This leukemia term covers many different types of cancerous blood diseases. Despite the common name, they differ greatly in terms of their course and treatment. Some have a cure rate close to 100%, while others have a worse prognosis. Prof. dr hab. n. med. Wiesław Wiktor Jędrzejczak, head of the Department and Clinic of Hematology, Oncology and Internal Diseases of the Medical University of Warsaw.
Each year, approx. 3 thousand people come to Poland. new cases of leukemia.
The percentage of patients with five-year survival in the last 40 years has more than tripled and now stands at 42%, in children it has increased from 4% to almost 80%. According to estimates, over 20,000 people live in Poland. patients with leukemia.
We talk to prof. dr hab. n. med. Wiesław Wiktor Jędrzejczak, head of the Department and Clinic of Hematology, Oncology and Internal Diseases of the Medical University of Warsaw.
- How many leukemias do we know?
Wiesław Wiktor Jędrzejczak: We do not know that until the end, as we have access to new diagnostic possibilities, we recognize leukemias with new features. The more and more detailed division allows us to treat leukemias more effectively, especially when we have the option of targeted treatment, i.e. more precise hitting a specific change related to this particular leukemia. We define a target characteristic for a given leukemia and hit it.
- Can the same type of leukemia be different in two patients?
W.W.J .: A bit different. Both people share a common risk and a common threat. Leukemia is mainly a disease of the elderly, most of the patients suffer from chronic diseases. These conditions will overlap with the course of the leukemia. Leukemia itself has other risks, and leukemia occurs in people with heart or kidney failure, after two heart attacks or with diabetes.
- Is it true that there are no known causes of leukemia development?
W.W.J .: It is impossible to pose a problem like this. The onset of leukemia is a random event and is therefore difficult to rationalize. In each of us, a billion cells divide every day. So there is a billion opportunities to get inone of these cells had a genetic error. This cell will not die and will start to act like a leukemia cell. This is called an initiation mutation that has two effects. The first, a direct one, depends on what specific gene has been mutated and what exactly its product does. The second is that the progeny of the cell that mutated first are more susceptible to subsequent mutations. During the development of leukemia, the first mutation is overlapped by subsequent mutations, which lead to the disease becoming more complex during its course. Leukemia is a clonal disease, which means it begins in one cell. The resulting subclones attack the body with greater force.
- What symptoms should worry us and lead us to do tests that can detect leukemia?
W.W.J .: I promote the acronym NZS, where "N" is anemia, "Z" is an infection, and "S" is a hemorrhagic diathesis. In other words, leukemia manifests as either weakness, shortness of breath, or an infection such as angina. The doctor examines the patient, but also orders a morphology and it turns out that the angina is not only a consequence of a bacterial infection, but also that the body has become more susceptible to infections because it contains leukemia. A haemorrhagic diathesis manifests itself as petechiae on the skin and is caused by a low number of platelets. Sometimes there are three symptoms, sometimes two, sometimes one. Sometimes the disease is detected incidentally, but this mainly applies to chronic leukemias.
- Leukemia develops mainly in the elderly, but also children.
W.W.J .: Statistically speaking, people suffer from different leukemias at different ages. In children, they are mainly acute lymphoblastic leukemias. Acute myeloid leukemias are less common, and chronic myeloid leukemias are even less common. Chronic lymphocytic leukemia is practically absent in children.
- Is the treatment of children similar to that of adults?
W.W.J .: Similarly. But it can also be said that the treatment of adults is carried out in the same way as for children. In other words, the aggressive chemical treatment of acute leukemia that has successfully cured many children has moved to adult therapy. Many of the treatment regimens for leukemia originated in pediatric hematology.
- Various therapies are used to treat leukemia. One of them is bone marrow transplantation.
W.W.J .: Bone marrow transplantation has a well-defined application. Other than transplantation, very effective methods of treating leukemia have emerged. This does not apply to all types of disease, but they areone where bone marrow transplantation is the last resort. Today, all people with leukemia are given drugs first. We know that most lymphoblastic leukemias that affect children can be cured with chemotherapy alone, so there is no indication for a bone marrow transplant in first remission. There is a high probability that the first remission is equal to the cure of leukemia. If the disease recurs and we achieve a second remission, we know that the patient will require a transplant. Then you should strive for the procedure to take place as soon as possible.
- Where do you start your search for a bone marrow donor?
W.W.J .: From checking if there is a family donor. It is not always possible to find a suitable donor in the family, because families are small. But as new haploidentical transplant technology has emerged, the donor may be someone who has only half of the characteristics of the recipient. And such donors are parents, especially the father. If there is no family donor or we do not decide to choose a haploident donor, we look for a donor in bone marrow donor registers.
- How much does a bone marrow transplant cost?
W.W.J .: It depends on the type of transplant. In the case of autologous transplants, i.e. transplantation of properly prepared cells of the patient's bone marrow, the cost of the procedure is approx. PLN 50,000. zloty. When a sibling's marrow is transplanted, the rate is $ 125,000. zloty. For a transplant from an unrelated or family donor, but 50% compatible, you have to pay about a quarter of a million zlotys. These are unlimited benefits financed by the National He alth Fund.
- After achieving remission, can you believe that the disease will not come back?
W.W.J .: Unfortunately, even after transplantation there is a risk of he alth deterioration. We are trying to work on such transplant technologies to make them safer for patients. However, there is a risk, even if related to the long-term side effects of the applied therapies. But for now there are no other options. Admittedly, there is some hope, because we can increasingly use targeted therapies that have made a real revolution in the treatment of chronic myeloid leukemia. From a disease that has killed the patient within three years from diagnosis, it has become a disease with which one lives as long as without it. Of course, on the condition that you swallow one tablet once a day by the end of your days. This is true for most patients. Similar possibilities are starting to emerge in other leukemias as well. One of the acute myeloid leukemias, acute promyelocytic leukemia (a type of myeloid leukemia), can be treated with twodrugs, none of which are cytostatic and the treatment is low-toxic and very effective.
Worth knowingTwo dividing linesLeukemia is a disease that has become infamous. We often hear about it, but not everyone knows that it is a disease with many faces - says prof. Jędrzejczak. There are many diseases that hide under the name leukemia. It can be said that there are two dividing lines for these diseases that intersect with each other. The first line, let's call it the horizontal, is the line that separates acute from chronic leukemias. The second line - vertical - separates myeloid leukemias from lymphoblastic leukemias. Both can be acute and chronic. When it comes to acute (myeloid and lymphoblastic) leukemias, the division is still simplified, as there are more than 20 more specific varieties in each of these types of the disease.
In Poland, statistically, every half hour, one person learns that they suffer from leukemia. Often the only salvation is a bone marrow transplant
- It is assumed that in Poland, every half an hour someone develops a cancer of blood and bone marrow. They are rare diseases. According to my calculations, about 1.5 thousand people annually require hematopoietic cell transplantation in Poland. Currently, we perform about 700 transplants - says the Newseria Biznes news agency, dr hab. n. med. Grzegorz Basak from the Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw.
Source: Lifestyle.newseria.pl
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