Leukemia Symptoms and Treatment

Leukemia Symptoms and Treatment



Memorial Health Group Hematology Department Experts informed about leukemia, which constitutes an important group of blood cancers.
Contents

    What is Leukemia?
    What are the types of leukemia?
    What Is Acute Leukemia?
    What is Chronic Leukemia?
    Lymphocytic Leukemia (CLL)
    Causes of Leukemia
    What are Leukemia Symptoms?
    Leukemia Symptoms in Children
    Diagnosis of leukemia
    Leukemia Diagnosis Methods
    Diagnosis of Acute Leukemia
    Leukemia Treatment
    How is Leukemia Stem Cell Transplanted?
    Stem Cell Transplants Who Should Do?
    Acute Leukemia Treatment
    Is Acute Leukemia Repeated?
    Chronic Leukemia Treatment
    How is KLL Treatment done?
    How is CML treated?
    What You Need to Know About Leukemia

What is Leukemia?

Known as one of the blood cancer types in the society, leukemia is the start of a blooming of blood stem cells, one of the blood stem cells, which stops the growth of a variety of factors and stops the growth of one of the blood cells. Leukemia first seizes bone marrow, then all organs. Leukemia, which affects the body's blood-producing system, the bone marrow and the lymphatic system, is malignant, progressive if not treated. Leukemia; If it is due to uncontrolled increase of mature white blood cells, it is chronic and slow. Those that develop due to the uncontrolled increase of immature white blood cells are defined as acute, ie, fast-moving. Fast-acting blood cancers often show a sudden onset and give clinical signs and symptoms within 1-2 months. For this reason, diagnosis should be made shortly and treatment should be started as soon as possible.

Although leukemia is not exactly known, it is known that exposure to chemicals and agricultural chemicals, especially radiation, benzene, increases the risk of leukemia. One of the best known of the blood cancers, leukemia can be successfully treated with targeted smart drugs as well as patient-specific stem cell transplantation options.
What are the types of leukemia?

Leukemia is assessed in two groups: acute (sudden onset, rapid progressive) and chronic (slow onset, chronic). Acute leukemia is divided into acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML). Chronic leukemia is also subdivided into Chronic Lymphocytic Leukemia (CLL) and Chronic Myeloid Leukemia (CML).

Among the leukemia types, acute leukemia is a very aggressive and rapidly progressing disease. If a diagnosis is made at the time of acute leukemia and treatment is not initiated, it may cause the patient to be lost within days or weeks. Chronic leukemia can remain silent for very long periods of time and progress over the years.
What Is Acute Leukemia?

The incidence of acute leukemia in blood cancers is 15-20%. Acute leukemia is the most common type of cancer in children and progresses very quickly. Acute leukemia, which can be seen at any age, also increases in later ages. Acute leukemia, which manifests itself in a very short period of time with signs and symptoms, results in uncontrolled and rapid proliferation of stem cells in the bone marrow that are responsible for the production of blood cells. Cancer cells in acute leukemia spread quickly to the bone marrow and then to the whole body first. Since white blood cells called leukocytes can not be made in acute leukemia patients, severe infections can often be seen. Since platelet cells responsible for blood clotting can not be produced, skin bleeding, hemorrhage from the gastrointestinal tract, or vital organs can be encountered with severe hemorrhaging. Anemia, the greatest symptom of acute leukemia, is one of the symptoms most easily recognized by patients. In addition, since it has spread to other organs in the body, it can also be confronted as a disorder occurring in any organ.



Acute leukemia is divided into two main groups as acute myelogenous leukemia (AML) and acute lymphoblastic leukemia (ALL), which have many subtypes. It is very important to start early diagnosis, typing and rapid treatment against these very rapidly progressing types of tumors. Diagnosis should be made by specialist doctors in the specialist oncology centers and appropriate treatment should be planned.

What is Chronic Leukemia?

Chronic leukemia is a type of leukemia that progresses more slowly than acute leukemia. However, chronic leukemia gives better results. There are two main subgroups of chronic leukemia, chronic lymphocytic leukemia (CLL) and chronic myelositic leukemia (CML), which occur with mature cells failing to perform their duties and with abnormal proliferation.

