Leukemia

Leukemia is defined as a group of blood diseases characterized by the production and development of lymphocytes in a way that does not function, which is a type of white blood cell (white blood cell) cells responsible for body defense.

Although blood cancer is a type of cancer that can occur at any age, it is more common in children and adults over the age of 50. The chance of treatment is very high with early diagnosis and it is of great importance to recognize the disease in the early stages and start treatment.

Leukemia can most simply be defined as blood cancer. It occurs as a result of the development of stem cells in the bone marrow being suspended for various reasons and uncontrolled proliferation, and may spread primarily to the bone marrow and then to all organs.

Bone marrow is the spongy tissue where blood cells such as red blood cells, lymphocytes and white blood cells such as platelets (thrombocytes) are made, and these cells are mixed with the blood after they are made in the bone marrow. White blood cells are one of the most important parts of the immune system. On the one hand, it protects the body against the invasion of viruses and foreign microorganisms such as bacteria, fungi or parasites, on the other hand, it determines the cells that tend to become cancerous in the body and ensures their elimination.

Unlike other cells produced in the bone marrow, white blood cells can also be produced in other organs such as the lymph node, spleen, and thymus.

Leukemia, which is a progressive disease that causes serious problems when left untreated, follows a slower course if it develops due to the uncontrolled increase in maturing white blood cells.

Bone marrow cancer, which develops due to the uncontrolled production of immature white blood cells, progresses rapidly and may cause clinical findings within 1-2 months.

What are the Types of Leukemia?

According to the course of the disease, blood cancer is of two types, acute and chronic. The type of leukemia that progresses rapidly and gives clinical signs and symptoms in a short time is defined as acute, slowly progressing and developing leukemia type over many years is also expressed as chronic leukemia.

Cancer cells in acute leukemias are less mature, multiply rapidly and leave the bone marrow dysfunctional compared to cancer cells in chronic leukemias, and these dysfunctional cells are called blasts. With the rapid proliferation of blast cells in acute leukemias, it also invades the necessary living spaces for other healthy cells in the bone marrow, leading to the formation of symptoms in a short time.

Both types of leukemia are divided into two branches according to the type of white blood cell. If the white blood cell is myelocyte, it is called myeloid leukemia, and if it is lymphocyte, it is called lymphoblastic leukemia. In addition to these types of leukemia, there are different types of leukemia such as juvenile myelomonocytic leukemia, chronic myelomonocytic leukemia, myelodysplastic syndrome, myeloproliferative diseases and hairy cell leukemia, which are much less common.

Acute myeloid and chronic lymphocytic leukemia are common in adults, and leukemia in children often presents as myeloid and acute myeloid leukemia (AML). Acute leukemia is used to describe bone marrow cancer characterized by leukocytes that have not fully developed.

Chronic Lymphocytic Leukemia (CLL)

CLL results in uncontrolled proliferation of lymphoid-derived white blood cells after they complete their maturation. these cells lack function, CLL most commonly occurs in individuals between the ages of 60 and 70. The predicted 5-year survival rate for this type of leukemia is around 83 percent.

Chronic Myeloid Leukemia (CML)

CML, which is a type of blood cancer that especially affects individuals between the ages of 25-60, occurs after the proliferation of myeloid cells. The 5-year survival rate for this type of leukemia is around 67 percent.

What Are the Symptoms of Leukemia?

Among the clearest signs of leukemia, which is similar to the symptoms of other bone marrow diseases, are weakness, pallor, fatigue and shortness of breath due to anemia.

Symptoms of leukemia include nose, tooth and gum bleeding, unexpected bleeding under the skin, bruising, and pinhead-sized red rashes (petechiae) on the skin due to infections caused by the weakening of the immune system and the influence of platelets.

Anorexia, weight loss, night sweats, febrile infections that cannot be controlled with treatment, bone pain, enlargement of neck and armpit lymph nodes, swelling in the gums and abdomen are also considered among the symptoms of acute leukemia.

Leukemia Symptoms in Children

Leukemia, which accounts for about 30 percent of childhood cancers, is more common in children aged 2-5 years and 5-10 years. Newborn babies use the immune support they receive from breast milk in the first 6-8 months of their lives, and after this period, they regulate their own immune system until the age of 2, but it is possible that viral infections they will experience during this period may trigger leukemia cancer.

Rickets at this age and vitamin D deficiency due to this disease have a supportive role in the formation of blood cancer. Therefore, it is of great importance that children be exposed to the sun in suitable weather conditions and at the hours recommended by the doctor.

