LEUKEMIA

CONTENTS

1. INTRODUCTION ...........................................................................................................3

2. ELABORATION .............................................................................................................4

2.1. About leukemia ....................................................................................................4

2.2. Discovery and early understanding ......................................................................4
2.3. Etiology and diagnosis...........................................................................................5
2.4. Classification .........................................................................................................5
2.4.1. Acute leukemia ..........................................................................................6
2.4.2. Chronic leukemia .......................................................................................8

3. CONCLUSION ...............................................................................................................9

4. SUMMARY ..................................................................................................................10

5. REFERENCES ...............................................................................................................11
 1. INTRODUCTION

Leukemia is the most common type of cancer. All cancers begin in cells of the body, and
leukemia is a cancer that begins in blood cells. Normally, cells grow and divide to form new
cells as the body needs them. When cells grow old, they die and new cells take their place.
Sometimes, this process does not work right. In cancer, new cells form when the body does
not need them, and old cells do not die when they should. Leukemia is one of the most
deadly forms of cancer known today. Although cancer was less common before the
twentieth century, humans have been getting cancer for a long time. Some explanations for
the increase during the twentieth century are that more people are surviving who would
have died of infectious disease, and that in the past many times cancer may not have been
properly diagnosed. On the other hand, some statistics show that in our not so long past
there is a significant increasment in number of people suffering from leukemia. Knowing
these facts can also help us provide a better understanding of the disease and its impact. For
example, the increase of childhood leukemia in modern times may be lifestyle-related. The
incidence of leukemia is higher among more industrialized nations, and in those nations
among people of higher socioeconomic status, because these people are living in an
environment that is least like the environment humans evolved to fit. People in these
privileged positions are exposed to more pesticides and chemicals, and fewer infectious
diseases, than other people. Also, in the 1920s, it was recognized that ionizing radiation
could cause mutations in DNA that would contribute to cancer. No one knows the exact
cause of this disease, and doctors can seldom explain why one person will get it and another
person will not. However, research has shown that people with certain risk factors, such as
genetic conditions or adverse environmental exposure, are more likely than others to
develop the disease. Although cure for leukemia is not still found, there are many ways that
improve treatment, and in the end, enable surviving and outfighting the disease. [1]
 2. ELABORATION

2.1. About leukemia

Leukemia is a type of cancer of the blood or bone marrow characterized by an abnormal

increase of immature white blood cells called "blasts". It is a broad term covering a spectrum
of diseases. In turn, it is part of the even broader group of diseases affecting the blood, bone
marrow, and lymphoid system, which are all known as hematological neoplasms. In other
words, it includes a heterogeneous group of neoplasms arising from the malignant
transformation of hematopoietic (blood-forming) cells. The main reason for formation of the
disease is ability of cells to proliferate, which is usually not possible if our body contains
normal, healthy and mature tissue. But in case of leukemia there will happen some
malignant transformation of young cells, which will also be followed by cellular replication
and expansion of the whole transformed clone of cells. A fundamental characteristic of these
malignant cells, that is the main reason why it stays immature and constantly prolifirate, is
their inability to progress from basic stage to one higher level of growth. To concretize, it is
their failure to mature beyond the „blast“ level to promyelocyte or other lymphocyte level,
depending on specific type of leukemia developed by the time. Normal, healthy cells, when
mature, are naturally disabled to replicate but just can circulate in body in order to
participate in immune defense of organism, what is usually their primar task. But since to
their defect to grow normally, the failure to mature to nonreplicating end cells is the primary
reason for appearing leukemic cells in human body. It primarily proliferates in the bone
marrow, emigrates into the peripheral blood, and then may infiltrate into other tissues such
as lymph nodes, liver, spleen, skin, viscera and the central nervous system. [2]

