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VERIFIED CONTENTAuthor: lek. Piotr Podwysocki

Leukemia is a whole group of malignant neoplasms of the hematopoietic system. Leukemia can be acute or chronic, myeloid or lymphatic. The symptoms of leukemia are not specific, so recognizing it is not always easy. However, there are some symptoms which, when combined, may suggest blood cancer. Learn how to recognize the symptoms of leukemia in children and adults, and how to treat leukemia.

Leukemias(Latinleucaemia ) are neoplastic diseases of the hematopoietic system that affect the white blood cell system.

Their characteristic feature is the presence of a clone of transformed cells that originate in the early developmental stages of hematopoiesis. These cells dominate the marrow and blood and form infiltrates in various organs.

The incidence of the disease in the age of 30-35 is about 1 / 100,000, while in people over 65 it increases to about 10 / 100,000. It is worth knowing that leukemia is more common in men than in women.

Leukemia: causes

The causes of leukemia development are complex and, in many cases, unexplained. The most common etiological factors are:

  • genetic factors (e.g. patients with Down's syndrome have an increased risk of developing acute myeloid leukemia)
  • viruses (e.g. HTLV-1 or 2 human T-lymphotropic virus causes acute T-cell lymphocytic leukemia)
  • bone marrow damage by ionizing radiation
  • cytostatic drugs (e.g., alkylating drugs)
  • chemical substances (e.g. phenol)

As a result of the etiological factor, the genetic material is damaged, which results in translocations within chromosomes and the formation of hybrid genes.

This results in malignant transformation of hematopoietic stem cells and the expansion of a malignant clone of cells - all at the expense of normal hematopoiesis. There is also a progressive decline in bone marrow function.

Leukemia: types

Leukemias can be divided into acute and chronic.

Acute leukemias include:

  • undifferentiated acute leukemias (M0)
  • acute myeloid leukemias (non-lymphoblastic) AML (Acute MyelogenousLeukemia)

->non-maturing acute myeloblastic leukemia (M1) ->maturing acute myeloblastic leukemia (M2) ->acute promyelocytic leukemia (M3) - acute myelomonocytic leukemia (M4) ->undifferentiated (monoblastic) acute monocytic leukemia (M5a) ->differentiated acute monocytic leukemia (M5b) ->acute erythroleukemia (M6) ->acute megakaryocytic leukemia (M7)

  • acute lymphoblastic leukemias ALL (Acute Lymphoblastic Leukemia)

Morphological division: ->L1 subtype lymphocytic type ->L2 subtype lymphoblastic type ->L3 subtype Burkitt type

Immune breakdown: ->null ->pre-pre-B ->common ->pre-B ->pre- T ->thymocytic ->T-cell

Chronic leukemias include:

  • chronic myelogenous leukemia CML (Chronic Myelogenous Leukemia) (included in the myeloproliferative syndromes)
  • chronic lymphocytic leukemia CLL (Chronic Lymphocytic Leukemia) (related to the group of lymphomas)
  • chronic myelomonocytic leukemia CMML (Chronic Myelomonocytic Leukemia) (included in the myelodysplastic syndromes)

Leukemia: Symptoms in Adults

Leukemia symptoms, due to the fact that they are not characteristic and usually develop gradually, are often completely underestimated in the initial stage by the patient. It happens that accidental diagnosis of this disease is based on routine peripheral blood counts. The symptomatology of the most common leukemias in adults and children is described below.

Acute myeloid leukemia: symptoms

Acute myeloid leukemia is growing rapidly. The patient comes to the doctor because of the presence of a set of symptoms related to bone marrow dysfunction.

The most common systemic symptoms are:

  • weakness
  • fever
  • bone and joint pain

In addition, there are symptoms related to anemia, decreased immunity, symptoms of hemorrhagic diathesis, leukostasis and symptoms resulting from infiltration of organs by leukemic cells.

Anemia symptoms include weakness, dizziness, pale skin and mucous membranes, and exertional dyspnoea.

The patient is more susceptible to infections. The oral cavity is a particularly predisposed area to the occurrence of inflammatory changes. There may be aphthas, painful ulcers, recurrent herpes, but also periodontal changes (e.g. abscesses) or severe angina.

ExceptTherefore, patients are exposed to pneumonia of bacterial and fungal etiology, which are often very severe.

The symptoms of hemorrhagic diathesis are especially dangerous for the patient's life. They take the form of bleeding from the nose and gums, mucosal and skin purpura, as well as gastrointestinal and vaginal bleeding in women.

It is worth mentioning here that very heavy bleeding may be a consequence of the intravascular coagulation syndrome caused by disintegrating leukemia cells. This is characteristic of promyelocytic leukemia.

Symptoms of the so-called leukostases occur only in about 5% of patients and result from impaired blood flow in microcirculation due to high leukocytosis - values ​​over 100,000 / ul.

