All about leukemia

It is a neoplasm that can cause non-specific symptoms. However, there are some alarm bells that should not be underestimated.

Leukemia is a cancer of the blood, which usually affects white blood cells (also known as lymphocytes). These represent the main actors of our immune system, fundamental to protect the body from infections.

White blood cells are derived from stem cells found within the bone marrow, the spongy tissue contained within the bones. Some types of lymphocytes are also produced in the lymph nodes, spleen or thymus, a gland that is located behind the sternum and in front of the heart.

When one of these progenitor cells undergoes a certain mutation in its DNA, it begins to proliferate uncontrollably. Loss of cell growth control interferes with the development of normal blood cells, including red blood cells and platelets.

Leukemia can cause damage to the body if it is not treated in time and, in a very serious situation, it can even be fatal. So let’s see how the various forms of leukemia are classified, what are the symptoms to pay attention to, and how it is possible to verify and set up a first therapeutic approach based on the prognosis.

Forms of leukemia

There are several forms of leukemia. A first distinction is made considering the speed of tumor growth, that is, the progression of the disease. In fact, a distinction is made between leukemia:

• chronic, if the onset and evolution of the disease follow a slow course. The initial symptoms may be vague, because cancerous cells multiply slowly and, for a time, may function no differently from normal cells;
• acute, characterized by a sudden onset and rapid progression of disease and symptoms, since leukemia cells multiply quickly and have a very long average life;

Another classification of leukemia is based on the type of cell that initiates the neoplasm:

• lymphoid leukemia, if it originates from lymphoid cells and therefore involves lymphocytes;
• myeloid leukemia, if it affects the cells of the myeloid line, i.e. red blood cells, white blood cells and platelets;

The four most common types of leukemia are:

Leukemia form	Who strikes?
Acute lymphoblastic leukemia (ALL)	The most frequent acute form in young people, but can also occur in adults
Acute myeloid leukemia (AML)	the most frequent acute form in adults, but can also affect children
Chronic lymphocytic leukemia (CLL)	the most frequent chronic form in adults (often indolent and free of specific symptoms, without the need for treatment)
Chronic myeloid leukemia (CML)	It mainly affects adults (patients who are affected by may go through an asymptomatic phase for months or years, before move to a stage where the progression of the disease is much more rapid)

There are also other rarer forms of leukemia, such as the so-called “hairy cell” leukemia.

Once the presence of relevant symptoms has been verified and the diagnosis confirmed, the first step, before embarking on a specific treatment, will be to define the type of leukemia. Based on the patient’s condition, in fact, a different variant of the disease could be more or less aggressive, manifest itself in a different way and influence the response of the body and drugs.

Symptoms that are difficult to recognize

The signs of leukemia can vary depending on whether the disease is chronic or acute.

Acute leukemia has flu-like symptoms, which come on suddenly. On the contrary, chronic leukemia can have an insidious course and be free of clinical manifestations for some time. In this case, symptoms appear progressively.

In both types of the disease, a common alarm bell is that of chronic weakness. The feeling of feeling constantly tired could also be due to other disorders, such as seasonal diseases (flu and colds), diseases of the most significant entity, such as mononucleosis, or deficiencies of elements contained in the blood, as in the case of anemia. However, if the weakness turns out to be chronic and without interruption periods, it could be due to the typical symptoms of neoplasms, such as leukemia.

Leukemia cells, like other blood cells, can move into the bloodstream, reaching different parts of the body.

Depending on their number and where they are located, such manifestations may occur as:

• fever;
• Sweats;
• tiredness and fatigue;
• headache;
• bone and joint pain;
• weight loss;
• increased frequency of infections;
• ease of bleeding;
• enlargement of the spleen and lymph nodes;

In some cases, the disease can also reach organs such as:

• stomach;
• intestine;
• kidneys;
• lungs;
• nervous system;

In these situations, patients will complain of problems related to the individual organs affected.

Beware, however, these signs and symptoms are not necessarily the manifestation of leukemia, because they are also common to other diseases. Essential, therefore, consult your doctor if you have any suspicions.

Some alarm bells

Since the symptoms of this disease are often non-specific and common to other disorders, sometimes it can happen to be alarmed unnecessarily.

However, it is good to keep your eyes open, especially if you fall into a category of people at risk, such as if you have close relatives who have fallen ill with leukemia.

Research, in fact, agrees in attributing genetics as one of the possible causes of leukemia. However, some categories of people could be considered at risk even without a previous history of leukemia in their family: this is the case of the elderly and subjects over 60 years of age, but also of people who have already been affected by blood diseases or who have already undergone treatment with chemotherapy drugs.

Below we see some alarm bells that can give rise to the suspicion of leukemia:

• Fatigue, a symptom common to many other diseases, should arouse your attention if you feel weak or exhausted most of the time. And, above all, if it is an unusual feeling for you;
• infections or fever, a very frequent clinical manifestation of this disease. They are caused by the fact that a leukemia’s immune system is not working as it should. As a result, you tend to get sick more often;
• shortness of breath, which goes hand in hand with lack of energy and, as in the case of fatigue, must arouse suspicion especially if it is a condition usually not proven;
• Slow healing of small wounds or bruises, which could indicate a change in your blood cells, which may be due to leukemia. The same goes for the appearance of small red dots, called petechiae, especially on legs and lower extremities of the body;

The difficulties in coagulation and the frequency of bleeding as a result of cuts, even superficial, could therefore represent a first sign to be kept under control in the diagnosis of leukemia.

