Leukemia

Leukemia is a type of blood cancer that develops as a result of a mutation in the DNA of a single cell in the bone marrow. The mutated cells lose their ability to perform their normal functions. Symptoms of leukemia include fatigue, pale skin, shortness of breath, and rapid weight loss. Treatment varies depending on the type of leukemia, as well as the patient’s age and overall health condition.

What is Leukemia?

Leukemia is a malignant type of blood cancer that occurs when white blood cells proliferate abnormally in the bone marrow or other blood-forming organs in the body. These abnormal blood cells suppress the production of normal blood cells, leading to the development of the disease.

This uncontrolled growth in the bone marrow occurs due to immature cells. Unlike other cancers, it generally does not appear as a tumor on imaging tests. The treatment approach for leukemia is determined based on its type, which occurs more frequently in children than in adults.

There are four main types of leukemia:

• Acute Lymphocytic Leukemia (ALL): A type of leukemia seen in children and adults up to the age of 40, though it can affect individuals of any age.
• Acute Myeloid Leukemia (AML): A type of leukemia most commonly found in adults, particularly prevalent in those over the age of 65, though it can also occur in children.
• Chronic Lymphocytic Leukemia (CLL): The most common form of leukemia, in which symptoms may not appear for several years.
• Chronic Myeloid Leukemia (CML): A type of leukemia that can affect adults of all ages but is rarely seen in children.

What Causes Leukemia?

Leukemia occurs as a result of genetic mutations developing in certain blood cells in the body. In the DNA of a normal cell, the cell grows at a regulated pace and eventually dies over time. In leukemia, however, the mutated cells continue to grow and divide aggressively, leading to uncontrolled blood cell production. Over time, these abnormally proliferating cells replace the healthy cells in the bone marrow, which in turn leads to the onset of leukemia symptoms.

What Are the Symptoms of Leukemia?

Leukemia symptoms vary depending on the type of the disease. In chronic forms, it may be detected in the early stages, while some types may present with no symptoms at all. Common symptoms of leukemia include:

• Fatigue and weakness
• Fever and night sweats
• Recurrent infections
• Shortness of breath
• Nosebleeds
• Pale skin
• Unexplained weight loss
• Joint pain or tenderness
• Pain or a feeling of fullness under the ribs on the left side
• Gum bleeding
• Swollen lymph nodes in the neck, armpits, groin, or abdomen

What Are the Diagnostic Methods for Leukemia?

Leukemia may initially be indicated through routine blood tests, but a more detailed evaluation is usually required for diagnosis. If signs of leukemia are detected in blood work, the following tests may be recommended:

Physical examination

The doctor evaluates the patient’s symptoms and checks for swollen lymph nodes, as well as an enlarged spleen or liver. The gums are examined for bleeding and swelling. The doctor also looks for skin rashes that may be linked to leukemia, which can appear red, purple, or brown in color.

Complete blood count (CBC)

A blood test is performed to determine whether red blood cell, white blood cell, and platelet levels are abnormal. In leukemia, the white blood cell count is often higher than normal.

Blood cell examination

A blood sample is analyzed under a microscope to detect the presence of leukemia cells or a specific type of leukemia.

Bone marrow biopsy

If an abnormal white blood cell count is found, a biopsy may be performed. During this procedure, a fluid sample is taken from the bone marrow and tested in the laboratory for leukemia cells. Bone marrow biopsy helps determine the percentage of abnormal cells in the marrow and confirm the diagnosis of leukemia.

Imaging and other tests

If bones, organs, or tissues are affected, a chest X-ray, CT scan, or magnetic resonance imaging (MRI) may be ordered. Leukemia cells themselves are not visible on imaging.

Lumbar puncture (spinal tap)

To determine whether leukemia has spread to the cerebrospinal fluid surrounding the brain and spinal cord, the doctor may collect a sample of this fluid for analysis.

What is done after the Diagnosis of Leukemia?

The first treatment is hospitalization, and the average length of stay is one month. Since leukemia cells invade the body, normal cells are not found; healthy cells are supported by external reinforcement. While the patient is given healthy cells, the process is complicated since it is necessary to apply chemotherapy, and the chemotherapy that is given destroys good cells as well as bad cells.

At the end of one month, a small piece of the patient's bone marrow is taken to see if the bad cells have disappeared.

It takes about 15 days for a healthy cell to become healthy again. Since this period is critical, the patient is protected like a baby. Antibiotic treatment can be started, and masks can be used to prevent infection. Despite precautions, infection can occur. As a result of infection, The risk of death can reach 80-90%.

How Is Leukemia Treated?

The primary treatment method for leukemia is chemotherapy. In addition, radiation therapy is often planned to target areas where leukemia cells have multiplied and accumulated. It may also be used to prepare the bone marrow for a stem cell transplant.

Leukemia treatment methods include:

Chemotherapy

The most commonly used form of leukemia treatment, designed to stop the proliferation of leukemia cells. During treatment, medication may be administered via injection, orally in pill form, or through subcutaneous injection.

Immunotherapy

Medications are used to strengthen the immune system in order to fight leukemia. In immunotherapy, the immune system identifies cancer cells and works to destroy them.

Targeted therapy

This involves the use of drugs aimed at specific areas that allow leukemia cells to invade healthy cells. This approach prevents their growth and reduces their blood supply.

Radiation therapy

Radiation therapy works to kill leukemia cells and stop their growth by using X-rays. During treatment, radiation is directed to the area of the body where cancer cells are located.

Hematopoietic cell transplantation

This method replaces cancer-producing cells destroyed by chemotherapy or radiotherapy with healthy cells.

Frequently Asked Questions About Leukemia

Can leukemia be cured?

Although a complete cure for leukemia may not be possible, various interventions are available to improve the patient’s quality of life.

How is bone marrow transplantation performed?

In patients under 45 years of age, bone marrow transplantation is preferred if there is no response to salvage therapy. Stem cells in the bone marrow are the primary cells that provide the formation of cells in our blood. These cells are collected with a device and kept in the Apheresis unit until the day of the stem cell transplantation and transferred to the patient on the day of transplantation.

From whom is bone marrow obtained?

Bone marrow and tissue groups can be obtained from suitable siblings or rarely from other family members and from eligible unrelated donors through tissue banks. Another option is to freeze and keep the patient's bone marrow and give it when necessary. On the other hand, umbilical cord blood is the blood collected from the mother-stem cells-rich placenta of the newborn sibling.

What is done after Bone Marrow Transplantation?

The transplant day is determined, and the cells collected from the donor are given to the patient. From the day of the patient's bone marrow transplant, it is expected to last until the thirtieth day. By the 30th day, the extent to which the cells taken have settled in the bone marrow is checked. If this rate is over ninety-five percent, the patient is discharged.

With this type of transplant, patients are followed for a long time due to their susceptibility to infections due to the medications' effects. Patients are called for checks two days a week. In the next five-year period, checks are carried out monthly.

What is the bone marrow transplantation success rate?

Bone marrow transplants are flourishing at a rate of 70 percent. But there is always a risk of recurrence of the disease. Chemotherapy treatment applied during the disease can also trigger another cancer disease. This is the most feared situation.