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Leukemia

Leukaemia

Leukemia is cancer of the blood forming tissues that also affects the bone marrow and the lymphatic system. Such a type of cancer causes abnormal development of cells that gradually enter the bloodstream [1].


Acute leukemia-ALL
Acute leukemia-ALL
Acute leukemia-ALL, CC BY-SA 3.0

Presentation

Symptoms of leukemia vary with the type. The common symptoms of the disease include the following [9]:

Easy Bruising
  • Disrupted hematopoiesis leads to the most common presenting symptoms (anemia, infection, easy bruising and bleeding).[merckmanuals.com]
  • Easy bruising or bleeding: People with leukemia may bleed from their gums or noses, or may find blood in their stool or urine. Bruises may develop from very minor bumps. Small spots of discoloration — called petechiae — may form under the skin.[my.clevelandclinic.org]
  • So, they experience prolonged bleeding and they also see easy bruising. Okay. And finally, we said that there is fewer white blood cells, which I'm just going to abbreviate as WBCs, right.[khanacademy.org]
Splenomegaly
  • CT, MRI, or abdominal ultrasonography may help assess splenomegaly or leukemic infiltration of other organs. Echocardiography is typically done to assess baseline cardiac function.[merckmanuals.com]
  • […] disease include the following: Undue weight loss Constant felling of tiredness and fatigue Pain in bone Fever accompanied by chills Excessive sweating especially during night hours Easy prone to infections Bleeding or bruising very easily Hepatomegaly Splenomegaly[symptoma.com]
  • […] lymphoblasts Many myeloblasts Small lymphocytes Entire myeloid series Anemia Severe in 90% Severe in 90% Mild in about 50% Mild in 80% Platelets Low in 80% Low in 90% Low in 20 to 30% High in 60% Low in 10% Lymphadenopathy Common Occasional Common Infrequent Splenomegaly[merckmanuals.com]
  • […] staging system classifies the leukemia according to whether a patient has, or does not have, any of the following: Lymphocytosis, which means there are high levels of lymphocytes in the blood Lymphadenopathy, meaning a patient has enlarged lymph nodes Splenomegaly[cancer.net]
  • Chronic Sinusitis , Asthma ) Step 2: Indications to proceed with Peripheral Smear Leukocytosis without other secondary cause (or despite treatment) White Blood Cell Count 20,000/mm3 Associated Anemia , Thrombocytopenia or Thrombocytosis Hepatomegaly , Splenomegaly[fpnotebook.com]
Dyspnea
  • Difficulty breathing (dyspnea). With T-cell ALL, these leukemia cells tend to clump together around the thymus, a small organ just behind the breastbone.[stanfordchildrens.org]
  • Signs and symptoms Signs and symptoms of ALL include the following: Fever Signs and symptoms of anemia, such as pallor, fatigue, dizziness, palpitations, cardiac flow murmur, and dyspnea with even mild exertion Bleeding Blood clots Palpable lymphadenopathy[emedicine.medscape.com]
Fever
  • This phase of CML is characterized by fever, weakness, and an enlarged spleen.[britannica.com]
  • We report a case of a 53 year old patient with T-LGL, Immune-Thrombocytopenia (ITP) and combined antibody deficiency, who presented with fever and reduced general condition.[ncbi.nlm.nih.gov]
  • Symptoms Symptoms of leukemia include fatigue, tiredness, unexplained weight loss, fever and chills, frequent nose bleeds, excessive sweating and bone pain along with tenderness.[symptoma.com]
  • She also mentions nose bleeds, swollen or enlarged lymph nodes, and fever or chills as possible symptoms.[prevention.com]
Anemia
  • Stage A: The patient does not have anemia or low levels of platelets. The leukemia can be felt in fewer than 3 areas of lymph nodes (Rai stages 0, I and II). Stage B: The patient does not have anemia or low levels of platelets.[cancer.net]
  • They also crowd out the normal cells in the marrow, causing a decrease in the number of new normal cells made in the marrow and resulting in a low red cell count (anemia).[hopkinsmedicine.org]
  • Disrupted hematopoiesis leads to the most common presenting symptoms (anemia, infection, easy bruising and bleeding).[merckmanuals.com]
  • Aplastic Anemia. Only neutropenia is regarded as independent risk factor for severe opportunistic infection in T-LGL patients.[ncbi.nlm.nih.gov]
