Leukemia-Commonly as Blood Cancer

Leukemia is a type of cancer that affects the blood and bone marrow, causing the body to produce too many abnormal white blood cells. These abnormal cells, called blasts or leukemia cells, are unable to fight infection and crowd out healthy blood cells. Like wise Leukemia is cancer of the body’s blood-forming tissues, including the bone marrow and the lymphatic system.

Many types of leukemia exist. Some forms of leukemia are more common in children. Other forms occur mostly in adults. Also Leukemia usually involves the white blood cells. Your white blood cells are potent infection fighters — they normally grow and divide in an orderly way, as your body needs them. But in people with leukemia, the bone marrow produces an excessive amount of abnormal white blood cells, which don’t function properly.

Causes of Leukemia 

Research don’t understand the exact causes of leukemia. It seems to develop from a combination of genetic and environmental factors. Additionally Leukemia begins in bone marrow, the soft spongy tissue in the inner cavity of your bones, where your body’s blood cells are made. Blood cells go through multiple stages before reaching their fully mature forms. Mature, normal blood cells.

Red blood cells

Cells that carry oxygen and other vital materials to all tissues and organs in your body.

White blood cells

Cells that fight infection.

Platelets

Cells that help your blood clot.
These blood cells start as hematopoietic (hemo = blood, poiesis = make) stem cells. The stem cells develop into either myeloid (MAI-uh-loyd) cells or lymphoid (LIM-foyd) cells. If blood cells were to continue to develop normally, the mature forms of these cells are as follows:

Myeloid cells develop into red blood cells, platelets and certain types of white blood cells (basophils, eosinophils and neutrophils).

Lymphoid cells develop into certain white blood cells (lymphocytes and natural killer cells).

One of the developing blood cells begins to multiply out of control. These abnormal cells called leukemia cells begin to take over the space inside of your bone marrow. They crowd out the cells trying to develop into healthy red blood cells, white blood cells and platelets.

In general, leukemia is thought to occur when some blood cells acquire changes (mutations) in their genetic material or DNA. A cell’s DNA contains the instructions that tell a cell what to do. Normally, the DNA tells the cell to grow at a set rate and to die at a set time. In leukemia, the mutations tell the blood cells to continue growing and dividing.

However happens, blood cell production becomes out of control. Over time, these abnormal cells can crowd out healthy blood cells in the bone marrow, leading to fewer healthy white blood cells, red blood cells and platelets, causing the signs and symptoms of leukemia.

Symptoms of Leukemia 

Bleeding and bruising
Bone pain
Fatigue
Fever
Increased risk of infections
Weight loss without trying
Swollen lymph nodes
Enlarged liver or spleen
Easy bleeding or bruising
Recurrent nosebleeds

Types of Leukemia 

The first type of classification is by how fast the leukemia progresses. The actual classification of leukemia based on its speed of progression and the type of cells involved.

Acute leukemia

This type of leukemia affects immature cells and grows quickly, requiring immediate treatment. In acute leukemia, the abnormal blood cells are immature blood cells (blasts). They can’t carry out their normal functions, and they multiply rapidly, so the disease worsens quickly. Acute leukemia requires aggressive, timely treatment.

Chronic leukemia

This type of leukemia affects mature or partially mature cells and grows more slowly. There are many types of chronic leukemias. Some produce too many cells and some less to be produced. Chronic leukemia involves more mature blood cells. These blood cells replicate or accumulate more slowly and can function normally for a period of time. Some forms of chronic leukemia initially produce no early symptoms and can go unnoticed or undiagnosed for years.

Classification by type of white blood cell affected

Lymphocytic leukemia

This type of leukemia affects the lymphoid cells (lymphocytes), which form lymphoid or lymphatic tissue. Lymphatic tissue makes up your immune system. A type of white blood cell that plays a role in the immune system.

