Leukemia

What is leukemia? 

Leukemia, a cancer of the blood, affects the production and function of blood cells (white blood cells, red blood cells, and platelets). It begins in the bone marrow, the spongy tissue inside bones where blood cells are produced. 

In leukemia, the bone marrow produces abnormal white blood cells, called leukemic cells or blasts, that do not function properly. These cells accumulate in the blood and bone marrow, crowding out healthy blood cells.  

It is important to note that these symptoms can be caused by other conditions, so it is essential to consult a doctor to obtain an accurate diagnosis. 
 

Leukemia Types 

There are four main types of leukemia, which are classified according to the speed of progression and the type of blood cell affected: 

• Acute leukemia: it is characterized by the rapid proliferation of immature cells (blasts) in the bone marrow. These cells do not function properly and accumulate in a short time, leading to a rapid onset of symptoms. 

• Acute lymphoblastic leukemia (ALL): it originates in lymphoblasts, a type of immature cell that normally develops into lymphocytes, a type of white blood cell that fights infections. ALL is the most common type of leukemia in children, but it can also affect adults. 

• Acute myeloid leukemia (AML): it begins in myeloblasts, immature cells that normally develop into different types of white blood cells, such as neutrophils, basophils, eosinophils, and monocytes. AML is more common in adults than in children. 

• Chronic leukemia: it is characterized by the gradual accumulation of relatively mature, but still abnormal, leukemic cells. Symptoms may develop slowly over time. 

• Chronic myeloid leukemia (CML): it originates from hematopoietic stem cells, the cells that give rise to all types of blood cells. It is more common in older adults, but it can affect adults of any age. It rarely occurs in children. Symptoms may not appear for several years. 

• Chronic lymphocytic leukemia (CLL): it affects lymphocytes. CLL is the most common type of leukemia in adults, especially in older people. Leukemic cells in CLL multiply slowly and may not cause symptoms for years. 

Causes of leukemia 

Leukemia originates when the DNA of a single cell in the bone marrow changes, or mutates. DNA is like an instruction manual that tells the cell what to do: when to grow, how to develop, and finally, when to die. In leukemia, an error in these instructions, called a mutation, causes the cell to multiply uncontrollably. All new cells that originate from this mutated cell inherit the same erroneous instruction.  

The exact cause of the mutation in these cells is not fully known. it is believed to be the result of a combination of genetic and environmental factors. 

Risk factors for leukemia 

Leukemia is not linked to any specific condition; however, certain factors can increase the risk of it developing, such as: 

• Age: most types of leukemia are more common in older adults. 

• Previous cancer treatments: radiotherapy or chemotherapy for other types of cancer may increase the risk of developing leukemia. 

• Exposure to certain chemicals: such as benzene, which is found in gasoline and tobacco smoke. 

• Family history of leukemia: although it is not considered hereditary in most cases, having a family member with leukemia may slightly increase the risk. 

• Certain genetic syndromes: such as Down syndrome or Klinefelter syndrome. 

• Smoking: smoking increases the risk of developing acute myeloid leukemia (AML). 

Diagnosis of leukemia 

Diagnosing leukemia is a process that requires a thorough evaluation by a hematology specialist.  

• Detailed medical history: where the doctor asks about symptoms, family history, and possible exposure to risk factors.  

• Physical examination: to assess for signs such as pallor, swelling of the lymph nodes or spleen, and unusual bruising or bleeding. 

• Laboratory tests: they are essential to confirm the diagnosis and determine the type of leukemia. A complete blood count (with white blood cell, red blood cell, and platelet counts) can reveal abnormalities in blood cells, such as a high number of immature white blood cells or a low red blood cell and platelet count. 

• Bone marrow biopsy: it is an essential test for a definitive diagnosis. In this procedure, a small sample of bone marrow, usually from the hip bone, is extracted using a needle. The sample is examined under a microscope to assess the presence of leukemic cells and determine the specific type. 

In addition, the following can be performed:  

• Cytogenetic tests: they allow the analysis of chromosomes in leukemic cells to identify specific genetic abnormalities, such as the Philadelphia translocation in chronic myeloid leukemia (CML).  