Lymphocytic Leukemia (CLL)

Lymphocytic leukemia (CLL) is caused by the proliferation of bone marrow leukemic cells that resemble mature normal lymphocytes and protect the body against infection, but can not function. The KLL cells settle into the bone marrow, lymph nodes and blood, with the result that the lymph nodes swell and the spleen grows. CLL, seen in the 60-70 age range, accounts for 30% of all leukemia. As the disease progresses very slowly, patients may live long without diagnosis. After diagnosis, no treatment is needed unless some patients develop KLL problems. The diagnosis of CLL is made by specific methods of identifying a genetic variation that is specific to the disease. This disease, which has been treated with chemotherapy and bone marrow transplantation very difficult in the past, can be treated very simply nowadays.
Causes of Leukemia

Scientists think viral, genetic, environmental or immunological factors are involved, although the exact cause of leukemia is unknown. Some of these are those;

    Exposure to high levels of radiation
    Exposure to industrial chemicals such as benzene and formaldehyde
    Part of chemotherapy drugs
    Some genetic diseases (Down syndrome etc.)
    viruses

However, these risk factors explain the causes of a very small portion of leukemia. No risk factor has been shown in the majority of patients with leukemia.

Other causes leading to leukemia are;

    Long-time use of technological devices such as tablets and mobile phones by children
    Air pollution
    Contributions to foodstuffs
    Chemicals
    Rotten food

What are Leukemia Symptoms?

The leukemia indication may have some common characteristics with some of the findings of other blood cancers. Depending on cancer risk;

    Paleness,
    Weakness,
    Quick fatigue,
    During effort, symptoms such as shortness of breath are observed.

Leukemia indications include infections caused by weakening of the immune system, gingiva, nose, gums and unexpected redness, bruising, and collective needle-head red scales under the skin. In the case of acute leukemia symptoms, these findings are remarkable;

    Pale, weakness,
    Loss of appetite, weight loss,
    Night sweats,
    Frequent recurrent fevers, infections,
    Bone pain,
    Bleeding under the skin (small red spots as small as the needle point, easy bruising)
    Nose and gingival bleeding, swelling in the abdomen, swollen gums in the neck and underarm lymph glands.

The leukemia indication may be the same as that of many diseases. Leukemia, which can spread to all organs of the body, may have similar indications, especially to rheumatic diseases, infectious diseases, hemorrhagic diseases, lymphoma, myeloma and other blood cancers.


Leukemia Symptoms in Children

Considering all childhood cancers, it is estimated that about 30 percent are leukemia. Childhood cancers and leukemia are often seen in the 2-5 year old or 5-10 year olds. In children, leukemia has extensive clinical manifestations, but some symptoms should be suspected. We can list them as follows;

    Fast weight loss
    Anorexia
    Pale in color
    Bruising in the body or unexpected beads continuing for a long time or growing gradually
    Swelling in the abdomen
    Joint pain
    Stubborn fever that lasted for over 5 days

New born babies can maintain their immune system from the mother for 6-8 months. Then he sets up his own immune system until the age of 2 years. It can infect up to 5 times a year until the turn. It should not be forgotten that viral infections may trigger leukemia cancers.

One of the causes of leukemia in children is lack of vitamin D. There are a number of studies showing that premature rickets and consequent lack of vitamin D are effective on cancer. For this reason, it is very important for children to see the sun at suitable weather conditions and at the hours recommended by experts. The importance of leukemia genetic factors should not be overlooked.

Diagnosis of leukemia

Early diagnosis in the leukemia is very important. Leukemia, which affects the function and reproduction of blood cells, matures the cells in the bone marrow and transforms erythrocytes, leucocytes or thrombocytes. Leukemic leukemic cells (blasts) multiply uncontrollably and suppress the development of normal blood cells. Blood and bone marrow tissue samples are taken and examined for the diagnosis in case of serious complaints such as infection, bleeding caused by the inability to produce blood. Usually a simple blood count and examination of the underlying cells under a microscope is sufficient for diagnosis. However, definitive diagnosis is made by bone marrow biopsy.

Acute leukemia constitutes approximately 95% of leukemia. 85% of acute leukemia is acute lymphoblastic and 15% is myeloblastic leukemia. Among these, acute lymphoblastic leukemia is more favorable for treatment. Because the life expectancy in children is longer, early diagnosis and treatment are of great importance as the success rates are higher compared to adult cancers.
Leukemia Diagnosis Methods

The story of the patient must be rested to allow the diagnosis of leukemia. In addition to the examination, it is necessary to carry out examinations with advanced diagnostic methods.

