the treatment and predicting the response to treatment. The results for the cytogenetic test are generally available within 3-4 weeks.

Chromosomal changes that occur in some people with leukemia include: translocations (part of a chromosome attaches to part of a different chromosome),
inversions (part of a chromosome breaks off, flips from end to end and enters the same chromosome), and loss or gain of chromosomes.

Fluorescent in situ hybridization (FISH)

Fluorescent in situ hybridization is similar to cytogenetic testing and can be used to detect specific changes in the chromosomes of blood or cells of the bone marrow. Some anomalies that are too small to be found with the normal cytogenetic test can be found using this technique that uses special dyes that adhere only to specific parts of certain chromosomes. It is a very precise technique and the results are usually ready in a couple of days.

Polymerase chain reaction (PCR)

The polymerase chain reaction (PCR) and the polymerase chain reaction and reverse transcriptase (RT-PCR) are sensitive genetic tests used to find specific abnormalities in the blood or bone marrow cells. Abnormalities can be found even if there are very few leukemia cells present in a tissue sample.

Bone marrow aspiration and biopsy

During a bone marrow aspiration, cells are extracted from the bone marrow (biopsy) so that they can be examined in the laboratory. The laboratory pathology report will confirm if the person has leukemia and, if so, what type of leukemia.

Lumbar puncture

A lumbar puncture removes a small amount of cerebrospinal fluid from the space around the spine for examination under a microscope. Cerebrospinal fluid surrounds the brain and spinal cord. A lumbar puncture is done to see if the cancer has spread to the spinal fluid.

Lymph node biopsy

An excisional biopsy is performed, in which the lymph node is completely removed and examined under a microscope to identify the type of cells and the pattern in which they are growing.

X-ray of the chest

Chest radiography is used to look for mediastinal lymph nodes (lymph nodes in the center of the chest), enlarged thymus, fluid accumulation around the lungs, and pneumonia (lung infection).

Computed tomography

A CT scan uses special X-ray equipment to create three-dimensional images and a cross section of organs, tissues, bones, and blood vessels inside the body. A computer converts the images into detailed images. It can be used to show enlarged lymph nodes around the heart, near the trachea or in the back of the abdomen.

Magnetic resonance

MRI uses powerful magnetic forces and radiofrequency waves to create cross-sectional images of organs, tissues, bones and blood vessels. A computer converts images into three-dimensional images. It is useful to examine the brain and spinal cord. It is most often used when there is concern that the leukemia has spread to the brain.

Ultrasound

Ultrasound uses high-frequency sound waves to create images of structures inside the body. It is used to see if internal organs, such as kidneys, liver or spleen, have been affected by leukemia.

TREATMENT OF LEUKEMIA

The treatment for leukemia is determined by cancer specialists (oncologists), who are sometimes specialists in surgery, radiotherapy and chemotherapy (drugs).