Myelogenous leukemia

This type of leukemia affects the cells that mature into red blood cells, white blood cells, and platelets. This type of leukemia affects the myeloid cells. Myeloid cells give rise to red blood cells, white blood cells and platelet-producing cells.

Diagnostically there are four main types

Acute lymphocytic leukemia (ALL)

The most common type of leukemia in children, teens and young adults up to age 39. ALL can affect adults of any age.

Acute myelogenous leukemia (AML)

The most common type of acute leukemia in adults. It’s more common in older adults (those over 65). AML also occurs in children.

Chronic lymphocytic leukemia (CLL)

The most common chronic leukemia in adults (most common in people over 65). In fact Symptoms may not appear for several years with CLL.

Chronic myelogenous leukemia (CML)

The is more common in older adults (most common in people over 65) but can affect adults of any age. It rarely occurs in children. Symptoms may not appear for several years with CML.

Diagnosis of Leukemia

A needle suctioning out liquid bone marrow from hipbone
Bone marrow exam
Enlarge image
Doctors may find chronic leukemia in a routine blood test, before symptoms begin. If this happens, or if you have signs or symptoms that suggest leukemia, you may undergo the following diagnostic exams:

Physical examination

Physician will look for physical signs of leukemia, such as pale skin from anemia, swelling of your lymph nodes, and enlargement of your liver and spleen.

Blood tests

By looking at a sample of your blood, physician can determine if you have abnormal levels of red or white blood cells or platelets which may suggest leukemia. A blood test may also show the presence of leukemia cells, though not all types of leukemia cause the leukemia cells to circulate in the blood.

Bone marrow test

Sometimes the leukemia cells stay in the bone marrow. Physician may recommend a procedure to remove a sample of bone marrow from your hipbone. The bone marrow is removed by a needle to look for leukemia cells. Specialized tests reveal certain characteristics that are used to determine your treatment options.

Flow cytometry

Flow cytometry is a test that uses a laser to analyze cells in a sample to diagnose leukemia. It’s a powerful tool that can quickly identify abnormal cell populations and determine the type of leukemia.

A lab technician places a sample of blood, bone marrow, or tissue in a liquid suspension.
The technician treats the cells with fluorescent antibodies.
The sample is injected into a flow cytometer.

Furthermore the flow cytometer

1.Passes the cells in a single line in front of a laser beam.
2. Counts and categorizes the cells based on how the laser light scatters off them.
3.Sends the data to a computer, which generates a report.

Leukemia and Flow Cytometry

Flow cytometry can help diagnose Particularly

Acute Lymphoblastic Leukemia (ALL),

Acute Myeloid Leukemia (AML),

Chronic Lymphocytic Leukemia (CLL), and

Chronic Myeloid Leukemia (CML).

Lymphoma

Non-Hodgkin’s lymphoma and multiple myeloma.

Tumor lineage

Flow cytometry can help identify the tumor lineage as T cell, B cell, or myeloid.

DNA ploidy

Flow cytometry can help determine DNA ploidy, which can help with diagnosis and prognosis.

A flow cytometry leukemia panel is a test that uses a flow cytometer to analyze white blood cells for the presence of leukemia. The test cused to monitor leukemia and classify it as a subtype.

Procedure of Flow cytometry

A sample of blood, bone marrow, tissue, or fluid is stained with monoclonal antibodies
The antibodies bind to antigens on the cell surface, in the cytoplasm, or in the nucleus
The flow cytometer measures the physical characteristics and markers of the cells
A hematopathologist analyzes the results to identify and diagnose leukemia

In fact Flow cytometry can quickly diagnose leukemia
It can help determine a prognosis and treatment options
It can help monitor the progress of leukemia after treatment

Leukemia/Lymphoma Phenotyping Evaluation by Flow Cytometry

Leukemia and lymphoma analysis by flow cytometry aids in identifying the tumor lineage, which in most cases is identified as T cell, B cell, or myeloid. Lineage identification can provide a confirmatory diagnosis or differential diagnosis, prognosis, and treatment options.