2.2.Discovery and early understanding

Generally, the ancient Greeks are credited with being the first to recognize cancer some time
in the 4th or 5th century B.C.E. Around the begining of the last century there were found
some evidences of Australopithecus or Homo erectus that was believed to had had
malignant tumor of mandible, called Burkitt's lymphoma, a common cancer of the jaw in
contemporary east Africa.
Leukemia was not officially diagnosed until 1845, when John Hughes Benett diagnosed it in
Edinburgh. Other European physicians in the 19th century observed that their patients had
abnormally high levels of white blood cells, and they called the disease “weisses blut”,
meaning “white blood”. The term “leukemia” that is used now comes from the Greek words
“leukos” and “heima,” also meaning “white blood”. In 1913, four types of leukemia were
classified: chronic lymphocytic leukemia, chronic myelogenous leukemia, acute lymphocytic
leukemia, and erythroleukemia. In 1970, it was first confirmed that some patients could be
cured of leukemia, and by the 1980s and 1990s the cure rates for leukemia were around
70%. [1]

2.3.Etiology and diagnosis

The cause of leukemia is not known in most patients, although both genetic and
environemantal factors may be important. There is a high concordance rate among identical
twins if acute leukemia develops in the first year of life, and families with an excessive
incidence of leukemia have been identified. Acute leukemia occurs with an increased
frequency in a variety of congenital disorders, including Down's, Klinefelter's and certain
other genetic diseases caused by abnormal chromosomes which may increase the risk of
leukemia. Environmental factors are also known to play a role in the etiology of leukemia.
Ionizing radiation causes leukemia in experimental animals, and there is a clear relationship
between such exposure and the development of leukemia in humans. For example,
individuals with occupational exposure, patients receiving radiation therapy, or Japanese
survivors of the atomic bomb explosions have a predictable and dose-related increased
incidence of leukemia. One more famous example of death caused by radiation is famous
scientist Marie Curie. She suffered for years from radiation poisoning and finally succumbed
to "aplastic pernicious anemia" or, as we call it today, leukemia. Furthermore, working with
certain chemicals have also been associated with the development of leukemia. People who
work with chemicals such as benzene and formaldehyde may be at a greater risk of
developing this disease and both benzene and formaldehyde are used by the chemical
industry. Then there is also a case of virus-caused leukemia known as human T-cell leukemia.
It was not until very recently that a unique human retrovirus, reffered to as human T-cell
leukemia virus (HTLV-I) has been isolated from the cells of patients with adult T-cell leukemia
(ATL). There is overwhelming evidence that HTLV causes ATL in many parts of the world. The
disease is endemic in southwestern Japan and parts of the Caribbean and central Africa.
Except for the HTLV family, no other virus has been associated with the more common
human acute and chronic leukemias. Although it is a viral disease, it does not appear to be
contagious. One more cause of developing disease, which also turns out to be very ironic, is
receiving chemotherapy, and people with cancer who are treated with certain cancer-
fighting drugs have great possibility to develop leukemia. [2]

2.4.Classification

Leukemias are classified according to the cell types primarily involved (myeloid or lymphoid)
and as acute or chronic based upon the natural history of the disease. Acute leukemias have
a rapid clinical course, resulting in death within a matter of months without effective
treatment, whereas chronic leukemias have a more prolonged natural history. Four major
kinds of leukemia are acute lymphocytic leukemia (ALL), acute myelogenous leukemia (AML),
chronic lymphocytic leukemia (CLL) and chronic myelogenous leukemia (CML). There is also a
hairy-cell leukemia which is sometimes considered as a separate type and sometimes as a
subset of CLL. [2]

2.4.1. Acute leukemia is characterized by a rapid increase in the number of immature blood
cells. Crowding due to such cells makes the bone marrow unable to produce healthy blood
cells. Immediate treatment is required in acute leukemia due to the rapid progression and
accumulation of the malignant cells, which then spill over into the bloodstream and spread
to other organs of the body. In other words, it refers to the relatively short time course of
the disease (being fatal in as little as a few weeks if left untreated) to differentiate it from the
very different disease of chronic lymphocytic leukemia, which has a potential time course of
many years. It is interchangeably referred to as lymphocytic or lymphoblastic. This refers to
the cells that are involved, which if they were normal would be referred to as
lymphocytes but are seen in this disease in a relatively immature (also termed „blast“) state.
[3]

