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Leukemia

more about Leukemia


  • Leukemia is a life-threatening cancer of the white blood cells in the bone marrow.  White blood cells normally function to fight infections.  There are two major types of white blood cells -- neutrophils and lymphocytes -- allowing for 4 types of leukemias: acute myelocytic (also known as AML), acute lymphocytic (also known as ALL), chronic myelocytic (also known as CML) , and chronic lymphocytic (also known as CLL).
  • Subtypes of ALL:
    1. L1, L2, L3 by morphologic features
    2. T cell ALL, B cell ALL, pre-B cell ALL, early pre-B ALL, non-T, non-B ALL by cytologic, immunologic and karyotypic features
  • Subtypes of AML: M1, M2, M3, M4, M5, M6, M7 AML
  • Both forms of acute leukemia inhibit the bone marrow's production of needed blood components, including red blood cells and platelets (structures involved in clotting blood).
  • ALL is the most common cause of cancer in children, generally occurring between ages 3 and 5, but it can also affect adolescents and, occasionally, adults.
  • AML affects people of all ages but is more common in adults.  It is a life-threatening cancer that rapidly replaces the normal cells in the bone marrow.

  • Bleeding in gums
  • Bleeding under the skin, such as bruises or spots
  • Nosebleeds
  • Increased menstrual bleeding
  • Thickened and swollen gums
  • Bone pain
  • Joint pain
  • Weight loss
  • Fatigue
  • Enlarged lymph nodes
  • Shortness of breath
  • Severe infections are rare.
  • Bloody urine
  • Abdominal distention
  • Nausea/vomiting
  • Headache
  • Fever
  • Pallor
  • Poor appetite

  • Usually unknown
  • Radiation
  • Benzene
  • Cancer chemotherapy

  • Bloom syndrome
  • Identical twin of a leukemia patient
  • Siblings of leukemia patients
  • Down Syndrome

  • Examination:
    1. Skin is pale
    2. Rash with red dots on the skin called petechiae
    3. Enlarged liver
    4. Enlarged spleen
    5. Enlarged lymph nodes
    6. Bone tenderness
  • Laboratory Findings:
    1. Manual complete blood count shows diffuse decrease in all blood cell lines with the presence of blast cells (immature white blood cells).
    2. Acute lymphocytic leukemia (ALL) will have granules in blast cells.  A special cell marker called TdT is present in 95 percent of cases.  It is subtyped to either B-cell or T-cell type.
    3. Genetic testing on the cells is performed.  Hyperdiploid genes have a more favorable prognosis.  Monosomy 5 and 7, the Philadelphia chromosome, and an 11q23 abnormality indicate a poorer prognosis.
    4. Acute myelogenous leukemia (AML) shows Auer rods in the blast cells.  Special stains may also be done. 
    5. Genetic testing is performed and t (8,21), t (15,17), and inv16q have a more favorable prognosis.
    6. A bone marrow biopsy showing 30 percent or more blast forms, confirming the diagnosis
    7. Other lab findings may include disseminated intravascular coagulation (DIC), which is a severe depletion of clotting factors in the blood.
    8. Uric acid level may be elevated.
    9. Lumbar puncture (spinal tap) will show blasts if meningeal leukemia is present.

  • Intensive chemotherapy is recommended.  During this period, there is a high risk of infection.  Transfusion of blood products may be needed.
  • Drug agents prescribed for AML include daunorubicin (antibiotic) and cytarabine.
  • Drug agents prescribed for ALL include daunorubicin, vincristine, prednisone, and asparaginase.
  • After initial therapy, intense chemotherapy, high dose chemotherapy, and radiation with bone marrow transplant may be recommended to cure the disease.
  • Supportive therapy:
    1. Interferon, antiviral agents, and antibiotic therapy for infection
    2. Transfusion

  • Prognostic factors:
    1. Age
    2. Initial WBC count
    3. Cell type/cell marker
    4. Chromosomal abnormality
  • Good prognosis:
    1. Between 2 years and 9 years of age
    2. White blood cells counts lower than 10,000 per milliliter
    3. L1 cell type, non-T, non-B type
    4. No mediastinal or central nervous system involvement
    5. Girls or boys who have platelet counts higher than 10,000 per milliliter

  • Your child needs need immediate medical treatment.  This is a curable disease.  In AML, nearly 80 percent of adults younger than 60 years of age can be cured.  Fifty percent of patients older than 60 years may also be cured.  In ALL, usually 80% of adults and 95%of children are cured.  The 5-year survival rates are 80-90% for the good prognosis group and 50% for the poor prognosis group.

  • Lymphoma
  • Chronic myelogenous leukemia
  • Myelodysplastic syndromes
  • Chronic lymphocytic leukemia
  • Hairy cell leukemia
  • Mononucleosis
  • Rheumatic arthritis
  • Hemorrhagic disorder
  • Aplastic anemia
  • Osteomyelitis

  • Blast Crisis:

- This is a severe elevation of the white blood cell count to greater than 200,000/uL.  Normal levels of white blood cells are 10,0000/uL.  The high level of white bloods cells interferes with the circulation of red blood cells, which carry oxygen.  Confusion, headaches, and shortness of breath are some of the symptoms.  This is a life-threatening emergency.  Blood must be filtered in a process called leukapheresis, and chemotherapy administered immediately.




more about Leukemia


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