Treatment decisions for leukemia are based on the type of leukemia, the person's age, chromosomal (genetic) abnormalities, and the general health of the person.
  Spanish English The treatment options for leukemia are: - chemotherapy: main treatment for many types of leukemia; - stem cell transplantation: an option for some people under 55; - Radiotherapy: often used to treat or prevent the spread to the central nervous system and to prepare for stem cell transplantation; - therapy aimed at those who have the Philadelphia chromosome (Ph); - supportive therapy to manage treatment complications; - follow-up after finishing the treatment.  Acute lymphocytic leukemia  acute lymphocytic leukemia Acute lymphocytic leukemia The main treatment for acute lymphocytic leukemia involves the long-term use of chemotherapy, and the total treatment usually takes about 2 years. An important part of the treatment is central nervous system prophylaxis, to make sure that the leukemia does not spread or stay in the brain or cerebrospinal fluid.  Treatment decisions are based on age, chromosomal abnormalities, the subtype of acute lymphocytic leukemia, the cancer phase, the general health of the person and the response to treatment.  A complete remission (complete answer) means that: - Peripheral blood cell counts return to normal levels. - Less than 5% of the cells in the bone marrow are blasts.  It is considered minimal residual disease when: - Standard tests, such as observing cells under a microscope, can not find leukemic cells in the bone marrow. - More sensitive tests, such as flow cytometry or polymerase chain reaction, find evidence that there are still leukemic cells in the bone marrow.  It is considered active disease when the leukemia is still present during treatment or has recurred after treatment.  Relapse means that more than 5% of the cells in the bone marrow are blasts.  Chemotherapy  Chemotherapy is used during all phases and for the prophylaxis and treatment of the central nervous system. Medications used to treat acute lymphocytic leukemia include: vincristine (Oncovin), daunorubicin (Cerubidine), doxorubicin (Adriamycin), idarubicin (Idamycin), mitoxantrone (Novantrone), cytarabine (Cytosar, Ara-C), asparaginase (Kidrolase), etoposide (VePesid, VP-16), teniposide (Vumon, VM-26), mercaptopurine (Purinethol, 6-MP), methotrexate (Methotrexate), cyclophosphamide (Cytoxan, Procytox), and steroids such as prednisone (Deltasone) or dexamethasone ( Decadron, Dexasone).  Radiotherapy  Radiation therapy is used to: - prevent or treat the spread of acute lymphocytic leukemia through the central nervous system; - total body irradiation before a stem cell transplant; - to relieve bone pain; - to treat the spread of leukemia to areas such as the testicles or the skin; - Sometimes it is used to reduce the size of the tumor, if it is pressing the trachea.  Stem cell transplant  This therapy can be considered for people with acute lymphocytic leukemia in the following cases: - at the beginning of the first remission or after a relapse if a partial or complete remission can be achieved; - an infusion of donor lymphocytes can be given to stimulate the immune system after a stem cell transplant.  Targeted therapy  People who have the Philadelphia chromosome (Ph +) can be given imatinib (Gleevec) or another tyrosine kinase inhibitor, as part of the chemotherapy regimen.  Supportive therapy to treat the complications of treatment


- Antibiotics and antifungals: medicines to fight infections.
- Blood products. Replacement therapy when the blood cell count is low.
- Growth factors: to stimulate the production of white blood cells.
- Drugs to reduce the high levels of some chemicals in the blood that result from rapid cell death at the beginning of treatment.
- Leukapheresis: to eliminate a large number of white blood cells.

After completing treatment it is important to have frequent follow-up visits, especially in the first 5 years after treatment, even if there are no signs of illness. The time between exams will be longer as time passes, but it will continue indefinitely.

AML

AML
AML
Treatment decisions are based on the age of the person, the subtype of acute myeloid leukemia, chromosomal (genetic) abnormalities, if the person has had chemotherapy before treating a different cancer, if the person has had the myelodysplastic syndrome, if The cancer has spread to the central nervous system and the general health of the person.

Chemotherapy drugs used to treat acute myeloid leukemia include: cytarabine (Cytosar, Ara-C), daunorubicin (Cerubidine), doxorubicin (Adriamycin), idarubicin (Idamycin), mitoxantrone (Novantrone), thioguanine (Lanvis, 6-TG) , mercaptopurine (Purinethol, 6-MP), fludarabine (Fludara), etoposide (VePesid, VP-16), cyclophosphamide (Cytoxan, Procytox), topotecan (Hycamtin), methotrexate (Methotrexate), hydroxyurea (Hydrea), amsacrine (AMSA PD ) and azacitidine (Vidaza).

Medications used to treat acute promyelocytic leukemia include: tretinoin (trans-retinoic acid, ATRA, Vesanoid) and arsenic trioxide.

As with acute lymphocytic leukemia, radiation therapy, stem cell transplantation, and supportive therapy may also be applied.

Chronic lymphocytic leukemia

Chronic lymphocytic leukemia
Chronic lymphocytic leukemia
Expectant management (observation of the progression of the disease without administering any treatment) may be an option if there is evidence of acute lymphocytic leukemia but the person has no symptoms.