Acute lymphoblastic leukemia (ALL) is a form of leukemia, or cancer of the white blood
cells characterized by excess lymphoblasts. ALL causes damage and death by crowding out
normal cells in the bone marrow, and by spreading (infiltrating) to other organs. ALL is most
common in childhood with a peak incidence at 2–5 years of age, and another peak in old
age. In general, cancer is caused by damage to DNA associated with exposure
to radiation and chemicals in animals and humans. High level radiation exposure is a known
risk factor for developing leukemia, as found by studies of survivors of atom bomb exposure
in Hiroshima and Nagasaki. Some evidence suggests that secondary leukemia can develop in
individuals treated for other cancers with radiation and chemotherapy as a result of that
treatment. Remission and survival rates in adult patients are significantly lower than for
children with the same disease. [4]

Acute myeloid leukemia (AML), also known as acute myelogenous leukemia or acute
nonlymphocytic leukemia (ANLL) is the most common acute leukemia affecting adults, and
its incidence increases with age. The symptoms of AML are caused by replacement of normal
bone marrow with leukemic cells, which causes a drop in red blood cells, platelets, and
normal white blood cells. These symptoms include fatigue, shortness of breath, easy bruising
and bleeding, and increased risk of infection. Several risk factors and chromosomal
abnormalities have been identified, but the specific cause is not clear. As an acute leukemia,
AML progresses rapidly and is typically fatal within weeks or months if left untreated. AML is
treated with chemotherapy. The five-year survival rate is 40%. Subtypes of AML
include acute promyelocytic leukemia, acute myeloblastic leukemia, and acute
megakaryoblastic leukemia. [5]

2.4.2. Chronic leukemia is characterized by the excessive build up of relatively mature, but
still abnormal, white blood cells. Typically taking months or years to progress, the cells are
produced at a much higher rate than normal, resulting in many abnormal white blood cells.
Whereas acute leukemia must be treated immediately, chronic forms are sometimes
monitored for some time before treatment to ensure maximum effectiveness of therapy.
Chronic leukemia mostly occurs in older people, but can theoretically occur in any age group.
[3]

Chronic lymphoid leukemia (CLL), is the most common type of adulthood leukemias. CLL is a
disease of adults, but, in rare cases, it can occur in teenagers and occasionally in children
(inherited). Most (>75%) people newly diagnosed with CLL are over the age of 50, and the
majority are men. Most people are diagnosed without symptoms as the result of a routine
blood test that returns a high white blood cell count, but, as it advances, CLL results
in swollen lymph nodes, spleen, and liver, and eventually anemia and infections. Early CLL is
not treated, and late CLL is treated with chemotherapy. [6]

Chronic myelogenous (myeloid) leukemia (CML), also known as chronic granulocytic

leukemia (CGL), is a cancer of the white blood cells. It is a form of leukemia characterized by
the increased and unregulated growth of predominantly myeloid cells in the bone
marrow and the accumulation of these cells in the blood. CML occurs in all age groups, but
most commonly in the middle-aged and elderly and represents about 15–20% of all cases of
adult leukemia in Western populations. The only well-described risk factor for CML is
exposure to ionizing radiation. For example, increased rates of CML were seen in people
exposed to the atomic bombings of Hiroshima and Nagasaki. The five-year survival rate is
90%. [7]

3. CONCLUSION
Living with a serious disease such as leukemia is not easy, and finding out that you came
down with the disease which in most cases is not curable is certainly hard to take. Also, the
most important thing is no one should just give up when hearing the diagnosis but it is
exactly that moment of becoming aware of your state when a person must collect all of the
energy that has inside itself in order to struggle for its life. Some people find that after a
leukemia diagnosis, they need help coping with the emotional and practical aspects of their
disease. Leukemia support groups can help. In leukemia support groups, patients or their
family members get together to share what they have learned about coping with the disease
and the effects of their leukemia treatment. Scientists are finding better ways to treat
leukemia, and the chances of recovery keep improving. A physician who specializes in the
treatment of leukemia is in the best position to discuss a person's prognosis and to offer the
best course of treatment for a particular type of leukemia.
Survival rates may indicate how long groups of people may live. However, it's important to
remember that statistics are averages based on large numbers of people. These numbers
cannot be used to predict what will happen to an individual because no two people are
identical, and treatments and responses vary. [8]