Diagnosis/Treatment Issues regarding Method Flow Cytometry

Phenotyping by flow cytometry can aid in the evaluation of hematopoietic neoplasms.
Specimens include bone marrow, whole blood, tissue, or fluid.
Phenotyping may aid in monitoring response to therapy in individuals with an established diagnosis of hematopoietic neoplasms.

Test Interpretation

Markers are analyzed as needed, based on clinical evidence, to fully characterize any abnormalities identified by the screening panel.
Additional markers  interpretation of the screening panel results.
Antigens included:
T cell: CD1a, CD2, CD3, CD4, CD5, CD7, CD8, TCR γ-δ, cytoplasmic CD3
B cell: CD10, CD19, CD20, CD22, CD23, CD103, CD200, kappa, lambda, cytoplasmic kappa, cytoplasmic lambda
Myeloid/monocyte: CD11b, CD13, CD14 (Mo2), CD14 (MY4), CD15, CD33, CD64, CD117, myeloperoxidase
Miscellaneous: CD11c, CD16, CD25, CD30, CD34, CD38, CD41, CD42b, CD45, CD56, CD57, CD61, HLA-DR, glycophorin, TdT, bcl-2, ALK-1, CD123, CD138, CD200, CD26, CD45, CRLF-2

Clinical Sensitivity

Limit of detection is 0.01–1.0% depending on phenotype and disease.

Results

Antigens will be reported as positive or negative.
Interpretive comments that further characterize intensity patterns are included.
Dim, bright, variable, or partial may be reported.
Light-chain expression may be reported as polytypic/polyclonal or restricted/monotypic/monoclonal.
May include kappa/lambda ratio.
Pattern of CD antigen testing will be interpreted with recommendations for further testing, if indicated.

Limitations

Some hematopoietic neoplasms do not show phenotypic abnormalities and may not be detected by flow cytometry.
Poor cell viability may adversely affect antigens and impede the ability to properly identify neoplastic cells.
Flow results cannot be used alone to diagnose malignancy.
Results should be interpreted in conjunction with morphology, clinical information, and other necessary ancillary tests for a definitive diagnosis.

Treatment of leukemia

Treatment depends on the type of leukemia.
Research has led to improved outcomes for children diagnosed with leukemia. Treatment for your leukemia depends on many factors. Physician determines your leukemia treatment options based on your age and overall health, the type of leukemia you have, and whether it has spread to other parts of your body, including the central nervous system.

Common treatments used to fight leukemia

Chemotherapy

Chemotherapy is the major form of treatment for leukemia. This drug treatment uses chemicals to kill leukemia cells.

Depending on the type of leukemia you have, you may receive a single drug or a combination of drugs. These drugs may come in a pill form, or they may be injected directly into a vein.

Targeted therapy

Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Your leukemia cells will be tested to see if targeted therapy may be helpful for you.

Radiation therapy

Radiation therapy uses X-rays or other high-energy beams to damage leukemia cells and stop their growth. During radiation therapy, you lie on a table while a large machine moves around you, directing the radiation to precise points on your body.

You may receive radiation in one specific area of your body where there is a collection of leukemia cells, or you may receive radiation over your whole body. Radiation therapy may be used to prepare for a bone marrow transplant.

Bone marrow transplant

A bone marrow transplant, also called a stem cell transplant, helps reestablish healthy stem cells by replacing unhealthy bone marrow with leukemia-free stem cells that will regenerate healthy bone marrow.

Prior to a bone marrow transplant, you receive very high doses of chemotherapy or radiation therapy to destroy your leukemia-producing bone marrow. Then you receive an infusion of blood-forming stem cells that help rebuild your bone marrow.

You may receive stem cells from a donor or you may be able to use your own stem cells.

