LEUKEMIA
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One form of cancer that affects the body's blood-forming tissues, such as the lymphatic and bone marrow, is called leukemia. The quick synthesis of aberrant white blood cells is the cause of it. These aberrant cells hinder the bone marrow's capacity to generate red blood cells and platelets and are unable to combat infection.
Could I be in danger? (risk).
1.Exposure to Agents Causing Cancer. Leukemia is more common in those who have received high radiation doses from sources such atomic bomb blasts, nuclear reactor mishaps, or employment in atomic weapons plants. Prolonged contact with solvents such as benzene, mainly found on work place. Chemical exposure during the Vietnam War, known as Agent Orange, may have contributed to the development of Chronic Lymphocytic Leukemia (CLL).
2.Smoking: A number of substances in cigarettes can cause cancer. Smoking is linked to 20% of cases of acute myeloid leukemia (AML).
3.The past of chemotherapy and radiation therapy. Chemotherapy and radiation therapy can alter a cell's DNA, which may result in leukemia. Treatments for diseases like Hodgkin's disease, non-Hodgkin lymphoma, acute lymphoblastic leukemia (ALL) in children, and other cancers like ovarian and breast cancer are associated with AML.
4.Myelodysplastic Syndromes (MDS): MDS is a condition of bone marrow failure that can lead to leukemia in around one-third of its victims.
5.Uncommon genetic syndromes. Leukemia is a little bit more common in people with Down syndrome, Fanconi anemia, ataxia-telangiectasia, and Bloom syndrome.
6. Ancestry(family history), Increases two to four times if there is a first-degree relative (parent, child, or sibling) who has CLL. Nonetheless, the majority of leukemia patients do not have a family member who also has the illness.
Types of leukemia.
Acute or chronic leukemia are both possible. Compared to acute leukemia, which needs to be treated right away, chronic leukemia advances more slowly. Another classification for leukemia is lymphocytic or myelogenous. The term "lymphocytic leukemia" describes aberrant cell proliferation in the bone marrow that results in the production of lymphocytes, a subset of white blood cells that are involved in immunity. The marrow cells that develop into red blood cells, white blood cells, and platelets proliferate abnormally in myelogenous leukemia.
How could I differentiate between acute and chronic leukemia?
Acute Leukemia:
Rate of Development: The disease advances quickly. Its aggressive nature necessitates immediate treatment.
Cell Features: The malignant cells in acute leukemia, known as blasts, are immature and unable to properly carry out the tasks of the immune system.
Symptoms: The illness can worsen quickly, and symptoms start to show up quickly.
Diagnosis: Symptoms are frequently identified quickly after they appear.
Treatment: For the optimum result, immediate action is required.
Chronic leukemia,
Development Pace: Over time, chronic leukemia progresses slowly. Health issues may not show symptoms for years.
Cell Features: The cells in chronic leukemia undergo partial maturation, but not full maturation. They may look healthy, but they are not as good at fighting infections as regular white blood cells are.
Symptoms: Light-hearted symptoms at first could go overlooked. It is frequently by accident that chronic leukemia is discovered during normal blood tests.
There are four major categories for leukemia:
1.Acute lymphocytic leukemia (ALL). Usually occurs before 14 years of age peak ,incidence is between 2-9 years of age, older adult. It arising from a single lymphoid stem cell, with impaired maturation and accumulation of the malignant cells in the bone marrow. group of tumors composed of immature, precursor B or T lymphocytes known as lymphoblasts; the majority (85%) are Pre-B cell tumors, which are typically found in Pre-T cell ALL manifests in adolescents as lymphoma with thymic involvement in infancy with substantial BM involvement.
2.Acute myeloid leukemia (AML). In AML, the bone marrow and blood contain abnormal cells known as blasts that are growing rapidly. The development of healthy blood cells, such as red blood cells, white blood cells, and platelets, is hampered by these immature cells.
3.Chronic myeloid leukemia (CML). Myeloid cells, or white blood cells, proliferate abnormally in the bone marrow and are the cause of CML. In contrast to acute leukemia, CML typically advances more slowly. Philadelphia Chromosome: The Philadelphia chromosome is a genetic anomaly linked to CML. A sectional swap between chromosomes 9 and 22 produced this chromosome. Tyrosine kinase is overproduced as a result of the BCR-ABL gene that the Philadelphia chromosome produces. Tyrosine kinase causes some blood cells to expand out of control, which leads to the promotion of cancer.
4.Chronic lymphocytic leukemia (CLL), The course of CLL is slower than that of other forms of leukemia. Older folks are the most usually affected. Although the precise reason is unknown, blood-producing cells' genetic alterations are involved. There are therapies available to assist in managing the illness. Multiplication of adult dysfunctional cells; 90–95% are B cell derived; Presents age >15 with a bimodal distribution; more often affects women <45 years old than men >45 years old. In Africa is associated with chronic malaria.
