LEUKEMIA

History

Leukemia is a malignant cancer of the blood and bone marrow. It was first described in 1827 by Alfred-Armand-Louis-Marie-Vlepeau, an anatomist and surgeon. But a comprehensive description was provided in 1845 by the German pathologist Rudolf Virchow who also named it in 1847. The word ‘leukemia’ is formed from two Greek words, ‘leukos’ meaning “white”, and ‘haima’ meaning “blood.” By the end of nineteenth century leukemia began to be viewed as a family of diseases instead of a single disease. Several leukemia types were known by 1913, but none were treatable. Although research went on for years to find its cure, the modern therapy of leukemia by introducing acid folic as an anti-cancer therapy was started in 1948 by Sidney Farber. In the late 1950s, researchers James Holland, Emil Freireich, and Emil Frei III and their colleagues used combination chemotherapy to cure leukemia and achieved success in children with acute lymphoblastic leukemia (ALL) surviving long after the tests.

Statistics

In 2015, leukemia was present in 2.3 million people and led to 353,500 deaths worldwide. Leukemia is the most common type of cancer in children, with three quarters of leukemia cases in children being the ALL type. In India, every year nearly 25,000 children are diagnosed with this cancer. The prevalence of childhood ALL is approximately 3 to 4 cases per 100,000 children under the age of 15 years. The annual occurrence of acute myeloid leukemia (AML) among children in India varies from 0.9 to 1.5 per 100,000 children. However, about 90% of all types are diagnosed in adults, with AML and chronic lymphocytic leukemia (CLL) being most common in adults.

Causes, Symptoms, and Treatment

Leukemia is an uncontrolled division of immature blood cells. Although, leukemia may begin in other blood cell types as well, it most commonly occurs in white blood cells (WBCs) resulting in an overproduction of abnormal WBCs. These abnormal or underdeveloped WBCs are unable to fight off infections and at the same time impair the bone marrow’s ability to produce healthy red blood cells (RBCs), platelets, and mature white cells/leukocytes essential for carrying oxygen, for blood clotting, and to fight infections, respectively.

Depending upon the pace of growth, leukemia is classified as acute (fast growing) or chronic (slower growing) and it is called myeloid or lymphocytic leukemia depending on whether it starts in myeloid cells or lymphoid cells. Accordingly, there are four main types of leukemia—acute myeloid leukemia (AML), chronic myeloid leukemia (CML), acute lymphocytic leukemia (ALL) and chronic lymphocytic leukemia (CLL).

Although leukemia is caused when the DNA of a single cell in the bone marrow mutates and becomes damaged, leading to a change in the cell’s ability to develop and function normally, what specifically causes this mutation is unknown. Certain factors such as very high doses of radiation, exposure to certain chemotherapy drugs, and chemicals like benzene may put a person at higher risk.

Once the disease is in progression some leukemia symptoms begin to appear such as swollen lymph nodes in throat, groin or armpits, easy bleeding from the nose, anemia, and lowered immunity.

Treatment of leukemia varies with patient’s age, genetic abnormalities, overall health of the patient, and the kind of leukemia. Depending upon these factors, different leukemia treatment options are considered, including chemotherapy which is the main treatment for most kinds; stem cell transplant (also known as bone marrow transplant) for people mostly younger than 55 years of age; and radiation therapy for preventing leukemia from spreading to, or treating the one that has spread to the central nervous system. Radiation therapy is also used for preparing the bone marrow for stem cell transplant. Some other therapies such as targeted therapy; supportive therapy that manages the expected complications of leukemia; and watchful waiting for chronic types, are also sometimes considered in specific cases.

Follow-up after treatment is an important part of leukemia care. Regular follow-up visits must be made as these visits allow the healthcare providers to monitor the patient’s progress and recovery from treatment.

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