Leukemia: Symptoms, Causes and Treatment

Leukemia: Symptoms, Causes and Treatment

We distinguish, in fact, lymphoblastic leukemias (also called lymphatic or lymphoid), when the cells involved are B and T lymphocytes (lymphoid line), which, once transformed, are called lymphoblasts, and myeloid (or myeloblastic, myelocytic or granulocytic), when the progenitor cells of the myeloid lineage are involved, that is, granulocytes and monocytes.

Another important classification is acute leukemia, much more frequent in children and adolescents and generally more aggressive and of rapid evolution, and chronic forms, which mainly affect people between 40 and 50 years of age, and whose clinical course is slower and more subtle. .

Causes of leukemias

Unfortunately, to date, the causes of leukemias are still largely unknown.

A series of elements are known that, often combined, represent predisposing factors for the appearance of the disease; in particular we talk about

  • environmental factors, including exposure to ionizing radiation (as a result of diagnostic or therapeutic procedures or linked, for example, to environmental contamination, such as the famous case of the explosion in the Chernobyl nuclear power plant) or chemical carcinogens, including benzene (found in gasoline and gasoline, widely used in the past as a paint thinner, now almost completely banned), benzopyrene, toxic aldehydes, and certain heavy metals. Certain drugs used to treat cancer, especially when combined with radiotherapy, can increase the risk of ‘secondary’ leukemia;
  • genetic factors, such as the presence in the family of other people with leukemia, other hematological malignancies or certain diseases, such as Down syndrome and Fanconi anemia, in which susceptibility to the disease is increased by alterations in the proteins involved in the DNA repair processes.

Signs and symptoms of leukemia

In leukemias, cancerous blood cells are derived from the hematopoietic stem cell, from which all corpuscular elements of the blood normally originate: red blood cells, platelets and white blood cellsincluding lymphocytes and granulocytes.

The accumulation of one or more mutations in the genetic makeup of this cell gives rise to clones of malignant, mature and non-functional cells, which spread in the bone marrow with a high rate of proliferation, leaving less and less room for healthy blood. . cells.

For these reasons, the subject in the symptomatic phase of the disease presents the following symptoms

  • chronic fatigue and exhaustion, weakness, dizziness, nausea, shortness of breath (due to red blood cell malfunction induced by bone marrow crowding of leukemic blasts);
  • bleeding (linked to poor platelet production) blood in urine, bleeding (typical onset is bleeding gums after brushing teeth);
  • abnormalities in the menstrual cycle;
  • headache, persistent fever, and recurrent infections (caused by reduced production of healthy white blood cells);
  • bone or joint pain, due to compression of the expanding bone marrow;
  • enlargement of the liver or other internal organs and lymph nodes, especially in the manifest and advanced stage of the disease;
  • weightloss.

In some cases, tumor blasts can accumulate within the central nervous system, causing vomiting, headache, and confusion, or in other organs (such as the liver, testicles, lungs, and bones); in other cases, the disease can be completely asymptomatic and only detected by chance after routine check-ups.

Leukemia Diagnosis

An abnormal blood count is usually sufficient to suspect a leukemic state: anemia, thrombocytopenia, or pancytopenia, especially the latter condition, are warning symptoms.

As mentioned, the fundamental examination is the complete blood count, followed by the microscopic reading of the peripheral blood smear. More in-depth diagnostics such as immunophenotyping; cytogenetic analysis (study of chromosomes); and bone marrow biopsy, which allows the aspiration of a sample of bone marrow from the back of the iliac bone.

This test is of fundamental importance in order to identify the type of leukemia and, therefore, the therapeutic strategy to adopt to stop this pathology.

leukemia therapy

Leukemias should be treated as soon as possible to increase the chance of disease remission.

The main treatment is chemotherapy, used to destroy the blasts and prevent them from proliferating.

Corticosteroids are the best combined treatment in cases of lymphoblastic leukemia.

Radiotherapy plays a marginal role and is often relegated to a few cases.

Drug therapy is usually divided into several phases:

  • induction: aimed at stopping the progression of the disease and symptoms, either temporarily or permanently, and killing leukemic cells using combinations of drugs;
  • maintenance: once remission is achieved, the goal is to keep the patient in complete remission for as long as possible using a therapeutic regimen whose goal is the destruction of residual leukemic cells that have not been eliminated by induction therapy;
  • supportive therapy: whose objective is to eliminate the symptoms of leukemia, improving quality of life and allowing the patient to cope with the toxicity of chemotherapy.

In cases of disease recurrence, bone marrow transplantation may be used, which involves giving the patient an overdose of chemo/radiotherapy aimed at suppressing hematopoiesis, followed by stem cell infusion of compatible stem cells (allogeneic bone marrow transplant). ) or not supported. (haploidentical marrow transplant) donors.

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