Signs and symptoms of leukemia;
1.Fever or chills: Unexplained fever or chills might be a symptom of leukemia.
2.Persistent Fatigue and Weakness: Having enough rest but still feeling too exhausted or feeble.
3.Severe or Recurrent Infections: Leukemia weakens the immune system, which increases your vulnerability to infections.
4.Unintentional Weight Loss: It may be an indication if you lose weight unintentionally.
5.Especially evident in the armpits and neck are swollen lymph nodes.
6.Liver or Spleen: Leukemia may cause these organs to enlarge.
7.Easy Bleeding or Bruising: Unusual bleeding or bruises, including petechiae (tiny red patches on the skin) or nosebleeds.
8.Overeating, Particularly at Night: Night sweats may be a sign.
9.Bone Tenderness or Pain: Leukemia may result in bone pain.
Diagnostic Investigations for chronic leukemia:-
• Full Blood Picture shows extreme lymphocytosis.
– WBC > 40 x 109/L in CLL
– WBC >500 x 109/L in CML, all stages of granulocyte development
– High basophil count in CML
•Peripheral Smear:
– smudge cells (damaged lymph's) in CLL
– Toxic granulation in CML
• Bone Marrow Biopsy – hypercellular
– CLL: >30% mature B lymphocytes
– CML: mature cells
• Cytogenetics: t(9;22) in CML
Diagnostic investigations for acute leukemia:-
• Full Blood Picture may show ↑WBC in 2/3 of cases but may be normal .
• Peripheral smear with blasts – Auer rods are pathognomonic for AML .
• Bone marrow biopsy shows >20% blasts – Blasts without granules in ALL – Blasts with granules in AML.
Treatment of leukemia according to type;-
a. Acute myeloid leukemia.
Induction phase, cytarabine (IV) 100mg/m2 24 hourly for 7days AND daunorubicin (IV) 60mg/m2 24hourly for 3 days.
consolidation phase, if in remission i.e. blast cells < 2% in bone marrow, high dose cytarabine (HiDAC) (IV) regimen is used.
Transplant, Allogeneic hSCT is considered in some patients (high risk patients).
Relapsed AML-(FLAG-IDA) regimen is used in relapsed cases. This is followed by allogeneic hSCT if remission is achieved. Fludarabine (IV) 30mg/m2 for 4 days, ANDhigh dose cytarabine (IV) 2g/m2 for 4 days AND Filgastrim (SC) 300mcg/m2 for 5days, AND idarubicin (IV) 10mg/m2 for 3 days.
Palliative single-dose regimen - Low- dose cytarabine (SC) 20mg 12 hourly for 10 days. OR azacitidine (SC) 75mg/m2 /day for 7 days. Repeat after every 4-6 weeks.
Acute lymphoblastic leukemia;
Treatment: The treatment of ALL is complex. The recommended regimens are; HYPER-CVAD/MTX-ARA-C Regimen (cyclophosphamide/mesna/vincristine/ doxorubicin/dexamethasone/methotrexate/cytarabine/leucovorin) (IV)
Chronic myeloid leukemia (CML);
Investigations: similar to other leukemia, plus BCR-ABL1 analysis by PCR or FISH for Ph chromosome analysis.
Treatment For BCR-ABL1 positive, first line treatment is Tyrosine kinase inhibitors (TKI) Chronic phase: Characterized by blast cells < 10%. Imatinib (PO) 400mg once a day every day. Accelerated phase: blasts 10 – 19%. Imatinib (PO) 600-800mg/day in 2 divided doses until chronic phase is reachived. Thereafter continue with 400mg once a day daily. Blast crisis: Blast cells > 20%. If the patient was not on TKIs, treat as in accelerated phase. If patient was on TKIs, treat as acute leukemia. Second line TKIs include nilotinib, dasatinib, bosutinib and ponatinib (PO) If BCR-ABL1 negative Hydroxyurea (PO) 40mg/kg daily. The dose ranges between 1mg and 3mg based on the WBC count.
N. B: Adequate hydration should be maintained. Blood transfusion is indicated based on the degree of anemia. Allopurinol (PO) 300mg 24hourly daily to prevent hyperuricemia.
Chronic lymphoid leukemia (CLL).
Treatment S: chlorambucil (PO) 0.1mg/kg 24hourly for 2weeks, then rest for 2 weeks, repeat until remission is achieved. OR Combination of Fludarabine, Cyclophosphamide and Rituximab (FCR) regimen (IV), prednisolone (PO) 1mg/kg 24 once a day for 2 weeks is added if there is evidence of autoimmunity (autoimmune hemolytic anaemia or autoimmune thrombocytopenia).
Pre referal treatment.
1.Correct anemia by blood transfusion (packed red blood cells).
2.If severe thrombocytopenia gives platelet transfusion.
3.Parenteral broad-spectrum antibiotics if present with features of infection.
4.Then referral for specific treatment (chemotherapy or ±radiotherapy).
HOW TO PREVENT LEUKEMIA??? brain storming.
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