  • Infection with a virus (eg, human T-lymphotropic virus 1 and 2, Epstein-Barr virus) Chromosomal translocations Preexisting conditions, including immunodeficiency disorders, chronic myeloproliferative disorders, and chromosomal disorders (eg, Fanconi anemia[merckmanuals.com]
Fatigue
  • A 21-year-old woman who presented fatigue had a new diagnosis of acute lymphoblastic leukemia underwent FDG PET/CT. The images demonstrated extramedullary infiltration in multiple organs, including the liver, pancreas, kidney and the bone.[ncbi.nlm.nih.gov]
  • Fatigue and weakness iStock/FangXiaNuo Fatigue and weakness are the most common leukemia symptoms, according to Mark Levis, MD, PhD, the director of the leukemia program at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center.[rd.com]
  • Symptoms Symptoms of leukemia include fatigue, tiredness, unexplained weight loss, fever and chills, frequent nose bleeds, excessive sweating and bone pain along with tenderness.[symptoma.com]
  • Here's what to watch out for: Fatigue As is the case with many other diseases , fatigue is a common symptom of leukemia, Wadleigh says.[prevention.com]
  • The last six months she started feeling extremely fatigued and having severe dizziness . When finally discovered she was severely anemic, she was admitted to the hospital.[emedicinehealth.com]
Down Syndrome
  • […] in Down syndrome children with ALL.[haematologica.org]
  • Some people with Down syndrome or blood disorders such as polycythemia vera (a disease in which there are too many red blood cells in the bone marrow and blood, causing the blood to thicken) may be more likely to develop leukemia.[cdc.gov]
  • Although experts are uncertain about the causes of leukemia, they have identified several risk factors that include the following: Exposure to high levels of radiation Repeated exposure to certain chemicals (for example, benzene) Chemotherapy Down Syndrome[hematology.org]
  • This includes earlier exposure to chemotherapy, Down’s syndrome and other genetic disorders, exposure to benzene and other chemicals, exposure to radiation therapy etc.[news-medical.net]
  • syndrome, infantile X-linked agammaglobulinemia) Pathophysiology Malignant transformation usually occurs at the pluripotent stem cell level, although it sometimes involves a committed stem cell with more limited capacity for self-renewal.[merckmanuals.com]
Weight Loss
  • Symptoms Symptoms of leukemia include fatigue, tiredness, unexplained weight loss, fever and chills, frequent nose bleeds, excessive sweating and bone pain along with tenderness.[symptoma.com]
  • loss or loss of appetite Enlarged lymph nodes The signs and symptoms of ALL can be the same as more common children’s illnesses and some children are treated for those other illnesses before leukemia is diagnosed.[curesearch.org]
  • Chronic myelogenous leukemia (CML), which has a peak incidence among adults in their 40s, may remain quiescent for long periods before symptoms such as weight loss, low fever, and weakness develop.[britannica.com]
  • loss may or may not be a symptom, depending on the subtype," Wadleigh adds.[prevention.com]
Bleeding Gums
  • Symptoms can include: Fever, chills, night sweats, and flu-like symptoms Weakness and fatigue Swollen or bleeding gums Headaches Enlarged liver and spleen Swollen tonsils Bone pain Paleness Weight loss 8.[everydayhealth.com]
  • Bleeding is usually manifested by petechiae, easy bruising, epistaxis, bleeding gums, or menstrual irregularity. Hematuria and GI bleeding are uncommon.[merckmanuals.com]
Hepatomegaly
  • […] symptoms of the disease include the following: Undue weight loss Constant felling of tiredness and fatigue Pain in bone Fever accompanied by chills Excessive sweating especially during night hours Easy prone to infections Bleeding or bruising very easily Hepatomegaly[symptoma.com]
  • […] means there are high levels of lymphocytes in the blood Lymphadenopathy, meaning a patient has enlarged lymph nodes Splenomegaly, which is an enlarged spleen Anemia, meaning low levels of red blood cells Thrombocytopenia, meaning low levels of platelets Hepatomegaly[cancer.net]
  • Bowel Disease , Chronic Sinusitis , Asthma ) Step 2: Indications to proceed with Peripheral Smear Leukocytosis without other secondary cause (or despite treatment) White Blood Cell Count 20,000/mm3 Associated Anemia , Thrombocytopenia or Thrombocytosis Hepatomegaly[fpnotebook.com]
