Leukemia :Type, Symptom, Risk factor, Stage, Treatment, And Drug

Leukemia is cancer of blood cells that usually begin in the bone marrow and result in high numbers of abnormal white blood cells.Bone marrow is the soft inner part of bones.New blood cells, such as red blood cells, white blood cells, and platelets are made in the bone marrow.It is found mainly in the flat bones, including skull, shoulder, blades, ribs, hip bones and vertebrae in the teen-agers.In infants, it is found in almost all bones of the body.

The types of blood cells :

• Red blood cells carry oxygen from the lungs to all other tissues in the body and take carbon dioxide back to the lungs to be removed.
• Platelets are cell fragments made by a type of bone marrow cell called the Megakaryocyte.They are important to stop bleeding by plugging up holes in the blood vessels.
• White blood cells help the body fight against infections

Types of White blood cells :

1. Lymphocytes are mature, infection-fighting cells that develop from lymphoblasts, a type of blood stem cell in the bone marrow.

There are two types of lymphocytes :

• B Lymphocytes (B cells) help in protecting the body against germs, such as bacteria and viruses.They make proteins called antibodies that attach to the germ.
• T Lymphocytes (T cells) help in protecting the body against germs.Some types of T cells destroy germ directly.

2. Granulocytes are mature, infection-fighting cells that develop from myeloblasts, a type of blood-forming cell in the bone marrow.

3. Monocytes develop from blood-forming monoblasts in the bone marrow and are related to granulocytes.

The Specific Types of Leukemia

• Acute Lymphoblastic Leukemia (ALL) is the most common type of leukemia in young children and affects adults  over the age of 65.

• Chronic Lymphocytic Leukemia (CLL) affects adults over the age of 55 and sometimes occurs in younger adults.

• Acute Myelogeneous Leukemia (AML) occurs commonly in adult men than in adult women and in children

• Chronic Myelogeneous Leukemia (CML) occurs mainly in adults and very small number in children.

• Hairy cell Leukemia (HCL) affects adult men.
• T-Cell Prolymphocytic Leukemia (T-PLL) affects more adult men than adult women.
• Large Granular Lymphocytic Leukemia is a rare and indolent leukemia.
• Adult-T Cell Leukemia is caused by human T- lymphotropic virus (HTLV), a virus similar to HIV.

The General Classification of Leukemia :

• Acute Leukemia is characterized by a rapid increase in the number of immature blood cells.
• Chronic Leukemia is characterized by the excessive build-up of relatively mature, but still abnormal white blood cells.
• Lymphoblastic or Lymphocytic Leukemia is the cancerous change to take place in a type of marrow cell that normally goes on to form lymphocytes, which are infection-fighting immune system cells.
• Myeloid or Myelogenous Leukemia is the cancerous change to take place in a type of marrow cell that normally goes on to form red blood cells, some other types of white blood cells and platelests.

The Symptoms of Leukemia

• Easy bleeding
• Easy bruising
• Fever
• Feeling tired
• Weight loss
• Loss of appetite
• Fequent infections
• Swelling of lymph nodes
• Muscular weakness
• Joints Pain or tenderness
• Easy shortness of breath
• Liver enlargement
• Night sweats
• Purplish patches or spots
• Diarrhea
• Sores in the mouth
• Chills
• Nausea

The Risk Factors of Leukemia

• Family history
• Race or Ethnicity
• Certain chemichal exposures, such as benzene
• Radiation exposure, such as atomic bomb
• Age
• Gender
• Certain chemotherapy drugs
• Tobacco smoking
• Certain blood disorders
• Workplace exposures, such as gasoline, diesel
• Genetic syndromes, such as fanconi anemia, ataxia-telangiectasia
• Herbicides or pepticides exposure
• Certain viral infections
• Chromosome mutations

The Tests are used in The Staging Process

• Chest X-Ray is an x-ray of the organs and bones inside the chest.
• MRI (magnetic resonance imaging) is a procedure that uses a magnet, radio, waves, and a computer to make a series of detailed pictures of areas inside the body.
• CT Scan (CAT Scan) is a procedure to make a series of detailed pictures of areas inside the body, taken from different angles.
• PET-CT Scan is a procedure that combines the picture from a positron emission tomography (PET) scan and a computed tomography (CT) scan.
• Blood Chemistry Studies are a procedure in which a blood sample is checked to measure the ammounts of certain substances released into the blood by organs and tissues in the body.
• Antiglobulin Test is a test in which a sample of blood is looked at under a microscope to find out if there are any antibodies on the surface of red blood cells and platelets.

The Stage Of  Chronic Lymphocytic Leukemia

• Stage 0 : There are too many lymphocytes in the blood, but there are no other signs or symptoms of leukemia.Chronic lymphocytic leukemia is indolent (slow growing).

• Stage I : There are too many lymphocytes in the blood and the lymph nodes are larger than normal.