Examination:

First of all, a good physical examination should be performed on the person with suspicion of leukemia (swelling in lymph glands, liver, size of spleen should be evaluated).

Appropriate blood tests:

Blood count and necessary biochemical studies

Bone marrow biopsy:

The bone marrow taken from the hip bone should be examined. Pathological examination of bone marrow biopsy and bone marrow fluid on glass.

Genetic studies:

Genetic studies of leukemia cells from bone marrow or canine samples
Diagnosis of Acute Leukemia

It is not difficult to diagnose acute leukemia. A simple whole blood count can diagnose acute leukemia. In full blood count; a decrease in normal blood cell numbers and an increase in the number of cancer cells called & quot; blast & quot ;, leukemia can be diagnosed easily. Bone marrow biopsy can also reveal that bone marrow has been retained by cancer cells. The difficult part in diagnosing leukemia is determining the type of cancer. The "immune phenotypic" method can differentiate acute leukemia in different types with various cytogenetic and molecular tests.

The identification of the subtype of leucemin is very important because it directly concerns the treatment process. Because there are different treatment methods for all subtypes of leucemin. If the patient is diagnosed with acute leukemia, risk situations are tried to be determined. When adults are diagnosed with acute leukemia, it is known that more than 70-80% of patients are at high risk. This means that even if leukemia is under control, it can be repeated in a very short time.

Leukemia Treatment

Leukemia therapy involves many disciplines. In fully equipped hospitals, adult and child are treated by hematology specialists. It is necessary to have a leukemia-treated oncology center, a well-educated nurse team for chemotherapy application, a blood bank with 24-hour service, an infectious disease specialist, radiation oncologist and sophisticated laboratory infrastructure to provide radiation therapy if necessary.

Leukemia is a treatable disease, and the success rate of treatment with many new methods discovered in recent years is increasing day by day. The discovery of new chemotherapeutic agents has led to a major phase in the introduction of targeted molecular drugs and biologic drug treatments into daily use, the development of advanced radiotherapy devices, the development of bone marrow transplantation, the prolongation of patients' lives and the complete cure of the disease.

Chemotherapy is the first treatment for leukemia. The type of chemotherapy drugs, dose, route of administration may vary according to the type of leukemia. Apart from about 24 months of chemotherapy treatment, bone transplantation is another method that comes to mind in the treatment of some types of leukemia. The success rates achieved in the treatment of leukemia in our country are at world standards with both bone marrow transplantation and chemotherapy.

Since 2000, chronic myeloid leukemia can be treated at large rates. When the disease is well recognized, drugs that disrupt the mechanism are used. This treatment, called targeted therapy, prevents myeloid cells from proliferating in the bone marrow to mature or mature into the bloodstream. In patients who can not be controlled with drugs, the most effective treatment method is "allogeneic stem cell transplantation". Stem cell transplantation, tissue-matched siblings, close relatives or volunteer non-relatives donated by the help of stem cells are made. For chronic lymphocytic leukemia (CLL), a slowly progressing type of leukemia, only supportive therapies are given in early stages. Drugs or targeted antibodies (immunotherapy) may be administered in advanced stages or high-risk patients. Chronic lymphocytic leukemia can be seen even before the age of 50, even though it is an advanced age disease. In these high-risk patients, allogeneic stem cell transplantation is one of the treatment options.

How is Leukemia Stem Cell Transplanted?

If the risk of recurrence of the disease is high during drug treatment with leukemia treatment and the disease is controlled early, stem cell transplantation is preferred. Stem cell transplantation; (allogeneic) from the individual itself (autologous) or from tissue-compatible siblings, other close relatives, or unrelated volunteer donors. For stem cell transplantation, the stem cells are harvested by applying anesthetic to the donor bone or by drawing the stem cells from the vein with special devices after using stimulant drugs. Before the stem cell transplant, a high dose of medication and / or radiation (radiotherapy) treatment is administered to the patient. The goal of this phase is to destroy the cancer cells that are likely to remain in the patient's body and to empty the cells of the patient's bone marrow. Transfer is carried out afterwards. Autologous transplantation can be performed in patients who do not have the appropriate stem cell donor, but the most effective treatment is allogeneic stem cell transplantation. Post-transplant patients may need to be followed for many years to avoid serious problems.