  • Extramedullary infiltration by leukemic cells may cause lymphadenopathy, splenomegaly, hepatomegaly, and leukemia cutis (a raised, nonpruritic rash). Gum hyperplasia may be prominent, particularly in acute monocytic leukemias.[merckmanuals.com]
  • As the disease progresses, lymphadenopathy, splenomegaly, and hepatomegaly develop. A secondary immune deficiency with hypogammaglobulinemia exists.[emedicine.medscape.com]
Hepatosplenomegaly
  • Hepatosplenomegaly and lymphadenopathy are rare in adults with acute myelogenous leukemia, but are present in about 50% of adults with acute lymphoblastic leukemia. 12 Central nervous system involvement occurs in approximately 5% to 8% of adults with[aafp.org]
Petechiae
  • Small red dots on your skin—a condition known as petechiae—could also result from leukemia, she adds. "Petechiae usually appears on the lower extremities," Wadleigh adds.[prevention.com]
  • Petechiae (small red spots under the skin caused by bleeding) iStock/lzf Dr. Crilley describes petechiae as “like someone painted little red dots with a pen.”[rd.com]
  • Constant felling of tiredness and fatigue Pain in bone Fever accompanied by chills Excessive sweating especially during night hours Easy prone to infections Bleeding or bruising very easily Hepatomegaly Splenomegaly Swollen lymph nodes Development of petechiae[symptoma.com]
  • […] breath when exerting physical effort Pale complexion from anemia Signs of bleeding caused by a very low platelet count, including black and blue marks occurring for no reason or because of a minor injury; pinhead-sized spots appearing under the skin (petechiae[cedars-sinai.edu]
  • Small spots of discoloration — called petechiae — may form under the skin.[my.clevelandclinic.org]
Bone Pain
  • pain, sometimes associated with swelling of the joints Weight loss or loss of appetite Enlarged lymph nodes The signs and symptoms of ALL can be the same as more common children’s illnesses and some children are treated for those other illnesses before[curesearch.org]
  • So, it's more generalized bone pain. So, if a patient starts showing signs and symptoms of leukemia, a doctor will often start off by getting a blood test, and if they get a blood test, the first thing that you will see is this picture over here.[khanacademy.org]
  • Symptoms Symptoms of leukemia include fatigue, tiredness, unexplained weight loss, fever and chills, frequent nose bleeds, excessive sweating and bone pain along with tenderness.[symptoma.com]
  • pain or tenderness When to see a doctor Make an appointment with your doctor if you have any persistent signs or symptoms that worry you.[mayoclinic.org]
Epistaxis
  • Bleeding is usually manifested by petechiae, easy bruising, epistaxis, bleeding gums, or menstrual irregularity. Hematuria and GI bleeding are uncommon.[merckmanuals.com]
Hematuria
  • Hematuria and GI bleeding are uncommon. Bone marrow and periosteal infiltration may cause bone and joint pain, especially in children with ALL.[merckmanuals.com]
  • In spite of appropriate antibiotic and antifungal therapy, pneumonia was aggravated and gross hematuria was accompanied.[cancerindex.org]
Headache
  • Pounding headaches iStock/AZarubaika Although not common, frequent pounding headaches may be a sign of leukemia-related anemia or even a life-threatening case of bleeding in the head. These are the signs of cancer men are most likely to ignore .[rd.com]
  • […] effects of Besponsa include low levels of platelets (thrombocytopenia), low levels of certain white blood cells (neutropenia, leukopenia), infection, low levels of red blood cells (anemia), fatigue, severe bleeding (hemorrhage), fever (pyrexia), nausea, headache[fda.gov]
  • I have no energy and I just lie down all the time with headaches .[emedicinehealth.com]
  • Chemotherapy Down Syndrome A strong family history of leukemia Symptoms vary depending on the type and stage of leukemia, but they can include the following: Fever, chills, night sweats and other flu-like symptoms Weakness and fatigue Swollen or bleeding gums Headaches[hematology.org]
  • A headache, low-grade fever, mouth sores or skin rash may accompany the infection. Swollen lymph nodes: Lymph nodes are small, bean-sized structures that contain clusters of lymphocytes.[my.clevelandclinic.org]
Peripheral Neuropathy
  • Peripheral neuropathy – Peripheral neuropathy, or numbness, tingling or pain in the hands and feet, can last months after therapy with agents such as Oncovin.[hopkinsmedicine.org]