Common symptoms of leukemia in children:

• a pale skin color
• Loss of appetite and rapid weight loss
• Prolonged febrile infections
• Formation of bruises or glands on the body
• swelling in the abdomen
• Joint Pains

During the course of leukemia, some symptoms can be seen with the involvement of other tissues and organs other than the bone marrow. For example, after the cancer has metastasized (splash) to the central nervous system, various symptoms such as headache, nausea, vomiting and seizures may occur.

Apart from the central nervous system, leukemia may spread to the lungs, digestive tract, heart, kidneys and testicles, causing complaints specific to these regions.

What are the Stages of Leukemia?

In order to determine at what level the leukemia has progressed in the body, the symptoms of the person and the areas where the damage occurred are examined. In order to determine the stage of the disease, a chest X-ray is taken and the bones in the chest and lungs are examined. In addition, imaging techniques such as computed tomography and MRI are often used.

In addition to the lung, the abdomen or other areas of the body may be examined. After these stages are passed, there is usually sufficient data to determine the stage of the disease. The general characteristics of the leukemia stages are given below:

Stage 0: At this stage, there are no serious symptoms and symptoms are usually detected incidentally. A partial increase in the absolute number of lymphocytes in the blood and bone is observed.

Stage 1: Absolute lymphocyte count has increased compared to the previous stage, and enlargement of the lymph nodes is also observed.

Stage 2: Symptoms occur in other parts of the body in addition to the lymph nodes, and enlargement of the spleen is the most prominent symptom.

Stage 3: Symptoms of anemia begin to appear, which can lead to intense weakness, exhaustion and fatigue.

Stage 4: A decrease in platelet levels is observed.

What Causes Leukemia, What Are the Risk Factors?

Leukemia is a malignant disease that ranks 15th in the frequency of diagnosed cancer diseases. It is also in the 11th place in cancer-related deaths, and it is seen 1.5 times more frequently in men than in women. Leukemia tends to be more fatal in male patients, and the cause and risk factors may vary depending on the type.

Risk Factors for Acute Lymphoblastic Leukemia

People living in areas close to nuclear explosion sites may be predisposed to ALL type of leukemia due to high radiation exposure.

Chemicals such as benzene in cigarette smoke and various chemotherapy drugs used in cancer treatment are also considered among the conditions associated with the development of ALL-type leukemia.

People infected with HTLV-1 and EBV viruses may have an increased risk of developing ALL. In addition to infectious diseases, the risk of ALL increases in people with disorders such as Down syndrome, Klinefelter’s syndrome, fanconi anemia and neurofibromatosis.

Risk Factors for Acute Myeloid Leukemia

AML is a type of leukemia that occurs as a result of mutations and abnormalities in DNA parts related to the development and division of stem cells in the bone marrow. The likelihood of a person developing AML increases with age, with the average age at diagnosis for AML being 68. For AML, which is more common in men, exposure to cigarette smoke, myelodysplastic syndrome and down syndrome are considered as risk factors.

Risk Factors for Chronic Lymphocytic Leukemia

Today, the exact underlying cause of CLL development has not been revealed yet, but being over 50 years old, male gender, exposure to chemical agents used in wars, and the presence of other individuals in the family with this disease are considered risk factors for the development of CLL.

Risk Factors for Chronic Myeloid Leukemia

CML is a type of leukemia that occurs as a result of genetic mutations, but what or what triggers these mutations has not yet been fully revealed. These genetic mutations are abnormalities that occur later in an individual’s life, and the person does not inherit the genes associated with this disease from their parents.

Humans have a total of 23 pairs of chromosomes. With the changes in parts between chromosomes 22 and 9, chromosome 22 becomes shorter than normal and chromosome 9 becomes longer than normal.

The mutated chromosome 22 is called the Philadelphia chromosome and can be detected in 90 percent of CML patients. The BCR-ABL gene on the Philadelphia chromosome triggers the uncontrolled proliferation of blood cells, leading to the development of CML.

How is Leukemia Diagnosed?

The examinations and applications for the diagnosis of leukemia are numerous and take a lot of time. The purpose of using many tests is to ensure that the type and stage of the disease are fully revealed.

During the physical examination performed by the doctor, the presence of signs indicating leukemia such as pale appearance due to anemia, enlarged lymph nodes, spleen and liver enlargement is examined.

Complete blood count, metabolic and biochemical values, liver function tests and coagulation values of the patient are among the useful tests in the diagnosis of leukemia. In addition to these tests, peripheral blood smear and bone marrow examination are important procedures with diagnostic value in terms of leukemia.