Chemotherapy can be used as a primary treatment to return blood cell counts to normal, to reduce spleen enlargement, and for chronic lymphocytic leukemia that is relapsing or refractory to treatment.

Chemotherapy medications used include: fludarabine (Fludara), cladribine (2-CDA, Leustatin), chlorambucil (Leukeran), cyclophosphamide (Cytoxan, Procytox), vincristine (Oncovin), and doxorubicin (Adriamycin). A steroid such as prednisone (Deltasone) can be given in combination with chemotherapy.

The biological therapy will be applied in the following cases: in chronic lymphocytic leukemias of intermediate or high risk, when it no longer responds to chemotherapy, and together with chemotherapy as first-line treatment or as second-line therapy.

The biological therapies used to treat chronic lymphocytic leukemia are alemtuzumab (Campath) and rituximab (Rituxan).

A splenectomy (removal of the spleen) can be done if the spleen is enlarged and other therapies do not decrease the size of the spleen, and to help improve blood cell counts.

Radiation therapy can be used to reduce the size of the spleen if chemotherapy does not work, to relieve bone pain caused by the growth of leukemia cells in the bone marrow, and to reduce the size of the lymph nodes in an area of ​​the body.

Currently stem cell transplantation is not used for people with chronic lymphocytic leukemia, but researchers continue to evaluate this option.


Supportive therapy to manage the complications of treatment consists of antibiotics and antifungals, gamma globulin (to help correct immunodeficiency), blood derivatives, growth factors (to stimulate the production of white blood cells), medications to reduce high blood levels. some chemicals in the blood due to rapid cell death at the beginning of treatment, leukapheresis and corticosteroids.

Chronic myeloid leukemia

chronic myelogenous leukemia
Chronic myeloid leukemia
The monitoring of blood and bone marrow is an important part to see the response to the treatment of chronic myelogenous leukemia. The blood cell counts are monitored closely, and the blood and bone marrow are monitored for the presence of the Philadelphia chromosome. If the Philadelphia chromosome can not be found, the polymerase chain reaction (PCR) test is performed to try to find small amounts of the BCR-ABL gene (which results from the Philadelphia chromosome).

Surveillance of the disease

The monitoring of the disease during the treatment is adapted to each person and can be similar to the following:
- complete blood count every week until the counts are stable, and then monthly;
- cytogenetic tests (analysis of the cells) of the bone marrow at the time of diagnosis, at 6 and 12 months after starting treatment, and then every year with continuous treatment;
- PCR test or reverse transcriptase PCR (RT-PCR) in blood at the time of diagnosis and approximately every 3 months with continuous treatment.

Hematological response

The haematological response usually occurs within the first 3 months of starting treatment, and may be:
- Complete haematological response. The blood cell counts have returned to normal, there are no immature cells in the blood and the spleen has returned to its normal size.
- Partial haematological response. It is similar to a complete answer but the three previous conditions are not given.

Cytogenetic response

The cytogenetic response may take several months or more to occur. A partial cytogenetic response within 3-6 months of initiation of treatment predicts an 80-95% chance of achieving a complete cytogenetic response. In the same way as the previous one, there are several types of responses:
- Complete cytogenetic response. There are no cells with the Philadelphia chromosome in the blood or bone marrow.
- Partial cytogenetic response. Less than 35% of the cells have the Philadelphia chromosome.
- Greater cytogenetic response. It is sometimes used to refer to a complete or partial response.
- Minor cytogenetic response. 35-90% of the cells have the Philadelphia chromosome.

There is no specific timeframe for a complete cytogenetic response before doctors consider a different treatment. A different treatment approach is decided on an individual basis, depending on the age of the person and other possible treatment options.

Molecular response

The molecular response is based on the results of the polymerase chain reaction (PCR) test. It can be of two types:
- Complete molecular response. The BCR-ABL gene is not found in the blood.
- Greater molecular response. A very low amount of BCR-ABL gene is found in the blood.