Immunotherapy

Immunotherapy uses your immune system to fight cancer. Your body’s disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.
Engineering immune cells to fight leukemia. A specialized treatment called chimeric antigen receptor (CAR)-T cell therapy takes your body’s germ-fighting T cells, engineers them to fight cancer and infuses them back into your body. CAR-T cell therapy might be an option for certain types of leukemia.
Clinical trials. Clinical trials are experiments to test new cancer treatments and new ways of using existing treatments. While clinical trials give you or your child a chance to try the latest cancer treatment, treatment benefits and risks may be uncertain. Discuss the benefits and risks of clinical trials with your doctor.

The phases of Leukemia Treatment

Depending on your treatment plan, you may receive ongoing leukemia treatments long-term or treatment in phases. Generally, phased treatment involves three parts. Each phase has a specific goal.

Induction therapy. The goal is to kill as many leukemia cells as possible in your blood and bone marrow to achieve remission. In remission, blood cell counts return to normal levels, no leukemia cells are found in your blood, and all signs and symptoms of the disease disappear. Induction therapy usually lasts four to six weeks.
Consolidation (also called intensification). The goal is to kill any remaining undetected leukemia cells, so the cancer doesn’t return. You’ll usually receive consolidation therapy in cycles, over four to six months.
Maintenance therapy. The goal is to kill any leukemia cells that may have survived the first two treatment phases and prevent the cancer from returning (relapse). Treatment lasts about two years.

Prognosis in Leukemia 

It’s difficult to predict the prognosis for leukemia because everyone’s experience is different. Outcomes depend on a variety of factors,

Genetic abnormalities or mutations

The mutations inside leukemia cells are the most important predictor of outcome.

Type of leukemia

Certain types of leukemia are associated with more favorable outcomes than others.

Blood cell counts at the time of diagnosis

The number of leukemia cells at your diagnosis can play a role in your outcome.

Age

Generally, the younger you are at your diagnosis, the better your outcome.

Health

Generally, the healthier you are at your diagnosis, the better your outcome.

Response to treatment

The length of time it takes for cancer to go into remission often indicates how successful treatment may be.

Presence of leukemia cells in your central nervous system

Cells in your spinal fluid are often more difficult to treat.

Ultimately

your Doctor is the most reliable resource for understanding how your cancer affects your unique prognosis. Ask them about treatment outcomes.

The survival rate of leukemia

Although the number of new cases of leukemia in the U.S. has remained relatively steady or slightly increased since the 1970s, the survival rate has also improved. Still, long-term outcomes vary for each person.

survival compares patients diagnosed with cancer vs. people of same age, race and sex who are cancer free.

There isn’t a cure for leukemia, but this doesn’t mean some people don’t achieve long-term remission. Being cured of leukemia means that the cancer’s gone, it’s not coming back and no more treatment is needed, but this is hard to know for sure with leukemia.

On the other hand, long-term remission means there’s no sign of cancer with or without treatment. Remission may last anywhere from a few weeks to many years. The leukemia may never return. If it does, your healthcare provider may recommend new treatments to achieve remission.

Your healthcare team can best answer the question, “Am I cured of my leukemia?” Your team will work closely with you to monitor your health and develop a personalized treatment plan.

Risk factors in Leukemia

Factors that may increase your risk of developing some types of leukemia

Previous cancer treatment.

People who’ve had certain types of chemotherapy and radiation therapy for other cancers have an increased risk of developing certain types of leukemia.

Genetic disorders.

Genetic abnormalities seem to play a role in the development of leukemia. Certain genetic disorders, such as Down syndrome, are associated with an increased risk of leukemia.

Exposure to certain chemicals.

Exposure to certain chemicals, such as benzene which is found in gasoline and is used by the chemical industry is linked to an increased risk of some kinds of leukemia.
Smoking. Smoking cigarettes increases the risk of acute myelogenous leukemia.
Family history of leukemia. If members of your family have been diagnosed with leukemia, your risk of the disease may be increased.

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