Bone marrow aspiration biopsy is necessary and important for the diagnosis of acute leukemia. In chronic leukemia, peripheral blood evaluation is generally considered adequate and further biopsy procedures may not be required in these individuals. BCR-ABL gene can be determined by genetic diagnostic methods in CML disease.

The bone marrow test is usually done from the patient’s hip bone. A bone marrow sample taken from this bone by means of a long needle is sent to the laboratory and evaluated for the presence of cancer cells.

How is Leukemia Treatment?

Before leukemia can be treated, its type must be determined. With a simple complete blood count, signs of cancer are detected in the blood and a diagnosis of leukemia is made depending on the increase in cancer cells called blasts in the blood.

A biopsy from the bone marrow indicates whether the bone marrow is involved with cancer cells. The important point in treatment is to determine the subtype of leukemia. The treatment technique varies according to the subtypes of leukemia.

Chemotherapy is the first method that comes to mind in the treatment of leukemia. Chemotherapy drugs are chemical drugs aimed at eliminating cancer cells that cause leukemia. Depending on the type of leukemia, the type, dose and route of administration of the drugs to be used in chemotherapy also vary.

Radiotherapy (radiation therapy) uses high-energy rays to destroy leukemia cells and prevent their growth. Radiation therapy can be applied to only part or all of the body. In addition, radiotherapy is a technique used in preparation for stem cell transplantation.

With the use of biological agents and immunotherapy drugs in these patients, it is aimed to ensure that people’s own immune systems recognize cancer cells. Thanks to these drugs, the defense cells, which detect malignant cells more frequently, eliminate cancer cells.

It is generally accepted that bone marrow transplantation is one of the most effective treatment methods in leukemia patients. In this method, which is known as stem cell transplantation, marrow transplantation can be performed from the patient’s own healthy marrow or from siblings, close relatives or donors who provide tissue compatibility.

The purpose of bone marrow transplantation is to replace the diseased bone marrow with healthy bone marrow. Before this procedure, high-dose chemotherapy and radiotherapy are given to the patient, and the diseased bone marrow is completely removed, and then blood-forming stem cells are infused to the patient and it is aimed to regenerate the healthy bone marrow.

Bone marrow transplantation is considered one of the major medical procedures and may cause side effects such as sudden blood pressure drop, headache, nausea, vomiting, pain, shortness of breath, fever and chills in the person to be transplanted. Apart from these symptoms, there are also more serious side effects of bone marrow transplantation. The occurrence of these serious side effects varies according to the age of the person, general health status, the disease that he received the treatment for, and the type of transplantation.

GVHD (Graft-versus-host disease) is an important health condition that describes the way a donor’s blood cells fight against cells in the recipient’s body. Apart from GVHD, transplant rejection and internal organ damage or bleeding are among the serious side effects that may occur after transplantation.

Leukemia treatment planning is carried out by hematology oncology specialists. It is possible that treatment will vary according to both the type of leukemia and patient-specific factors.

During chemotherapy treatment, it is very important to give additional supportive treatment to these drugs, especially in acute leukemia patients. By affecting the normal blood cells of the patient with chemotherapy drugs, it has an effect that increases the susceptibility to infectious diseases, bleeding and anemia. Therefore, in addition to chemotherapy treatment, antibiotic drugs and, if necessary, blood transfusion and transfusion of other blood products can be applied to the patient.

In addition to antibiotics, antifungal drugs and anti-nausea antiemetic drugs are among the drugs that can be prescribed to the patient by physicians when necessary.

Tyrosine kinase inhibitor drugs with imatinib active ingredient in CML patients have created a revolutionary treatment plan by acting against mutated genes and products. Another important feature of these drugs is that they have fewer side effects than chemotherapy drugs.

Acute and chronic leukemias have complex diagnosis and treatment stages that include many types of blood diseases. The earlier the diagnosis is made, the higher the effectiveness of the treatment, so it is important to be aware of these disorders. As the years progressed, a decrease in death rates and an increase in survival rates were observed in the light of new diagnosis and treatment techniques.

While the 5-year cancer survival rate in people with leukemia was 30 percent in 1975, this rate is over 60 percent today. The biggest reason for this is awareness and early diagnosis. Therefore, if you encounter symptoms of leukemia in yourself and the people around you; It is recommended that you do not neglect to seek help from a specialist doctor by applying to the nearest health institutions.