• Stage II : There are too many lymphocytes in the blood,  the liver or spleen is larger than normal, and the lymph nodes may be larger than normal.

• Stage III : There are too many lymphocytes in the blood,  there are too few red blood cells, and the lymph nodes, the liver or spleen may be larger than normal.

• Stage IV : There are too many lymphocytes in the blood,  there are too few platelets, and the lymph nodes, the liver or spleen may be larger than normal, and there may be too few red blood cells.

Stage I, Stage II, Stage III, and Stage IV of Chronic Lymphocytic Leukemia Treatments include :

• Watchful waiting when there are few or no signs or symptoms.
• Targeted therapy with a monoclonal antibody or a tyrosine kinase inhibitor.
• Chemotherapy with one or more drugs,  with or without steroids or monoclonal antibody therapy.
• Low-dose external radiation therapy to areas of the body where cancer is found, such as the spleen or lymph nodes.
• A clinical trial of chemotherapy and Biologic therapy with stem cell transplant.
• A clinical trial of a new treatment.

Treatment of Leukemia

I. Acute Lymphoblastic Leukemia (ALL) is treated into several phases :

• Induction chemotherapy brings about bone marrow remission.Standard induction drug plans for adults, include prednisone, vincristine, anthracycline, L-asparaginase or cyclophosphamide.Standard theraphy is usually used for children with low risk of ALL by using three drugs, such as prednisone, vincristine, and L-asparaginase for the first month of treatment.
• Consolidation therapy or intensification therapy eliminates any remaining leukemia cells.Patients with low-to average-risk ALL receive therapy with antimetabolite drugs, such as methotrexate and 6-mercaptopurine (6-MP).Patients with high risk of ALL receive higher drug doses of these drugs and additional drugs.
• CNS Prophylaxis (Preventive theraphy) stops the cancer from spreading to the brain and nervous system in high risk patients.Standard prophylaxis may include radiation of the head and/or drugs delivered directly into the spine.
• Maintenance treatments with Chemotherapeutic drugs prevent disease recurrence once remission has been achieved.Maintenance therapy involves the lower drug doses and  may continue for up to three years.
• Allogeneic bone marrow transplantation alternatively may be appropriate for patients with high risk of ALL

II. Chronic Lymphocytic Leukemia (CLL) is treated based on the stage and the symptoms of the indivual patient.

The indications for treatments are :

• Falling hemoglobin or platelet count
• Progression to a later stage of disease
• Painful, disease related overgrowth of lymph nodes or spleen
• An increase in the rate of lymphocyte production.

The primary chemotherapeutic plan is combination chemotherapy with chlorambucil or cyclophophamide, plus a corticosteroid, such as prednisone or prednisolone.In resistant cases, single-agent treatment with nucleoside drugs such as fludarabine, pentostatin, or cladribine may be successful.Younger patients may consider allogeneic or autologous bone marrow transplantation.

III. Acute Myelogeneous Leukemia (AML) uses various treatment according to the age of the patient and according to the specific subtype of AML.The oncologists rely on combination of drugs for the initial, induction phase of chemotherapy.Such combination chemotherapy usually offers the benefits of early remission and a lower risk of disease resistance.Consolidation and maintenance treatments are intended to prevent disease recurrence.Consolidation treatment often entails a repetition of induction chemotherapy or the intensification chemotherapy with additional drugs.

IV. Chronic Myelogeneous Leukemia (CML) uses Imatinib (Gleevec) Therapy.

V. Hairy cell Leukemia (HCL) uses Typical Treatment Approach.Patients receive one week of cladribine daily by intravenous infusion or a simple injection under the skin, or six month of pentostatin every four weeks by intravenous infusion.Other treatments include rituximab infusion or self-injection with interferon-alpha.

VI. T-Cell Prolymphocytic Leukemia (T-PLL) is difficult to treat.Alemtuzumab (Campath) is a monoclonal antibody to attack white blood cells.Purine analogues (pentostatin, fludarabine, cladribine), chlorambucil, and various forms of combination chemotherapy, such as cyclophosphamide, doxorubicin, vincristine, prednisone CHOP, cyclophosphamide, vincristine, prednisone (COP), vincristine, doxorubicin, prednisone, etoposide, cyclophosphamide, bleomycin (VAPEC-B) are used for the treatment in certain patients.Some patients successfully respond to undergo stem cell transplantation to consolidate the response.