Workup

The following are the various diagnostic procedures for detecting leukemia [10]:

  • A preliminary physical examination will be carried out for studying the various signs and symptoms of leukemia.
  • Blood tests such as complete blood count provide a useful insight for diagnosis of the condition. 
  • Bone marrow test forms an important part of the diagnostic procedure. In this a sample of the bone marrow is derived from the hip bone and studied for the presence of leukemia cells.

Treatment

Treating leukemia is a complex process as it would greatly depend on the stage of the disease and the type of leukemia present. Some of the common treatment methods employed for treating the condition are explained below [11]:

  • Chemotherapy: It is the method of choice for treating leukemia [11].
  • Biological therapy: In this method, therapies are targeted towards making the immune system recognize the cancer cells as invaders and attack them.
  • Radiation therapy: Radiation therapy employs high beam radiation to kill the target cells and arrest their growth. 
  • Targeted therapy: In this form of therapy, drugs are administered that attack specific component of the leukemia cells thereby preventing their growth and multiplication.
  • Stem cell transplant: In this, the affected bone marrow is transplanted with a healthy one. The prognosis of the disease is favorable with this kind of method [12]. Prior to this method, the patient is given chemotherapy in combination with radiation therapy to completely destroy the diseased bone marrow.

Prognosis

Prognosis of the disease condition depends on the type of leukemia and the stage at which the condition was diagnosed. If leukemia is diagnosed in its early stages then the prognosis is favorable with timely initiation of treatment and regular follow up checkups [8].

Etiology

The factor that triggers the development of leukemia is yet to be figured out. However, a combination of various factors such as environment and heredity are known to play foul. In addition, various types of risk factors such as exposure to chemical compounds such as benzene, tobacco smoking, ionizing radiation and prior treatment with chemotherapy can also predispose an individual to develop leukemia [3] [4].

Epidemiology

Leukemia is a widespread problem affecting the male and female population equally. It has been estimated that every year about 13.0 per 100,000 fresh cases of leukemia are diagnosed. Statistics also reveal that there were about 7.0 per 100,000 cases of death due to leukemia every year. Researchers have also established statistical data which state that in the year 2014, there would be 52,380 new cases of leukemia. Of these, 24,090 cases of death due to leukemia would also occur in the same year. Statistical data has also confirmed that leukemia accounts for 4.1% of all cancer deaths. This form of cancer is also widely prevalent amongst the pediatric population [5] [6]. It has been estimated that each year in US about 2500 – 3500 new cases are diagnosed [1].