• Molecular tests: for example, the polymerase chain reaction (PCR), which can detect specific genetic mutations that are characteristic of certain types of leukemia. These tests help refine the diagnosis, determine the prognosis, and guide treatment decisions. 

At HM Hospitales, we offer a wide range of diagnostic services for leukemia, including: 

• Blood tests. 

• Analysis of therapeutic targets. 

• Bone marrow biopsy. 

• Cytogenetic and molecular studies. 

• Diagnostic imaging, such as computed tomography (CT), magnetic resonance imaging (MRI) and PET-CT, to assess the extent of the disease. 

Leukemia treatment 

Leukemia treatment is tailored to each patient based on the type of leukemia, the stage of the disease, age, and overall health. The goal of treatment is to eliminate leukemia cells, restore normal bone marrow function, prevent disease recurrence, and improve the patient’s quality of life. Treatment options include: 

• Non-pharmacological treatments: lifestyle changes are recommended, including a balanced diet, regular exercise, infection prevention, and stress management. In addition, physiotherapy may be recommended to help manage symptoms such as fatigue and weakness, along with psychological support and integration with patient associations. Some patients will need transfusion support treatment (red blood cell or platelet transfusions). In the specific case of early-stage chronic lymphocytic leukemia, it may not be necessary to immediately start active treatment, requiring periodic follow-up in the Hematology clinic. 

• Chemotherapy: it is the main treatment for most types of leukemia. It uses powerful medications to destroy leukemia cells. Chemotherapy can be administered orally, intravenously, or intrathecally (into the cerebrospinal fluid). Chemotherapy can have significant side effects, such as nausea, vomiting, hair loss, infections, and fatigue. 

• Targeted therapy: it focuses on attacking specific characteristics of leukemic cells, such as specific proteins or genes that contribute to cancer growth and survival. These medications can be more effective and have fewer side effects than traditional chemotherapy. 

• Immunotherapy and cell therapy: it helps the patient’s immune system recognize and destroy leukemia cells. CAR-T cell therapy is a type of immunotherapy in which the patient’s T cells are genetically modified to recognize and attack leukemic cells. This therapy is currently used in a type of acute lymphoid leukemia when it does not respond to conventional treatment.  

• Radiotherapy: it uses ionizing radiation to destroy leukemia cells. It can be used to complement leukemia treatment or to relieve symptoms. It is sometimes used before a bone marrow transplant to help destroy any remaining leukemic cells. 

• Hematopoietic progenitor cell (stem cell) transplantation from bone marrow or peripheral blood: it is a type of cell therapy in which damaged bone marrow is replaced with healthy stem cells. This procedure is used in some cases of leukemia, especially in those cases with a high risk of relapse where chemotherapy treatment alone may not be as effective. The transplant can be autologous (using the patient’s own stem cells) or allogeneic (using stem cells from a donor). 

Currently, intensive research is being conducted into targeted therapies, immunotherapy, and cell therapy in order to improve treatments by making them less toxic, better tolerated, and more effective. Part of this research involves what are known as clinical trials, which are another treatment option in which drugs with proven effects can be combined with new ones under study.  

At HM Hospitales, we provide advanced treatments for leukemia, including: 

• Chemotherapy. 

• Targeted therapy. 

• Immunotherapy. 

• Hematopoietic stem cell transplantation. 

• Radiotherapy.  

• Clinical trials. 

Prognosis of leukemia and long-term effects of treatment 

The prognosis for leukemia varies depending on the type and stage of the disease, as well as the patient’s age and overall health. ALL in children has a good prognosis, with high cure rates. However, the prognosis for other types of leukemia can be more variable. A remission can last from a few weeks to many years. It is possible that leukemia may never reappear. 

The long-term effects of leukemia treatment may include: 

• Fertility problems: leukemia treatment could also affect sexual development and the ability to have children in the future. 

• Heart problems: some chemotherapy drugs can cause heart problems. 

• Secondary cancers: people who have had leukemia have a higher risk of developing other types of cancer. 

Remember that this article is for informational purposes only and does not replace professional medical advice. If you suspect you have leukemia, consult a specialist to obtain an accurate diagnosis and an appropriate treatment plan tailored to your needs.