There are also other symptoms, such as:

• weight loss;
• nosebleeds (nosebleeds);
• high night sweats;
• joint pain;

If you observe one or more of these signs, the best thing to do is to consult your doctor, who, only if necessary, will prescribe appropriate tests to eventually diagnose leukemia, or to rule it out with certainty.

The correct diagnosis of leukemia

In the case of chronic leukemia, diagnosis is often made randomly, thanks to normal routine tests.

In this case, the doctor will carry out a physical examination, easily performed at his office, during which he will evaluate the presence of signs such as:

• pallor;
• enlarged lymph nodes;
• increased size of liver and spleen;

The main examinations to be performed are:

• blood tests, to highlight the possible presence of abnormal values of white blood cells, red blood cells and platelets;
• bone marrow harvesting, in order to analyze the characteristics of diseased cells;

On the basis of the biopsy of immature cells (stem cells) extracted from the bone marrow, and the laboratory analyzes conducted accordingly, it will be possible to evaluate a treatment of leukemia and, in severe cases, analyze any risks to survival. Once all the results have been obtained, the specialist will choose the most suitable therapy for the condition of the individual patient.

How leukemia is treated

The hematologist oncologist is the reference specialist to turn to to obtain the most suitable treatments and guarantee the best quality of life for the patient.

The choice of therapy depends on several factors, such as:

• the form of leukemia (acute or chronic, myeloid or lymphoid);
• the stage of the disease;
• the age of the patient;
• the overall state of health, which takes into account both physical conditions and the simultaneous presence of other pathologies;

The main treatment options are:

• chemotherapy, which is the main treatment and is based on the administration of a drug or a combination of drugs, by mouth or intravenously, which aims to attack and destroy leukemia cells;
• Target therapy, which uses drugs targeted against specific characteristics present only in cancer cells, such as particular proteins found only on their cell membrane. This procedure allows you to selectively attack the tumor, with very reduced side effects compared to wide-ranging treatments such as chemotherapy;
• Biological therapy, also known as immunotherapy, which is based on the administration of drugs that help the immune system recognize leukemia cells and control the disease. An example is treatment with monoclonal antibodies;
• radiation therapy, which uses ionizing radiation to stop the proliferation of mutated cells; This technology allows to irradiate the whole organism, but in most cases the therapy is aimed at a specific target, in this case the bone marrow;
• stem cell transplantation, a procedure that allows the diseased bone marrow to be replaced with cells from a healthy marrow from a compatible individual, such as one of the parents, sibling or other member of the patient’s family. Before transplantation, high-dose chemotherapy or radiotherapy is administered with the aim of “cleaning” the diseased marrow. At this point, the doctor administers intravenously the donor’s stem cells, which, over time, should replenish a healthy bone marrow.;

Currently, bone marrow transplantation is one of the best and most effective therapies for the treatment of neoplasms. As research progresses, new therapeutic techniques are being improved and developed, such as hematopoietic stem cell transplantation. Thanks to the methods of modern medicine, today leukemia is considered a curable disease, from which a considerable amount of patients are able to recover, and to recover an excellent quality of life.

How widespread is leukemia?

Blood cancers strike much more frequently in childhood. In particular, acute leukemia accounts for more than 25% of cancers afflicting children.

Chronic forms, on the other hand, are more common among adults, while they occur only in rare cases during childhood.

In Italy there is talk of about 15 new cases per 100,000 people per year (16.9 cases per 100,000 men and 12.8 per 100,000 women), with an estimated number of about 4,700 new cases each year among men and just under 3,400 among women.

According to data recently released by AIRTUM (Italian Association of Cancer Registries), in our country the most frequent forms of leukemia are chronic lymphocytic (33.5% of total leukemia), acute myeloid (26.4%), chronic myeloid (14.1%) and acute lymphatic (9.5%).

What causes it?

The exact cause of this disease is not yet known. Researchers think it’s due to:

• Genetic causes;
• Environmental factors;

In general, it is thought that, as in most cancers, specific mutations occur at the DNA level of some cells that are then transformed into cancerous elements and proliferate in an uncontrolled manner causing damage to other healthy cells and to the whole organism.

For example, patients with chronic myeloid leukemia have a variation in the chromosomes of cancer cells, with the fusion of two chromosomes naturally present in a single and abnormal one.

This phenomenon very often results in an increase in the number of white blood cells, such as monocytes, and granulocytes, but also in the alteration of other blood cells, such as red blood cells and platelets. These types of changes are visible through blood tests, such as a blood count.

Risk factors for leukemia

If the causes are not known, the risk factors, on the contrary, are many and well known. These include:

• A family history of leukemia;
• smoking habits, which especially increases the risk of developing acute myeloid leukemia;
• genetic abnormalities such as Down syndrome, which seems to be related to a 10 to 20 times greater probability of leukemia;
• blood disorders, such as myelodysplastic syndrome, also known as “pre-leukemia”;
• previous cancer treatments, such as chemotherapy or radiotherapy, which may increase the risk of developing new types of cancer;
• exposure to high doses of ionizing radiation;
• exposure to chemicals, such as benzene or formaldehyde;