In the recent period, a patient with a high risk of recurrence who does not have a suitable stem cell donor can be made a "haploidentik" stem cell transplant from relatives who are partially eligible (50-80% compatible). With haploidentical transplantation, about half a year of disease control and survival can be achieved for longer than one year, depending on the risk of the disease. However, when the immunity of the end-stage immune system of the patients in this group is suppressed, it is necessary to follow closely in fully equipped and experienced centers.
Stem Cell Transplants Who Should Do?

When doing stem cell transplantation, it is necessary to pay attention to some points. The necessary evaluation is made considering the criteria of the age of the patient, whether there is an additional health problem, whether the patient is in the middle or high risk group. Some patients respond more late or the disease recurs sooner. In such patients, the risk of recurrence of the disease can be determined by the presence of some gene changes. As a result of examining gene changes, allogeneic transplantation should be performed in patients referred to as high risk group (younger age and no additional disease). In patients with low risk of recurrence; stem cell transplantation, excessive side effects and sometimes life-threatening side effects. However, in case of recurrence of the disease, the stem cell transplant is performed. Allogeneic transplantation can be used as a treatment option in patients with unresponsive blood cancer.
Acute Leukemia Treatment

The first step in the treatment of acute cancers is chemical treatment. The treatment is performed in two or three stages according to the patient's disease. At the beginning of treatment, it is aimed to decrease the number of cancer cells, increase the number of normal cells and eliminate the symptoms of the disease. This is the most important step. Even if this stage is completed successfully, cancer cells can start multiplying again and disease recur in a large part of the patients. After the control is given, treatments called reinforcement are applied to prevent the recurrence of the disease. Reinforcement therapy is also done with chemotherapeutic drugs or stem cell transplantation. In addition, in the treatment of acute lymphoblastic leukemia (ALL) patients, there is an idiopathic treatment period that lasts 2-3 years to prevent the recurrence of the disease. At these stages, the patients need to follow closely. The patient should be followed by an expert team in well-equipped clinics and sterile rooms.
Is Acute Leukemia Repeated?

Acute leukemia can recur in some cases. The disease is suppressed by high dose chemotherapy given in the treatment of acute leukemia. However, leukemia may recur within the first year, as it has entered the high risk group for most of the patients. Allogeneic bone marrow transplantation with stem cells is also recommended to prevent recurrence in the leukemia. First of all, the siblings of the patient are assessed and compatible stem cells are transplanted. If there are no compatible siblings, the bone marrow banks are referred to and the donor is investigated. Allogeneic stem cell transplantation is aimed at reducing the risk of recurrence of the underlying disease. Even if a fully compatible stem cell donor is not available today, compatible transplants are made. In addition, for older patients, mini-transplants using low-dose drugs can be performed and the chance of stem cell transplantation is recognized.
Chronic Leukemia Treatment
How is KLL Treatment done?

It may not be necessary to start treatment immediately for every patient diagnosed with CLL. Most CLL patients do not need treatment for many years. In the remaining part, the disease is progressive for several years and the need for treatment is emerging. When the treatment is started, it is important criteria for the disease to show progressive, various findings and no organ impairment. Disease indication is not a significant effect of treatment. With some special laboratory assessments, the risk factors of the disease are identified and individualized treatment is planned. The goal in the treatment of chronic leukemia is to prevent the patient from inflicting harm on the patient. With the exception of chemotherapy, smart drugs are frequently preferred only because cancer cells are targeted. Smart drugs have far fewer side effects than chemotherapy treatments because they have little effect on healthy cells. Smart drugs are much more useful for CLL, which is more common in advanced age.
How is CML treated?

In the treatment of CML, the second most common type of chronic leukemia, there were breakthroughs at the beginning of the 2000s. In KLM patients, leukemia is caused by a genetic change called stem cell BCR / ABL mutation. The ability to detect this change has greatly simplified the diagnosis of CML and has enabled the development of a drug against the impaired system. However, the use of trophic kinase inhibitors (TKI) has also been an effective treatment modality against the disease. Today, most CML patients have a life expectancy close to their normal life span, thanks to the use of oral TKIs.