VII. Juvenile Myelomonocytic Leukemia is treated by splenectomy, chemotherapy, and bone marrow transplantation.

The Drugs of Leukemia

Drugs approved for Acute Lymphoblastic Leukemia (ALL) 

• Abitrexate (Methotrexate)
• Arranon (Nelarabine)
• Asparaginase Erwinia Chrysanthemy
• Blinatumomab
• Blincyto (Blinatumomab)
• Cerubine (Daunorubicin Hydrochloride)
• Clafen (Cyclophosphamide)
• Clofarabine
• Clofarex (Clofarabine)
• Clolar (Clofarabine)
• Cyclophosphamide
• Cytarabine
• Cytosar-U (Cytarabine)
• Cytoxan (Cyclophosphamide)
• Dasatinib
• Daunorubicin
• Doxorubicin Hydrochloride
• Erwinaze (Asparaginase Erwinia Chrysanthemy)
• Folex (Methotrexate)
• Folex PFS (Methotrexate)
• Gleevec (Imatinib Mesylate)
• Iclusig (Ponatinib Hydrochloride)
• Imatinib Mesylate
• Marqibo (Vincristine Sulfate Liposome)
• Mercaptopurine
• Methotrexate
• Methotrexate LPF (Methotrexate)
• Mexate (Methotrexate)
• Mexate-AQ (Methotrexate)
• Nelarabine
• Neosar (Cyclophophamide)
• Oncaspar (Pegaspargase)
• Pegaspargase
• Ponatinib Hydrochloride
• Prednisone
• Purinethol (Mercaptopurine)
• Purixan (Mercaptopurine)
• Rubidomycin (Daunorubicin Hydrochloride)
• Sprycel (Dasatinin)
• Tarabine PFS (Cytarabine)
• Vincristine Sulfate
• Vincasar PFS (Vincristine Sulfate)
• Vincristine Sulfate Liposome

Drug Combinations used in Acute Lymphoblastic Leukemia (ALL) 

• Hyper-CVAD

Drugs approved for Chronic Lymphocytic Leukemia (CLL)

• Alemtuzumab
• Amblochlorin (Chlorambucil)
• Arzerra (Ofatumumab)
• Ofatumumab
• Bendamustine Hydrichloride
• Campath (Alemtuzumab)
• Chlorambucil
• Clafen (Cyclophosphamide)
• Cytoxan (Cyclophosphamide)
• Cyclophosphamide
• Fludara (Fludarabine Phosphate)
• Fludarabine Phosphate
• Gazyva (Obinutuzumab)
• Obinutuzumab
• Ibrutinib
• Idelalisib
• Imbruvica (Ibrutinib)
• Leukeran (Chlorambucil)
• Mechlorethamine Hydrochloride
• Mustargen (Mechlorethamine Hydrochloride)
• Linfolizin (Chlorambucil)
• Prednisone
• Rituxan (Rituximab)
• Zydelig (Idelalisib)
• Treanda (Bendamustine Hydrochloride)

Drug Combinations used in Chronic Lymphocytic Leukemia

• Chlorambucil-Prednisone
• CVP

Drugs approved for Acute Myelogeneous Leukemia (AML) 

• Arsenic Trioxide
• Cerubidine (Daunorubicin Hydrochloride)
• Daunorubicin Hydrochloride
• Clafen (Cyclophosphamide)
• Cyclophosphamide
• Cytarabine
• Cytosar-U (Cytarabine)
• Cytoxan (Cyclophosphamide)
• Doxorubicin Hydrochloride
• Idamycin (Idarubicin Hydrochloride)
• Idarubicin Hydrochloride
• Mitoxantrone Hydrochloride
• Neosar (Cyclophosphamide)
• Rubidomycin (Daunorubicin Hydrochloride)
• Tabloid (Thioguanine)
• Thioguanine
• Tarabine PFS (Cytarabine)
• Trisenox (Arsenic Trioxide)
• Vincristine Sulfate
• Vincasar PFS (Vincristine Sulfate)

Drug Combinations used in Chronic Myelogeneous Leukemia (CML) 

• ADE

Drugs approved for Chronic Myelogeneous Leukemia (CML) 

• Bosutinib
• Bosulif (Bosutinib)
• Busulfan
• Busulfex (Busulfan)
• Cyclophosphamide
• Clafen (Cyclophosphamide)
• Cytarabine
• Cytosar-U (Cytarabine)
• Cytoxan (Cyclophosphamide)
• Dasatinib
• Gleevec (Imatinib Mesylate)
• Iclusig (Ponatinib Hydrochloride)
• Imatinib Mesylate
• Mechlorethamine Hydrochloride
• Mustargen (Mechlorethamine Hydrochloride)
• Myleran (Busulfan)
• Neosar (Cyclophophamide)
• Nilotinib
• Tasigna (Nilotinib)
• Omacetaxine Mepesuccinate
• Synribo (Omacetaxine Mepesuccinate)
• Ponatinib Hydrochloride
• Sprycel (Dasatinin)
• Tarabine PFS (Cytarabine)

Drugs approved for Hairy cell Leukemia (HCL)

• Intron A (Recombinant Interferon Alfa-2b)
• Recombinant Interferon Alfa-2

Drugs approved for Meningeal Leukemia

• Cytarabine
• Cytosar-U (Cytarabine)
• Tarabine PFS (Cytarabine)