These include headaches, impaired consciousness, visual disturbances, symptoms of hypoxia (related to impaired blood flow in the pulmonary vessels), and sometimes priapism, i.e. painful penile erection.

Leukemia cells can invade various organs and therefore cause a variety of symptoms. They include

  • lymph nodes enlargement
  • liver enlargement
  • spleen enlargement
  • heart failure
  • heart rhythm disturbance
  • severe respiratory failure
  • stomach ache
  • hematuria
  • bone and joint pain
  • bone necrosis
  • visual acuity deterioration
  • inflammation of the inner or outer ear.

When leukemic cells are involved in the skin, there may be lumps or flat eruptions on its surface, and when the gingiva is infiltrated, an overgrowth can be observed, leading to covering the teeth in extreme cases.

Finally, we cannot forget about the possible presence of infiltrates within the peripheral and central nervous systems.

Chronic myeloid leukemia: symptoms

In approximately 20 to 40% of cases, chronic myeloid leukemia is asymptomatic in the early stages.

As the disease continues, symptoms similar to acute myeloid leukemia develop. It is related to high leukocytosis (>200,000-300,000 / ul).

These include:

  • weight loss
  • fever
  • sweating
  • feeling weak
  • disturbance of consciousness
  • headaches
  • priapism (painful erection)
  • feeling of fullness in the abdomen (due to enlargement of the liver and spleen)
  • pains in the left hypochondrium
  • bone pain

Acute Lymphoblastic Leukemia: Symptoms

Symptoms of acute leukemialymphoblastic disorders are similar to the symptoms of acute myeloid leukemia.

In its course, however, enlargement of the lymph nodes, liver and spleen occurs more often. This is usually manifested by abdominal pain, and when the mediastinal lymph nodes are involved - a feeling of tightness in the chest and shortness of breath.

Leukemia changes in the central nervous system are more frequent in the course of acute lymphoblastic leukemia.

Chronic Lymphoblastic Leukemia: Symptoms

This type of leukemia may be asymptomatic for years apart from enlarged lymph nodes and possibly a feeling of weakness.

The more characteristic symptoms such as fever, night sweats and rapid weight loss, anemia and increased susceptibility to infections due to immunodeficiency appear only in the advanced stage of the disease.

It is worth knowing that this type of leukemia is most often diagnosed in patients over 50 years of age.

Chronic eosinophilic leukemia: symptoms

At the time of diagnosis of this leukemia, patients do not have any symptoms - they appear gradually. In addition to fever, fatigue, loss of appetite and weight loss, cardiovascular, respiratory and gastrointestinal symptoms may occur. In addition, neurological and skin symptoms may be present.

On the part of the circulatory system, there can be found heart failure, arrhythmias and conduction disturbances, as well as a tendency to thromboembolic events.

On the part of the respiratory system - shortness of breath and dry cough.

In the course of chronic eosinophilic leukemia, abdominal pain and diarrhea (associated with the presence of mucosal ulceration, bleeding or perforation), as well as memory impairment, behavioral changes, symptoms of peripheral polyneuropathy, as well as ataxia may occur.

In addition, the skin may have subcutaneous nodules, hives, reddening of the skin, itchy skin and angioedema.

Patients often complain of muscle and joint pain and visual disturbances. When examining the patient, enlargement of the liver or spleen may be noticeable.

Chronic Neutrophilic Leukemia: Symptoms

Chronic neutrophilic leukemia is quite a rare neoplasm of the haematopoietic system. It happens that it coexists with another cancer - usually multiple myeloma.

Its course is characterized by enlargement of the liver and spleen, gout symptoms (most often acute inflammation of a single joint with erythema in its vicinity, with the greatest intensity within 6-12 hours) and often life-threateningthe patient has bleeding which is present despite the normal number of platelets and normal clotting times.

Chronic Myelomonocytic Leukemia: Symptoms

Chronic myelomonocytic leukemia is a rare cancer. Patients have typical general symptoms of leukemia:

  • low-grade fever (and even fever with night sweats)
  • weakness
  • weight loss

There are also symptoms resulting from anemia - pale skin and mucous membranes, fast fatigue, tachycardia, as well as increased susceptibility to infections and hemorrhagic diathesis.

Due to the fact that in the course of the disease, extramedullary leukemia cells infiltrates quite often, the patient may be diagnosed with enlargement of the liver, spleen and lymph nodes, as well as the presence of skin lesions.

With a large number of monocytes, exudative fluid may be present in the peritoneal, pleural and pericardial cavities.

Chronic Lymphocytic Leukemia: Symptoms

Chronic lymphocytic leukemia is the most common form of leukemia in Europe. In about 50% of patients the disease is completely accidentally diagnosed in the so-called asymptomatic period.

The remaining patients may experience deterioration of exercise tolerance, significant weakness, night sweats and weight loss.