Sex distribution
Age distribution

Pathophysiology

Leukemia begins with attacking the white blood cells of the body. As a result of this, the infection fighting ability of the white blood cells is greatly diminished making the body more prone to contract infectious diseases. Leukemia also affects the bone marrow as a result of which abnormal cells are produced which fail to function in the normal way. Such sequence of events causes the abnormal cells to affect other body organs such as the liver, eye and the spleen. There are basically 4 types of leukemia, namely: Acute lymphocytic leukemia, acute myelogenous leukemia, chronic lymphocytic leukemia and chronic myeloid leukemia. Other rare types of leukemia are myeloproliferative disorders, hairy cell leukemia and myelodysplastic syndromes [7].

Prevention

It is practically not possible to prevent leukemia. However, the spread of the disease can be prevented if detected on time and timely initiation of treatment.

Summary

There are several forms of leukemia; some which affect the children and some which affect the adult population. Leukemia usually begins by primarily attacking the white blood cells which are essential for warding off infections. But, when the cancer affects the white blood cells, these are no longer capable of safeguarding the body against infections. The underdeveloped white blood cells are known as blasts or leukemia cells [2]. Treatment of leukemia is a complex process that needs to be designed keeping in mind several factors.

Patient Information

Definition

Leukemia is the cancer of the white blood cells that also affects the lymphatic system and the bone marrow. It is a common condition affecting the children as well as the adult population.

Cause

The exact factor that triggers the abnormal development of cells is not clearly understood. However, interplay of environment and genetic factors are known to play foul in causation of leukemia.

Symptoms

Symptoms of leukemia include fatigue, tiredness, unexplained weight loss, fever and chills, frequent nose bleeds, excessive sweating and bone pain along with tenderness.

Diagnosis

Diagnosis of leukemia is done by blood tests to determine complete blood count which would give an idea about the white blood cell count. In addition to this, bone marrow test is also done to analyze for the presence of leukemia cells.

Treatment

Treatment of leukemia consists of chemotherapy and radiation therapy which targets the cancer cells and destroys them. In addition, stem cell transplant is also the method of choice wherein the diseased bone marrow is replaced with a healthy one. Patients suffering from leukemia are also given targeted therapy which works by destroying specific components of the leukemia cells.

References

Article

  1. Ward E, DeSantis C, Robbins A, et al. Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin 2014; 64:83.
  2. Rootman J, Gudauskas G. Treatment of ocular leukemia with local chemotherapy. Cancer Treat Rep. Jan 1985;69(1):119-22
  3. Kincaid MC, Green WR. Ocular and orbital involvement in leukemia. Surv Ophthalmol. Jan-Feb 1983;27(4):211-32.
  4. Buffler PA, Kwan ML, Reynolds P, Urayama KY. Environmental and genetic risk factors for childhood leukemia: appraising the evidence. Cancer Invest 2005; 23:60
  5. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin 2014; 64:9.
  6. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. Mar-Apr 2005;55(2):74-108. [Medline]. Galton DA. The pathogenesis of chronic lymphocytic leukemia. Can Med Assoc J 1966; 94:1005.
  7. Harris NL, Jaffe ES, Diebold J, et al. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Clin Oncol 1999; 17:3835.
  8. Jonsson OG, Sartain P, Ducore JM, Buchanan GR. Bone pain as an initial symptom of childhood acute lymphoblastic leukemia: association with nearly normal hematologic indexes. J Pediatr 1990; 117:233.
  9. Kaufman M, Rubin J, Rai K. Diagnosing and treating chronic lymphocytic leukemia in 2009. Oncology (Williston Park). Nov 15 2009;23(12):1030-7.
  10. Harnett AN, Plowman PN. The eye in acute leukaemia. 2. The management of solitary anterior chamber relapse. Radiother Oncol. Nov 1987;10(3):203-7. 
  11. Kerty E, Vigander K, Flage T, Brinch L. Ocular findings in allogeneic stem cell transplantation without total body irradiation. Ophthalmology. Jul 1999;106(7):1334-8.
  12. Rootman J, Gudauskas G. Treatment of ocular leukemia with local chemotherapy. Cancer Treat Rep. Jan 1985;69(1):119-22.

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Last updated: 2017-08-09 18:09