4. SUMMARY

Leukemia is cancer of the blood cells. It is characterized by the uncontrolled growth of

developing bone marrow cells. It is not a single disease, but a group of malignancies in which
the bone marrow and blood-forming organs produce excessive numbers of white blood cells.
When the process of white cell maturation goes awry, leukemia results. Immature white
cells prevent the normal production of all blood cells, including white blood cells, which fight
infection. In most leukemias, an increased number of cancerous white blood cells are
produced, causing the lymph nodes, liver, or spleen to enlarge.
Leukemias are classified by the type of white blood cell that has abnormal growth and by
how fast the disease is progressing. Acute leukemia can be fatal within weeks or months
without aggressive treatment. Abnormal blood cells that remain very immature, called
"blasts," increase rapidly and the disease worsens quickly. Chronic leukemia may show no
symptoms for years. Some immature cells may be present, but in general, these cells are
more mature than those in acute leukemia and are able to carry out some normal cell
functions (that is why we say it is development of mature cells). The number of blasts
increases less rapidly than in acute leukemia, and as a result, chronic leukemia worsens
progressively. Chronic leukemia can become acute leukemia, in the way as the cancer slowly
progresses, symptoms of chronic leukemia will appear as the number of leukemia cells in the
blood rises. Leukemia can arise in either of the two main types of white blood cells--
lymphoid or myeloid. Leukemia that affects lymphoid cells is known as lymphocytic
leukemia. When myeloid cells are affected, the disease is called myelogenous leukemia. The
disease can be categorized into one of four main types shown below, depending on whether
it is acute or chronic and myelogenous or lymphocytic.
While both children and adults can develop leukemia, certain types are more common in
one age group than in another.
In addition to the four main types, there are sub-types of leukemia, such is hairy cell - a
chronic leukemia in which the abnormal white blood cells appear to be covered with tiny
hairs when viewed under a microscope. [9]

5. REFERENCES

1. Rebecca Nelson; History of Leukemia. Available at

http://rebeccanelson.com/leukemia/history.html. Accessed April 6, 2013
2. Braunwald, Isselbacher, Petersdorf, Wilson, Martin, Fauci; Harrison’s Principles of
Internal Medicine, Eleventh Edition; Volume 2, The McGraw-Hill Companies, 2008;
1541-1550
3. Wikipedia; Leukemia. Available at http://en.wikipedia.org/wiki/Leukemia. Accessed
April 6, 2013.
4. Wikipedia; Acute lymphoblastic leukemia. Available at
http://en.wikipedia.org/wiki/Acute_lymphoblastic_leukemia. Accessed April 6, 2013.
5. Wikipedia; Acute myelogenous leukemia. Available at
http://en.wikipedia.org/wiki/Acute_myeloid_leukemia. Accessed April 6, 2013.
6. Wikipedia; Chronic lymphoid leukemia. Available at
http://en.wikipedia.org/wiki/B-cell_chronic_lymphocytic_leukemia. Accessed April 6,
2013.
7. Wikipedia; Chronic myelogenous leukemia. Available at
http://en.wikipedia.org/wiki/Chronic_myelogenous_leukemia. Accessed April 6,
2013.
8. Cancer Compass; Leukemia. Available at http://www.cancercompass.com/leukemia-
information/living-with-leukemia.htm. Accessed April 7, 2013.
9. Mamas health; Living with Leukemia. Available at
http://www.mamashealth.com/cancer/liveleuk.asp. Accessed April 7, 2013.