Targeted therapy with tyrosine kinase inhibitors is the first-line treatment for most people with chronic myelogenous leukemia. The inhibitors used include imatinib (Gleevec), dasatinib (Sprycel) and nilotinib (Tasigna).


Stem cell transplantation is the first-line therapy for some people during the chronic phase of the disease and second-line therapy after the leukemia becomes resistant to treatment with imatinib, dasatinib or interferon alfa. A reduced-intensity transplant may be an option for the elderly. An infusion with donor lymphocytes can be given to stimulate the immune system when there is a relapse after a stem cell transplant.

Biological therapy with interferon alfa (Intron A, Roferon A) used to be the first-line treatment for chronic myelogenous leukemia. It is still used to treat people who can not tolerate other therapies or whose leukemia is resistant to targeted therapy.

Chemotherapy was once one of the main treatments for chronic myelogenous leukemia. It is still used to treat people when targeted therapy has stopped working, and is part of the treatment during a stem cell transplant.
Chemotherapy drugs used include: busulfan (Myleran [oral] Busulfex [intravenous]), hydroxyurea (Hydrea, Apo-hydroxyurea, Gen-hydroxyurea) and cytarabine (Cytosar, Ara-C).

A splenectomy (surgical removal of the spleen) can be performed if the spleen becomes enlarged and painful, and also when chemotherapy or radiation therapy does not help to make the spleen smaller. The spleen can also be removed to help improve blood cell counts.

As in the case of other leukemia subtypes, radiotherapy and supportive therapy may also be used.

Anatomy and physiology of blood

The blood is composed of fluid (called plasma) and solid cells. The bone marrow is the soft, spongy substance in the center of the bones where the blood cells are produced.

Structure of blood

hematopoiesis
Hematopoiesis (Click to enlarge)
In adults, the most active bone marrow is found in the bones of the pelvis and shoulders, the bones of the back (vertebrae), the ribs, the sternum and the skull. The immature blood cells found in the bone marrow are called stem cells. Stem cells can also be found in small amounts in the bloodstream (they are called peripheral blood stem cells).

All our blood cells develop from stem cells. The process of developing blood cells is called hematopoiesis. In the early stages of development of blood cells, stem cells begin to develop along the lymphoid or myeloid cell line. In both cell lines, the stem cells become blasts, which are still immature cells. During the last stage of cell development, blasts mature into three types of blood cells called red blood cells, platelets, and white blood cells.

Blood function

The main function of blood is to supply nutrients, remove waste from cells, transport hormones to tissues and protect the body against harmful microorganisms. Each type of blood cell has a specific job. Red blood cells carry oxygen from the lungs to the rest of the body and return carbon dioxide to the lungs. Platelets form blood clots in damaged vessels to stop bleeding. White blood cells (leukocytes) help to prevent and fight infection by bacteria and viruses, and destroy other cells or foreign substances.

Types of white blood cells

White blood cells are classified as lymphocytes, granulocytes and monocytes.

- Lymphocytes (from the lymphoid cell line). Lymphocytes produce antibodies to fight infections. They are found in the lymph nodes, the thymus, the spleen, the tonsils, the adenoids, the bone marrow and in the lymphatic tissue in other parts of the body such as the stomach and the intestinal lining. There are several types: B cells (which produce antibodies to fight bacteria, viruses and fungi), T cells (which activate B cells to produce antibodies) and natural killer (NK) cells (which attack foreign cells).


- Granulocytes (from the myeloid cell line). Granulocytes destroy bacteria to fight infections. There are three types: neutrophils (which are the main cells that fight the infection, ingesting or phagocytose foreign cells), eosinophils (which help control inflammation and allergic reactions, and attack and destroy certain parasitic organisms), and basophils (which they play a role in certain allergic reactions).

- Monocytes (from the myeloid cell line). Monocytes help fight infection by ingesting substances such as bacteria and fungi.