In addition, patients almost always have enlarged lymph nodes, which are hard and painful.

Sometimes there is an enlargement of the spleen and a slight enlargement of the liver, which can cause abdominal pain or a feeling of fullness in the abdomen.

It happens that the disease also affects the skin. It is then manifested by its itching, the presence of eczema and inflammatory changes, bloody ecchymosis, lumpy infiltrates, and sometimes mycosis and herpes zoster.

It must not be forgotten that in the course of chronic lymphocytic leukemia, there may be swelling of the salivary glands and lacrimal glands - this is the so-called Mikulicz's team.

In addition, autoimmune haemolytic anemia and immune thrombocytopenia may develop as a complication of the disease.

Hairy cell leukemia: symptoms

In the case of hairy cell leukemia, about a quarter of patients report no symptoms at diagnosis. Others show general symptoms such as weight loss, weakness and excessive fatigue.

Fever and night sweats don't usually occur. Due to the enlarged spleen, the patient may complain of abdominal pain, a feeling of fullness in the abdomen, as well as an increased bleeding tendency due to thrombocytopenia and an increased tendency to infections asthe effect of granulocytopenia.

Please note that there may also be symptoms related to the involvement of the lungs, gastrointestinal tract, kidneys, bones, central nervous system, pleura and peritoneum.

Leukemia: Symptoms in Children

The most commonly diagnosed leukemia in children is acute lymphoblastic leukemia, with the peak incidence between the ages of 2 and 5.

Moreover, the symptoms of this cancer can develop much faster compared to adults.

Children suffer from acute myeloid leukemia or chronic myeloid leukemia much less frequently.

The presence of leukemia in a child may be indicated by:

  • feeling unwell
  • sleepiness
  • lack of appetite
  • pallor
  • increased susceptibility to infections

In addition, bruises, ecchymosis, nosebleeds and bone pain may be present - especially frequent at night and not associated with any injury.

In the presence of central nervous system disease, the following are characteristic:

  • headaches
  • vomiting
  • palsy of cranial nerves

The examination of the child shows enlarged lymph nodes, liver, spleen and sometimes the testes (with their leukemic infiltration).

Source: biznes.newseria.pl

Leukemia: diagnosis

In order to diagnose leukemia, many diagnostic tests are necessary. They include:

  • blood count with smear and platelet count
  • coagulation tests such as APTT, INR, D-dimers and fibrinogen concentration
  • marrow aspiration biopsy
  • bone marrow biomolecular and cytogenetic research
  • cytochemical and cytoenzymatic tests of peripheral blood or bone marrow blasts
  • immunophenotyping of blast cells from peripheral blood or bone marrow
  • ultrasound of the abdominal cavity, chest X-ray and lumbar puncture (especially if central nervous system involvement is suspected)

Leukemia: treatment

Currently, in the treatment of leukemia, polychemotherapy is used, i.e. combined cytostatic treatment with the use of drugs with different mechanisms of action.

The most commonly used drugs include alkylating drugs, herbal drugs, antimetabolites, anthracycline antibiotics, podophyllotoxin derivatives and drugs such as asparaginase, hydroxycarbamide and glucocorticoids.

It is worth knowing that leukemia therapy is based on three stages - remission induction, remission consolidation and remission maintenance.

Purposethe first stage is to reduce the mass of leukemia cells to about 1 g (about 109 cells), which leads to the resolution of clinical and laboratory symptoms of the disease, as well as the withdrawal of the organ changes identified at the beginning.

The patient then obtains the so-called complete haematological remission. One of the most important criteria for complete remission is the percentage of blast cells in the marrow - it should not exceed 5%.

In the second stage of treatment, the aim is to further reduce the number of neoplastic cells (about 1 mg of cells, i.e. about 106 cells) - then they are not subject to immune regulation mechanisms.

The last stage of therapy is completely cured and usually lasts two years. It is maintained with periodic polychemotherapy - for this purpose, cycles of less aggressive chemotherapy with changing cytostatics are administered at 4-6 week intervals, which prevents the formation of cross-resistance. This stage, like the previous ones, also leads to a reduction in the number of leukemic cells, but also maintains proper immune regulation.

It is worth remembering that autologous or allogeneic transplantation of bone marrow or hematopoietic cells is nowadays an alternative method of therapy to maintenance cyclic chemotherapy.

The chance of complete recovery (i.e. 5-year disease-free survival) in patients with allogeneic hematopoietic cell transplantation is approximately 60 percent, and in patients with autologous haematopoietic cell transplantation, it is approximately 30-40%.

However, in patients treated only with chemotherapy, it amounts to approx. 20-25%.

In addition to chemotherapy, autologous and allogeneic bone marrow or hematopoietic cell transplantation, drugs directed against surface antigens, multidrug resistance proteins, enzymes, and new cytostatic drugs are also used in the treatment of leukemias.

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Category:

Oncology