By – Dr. Kumardeep Dutta Choudhary, Sr. Consultant & Unit Head Department of Medical Oncology, Action Cancer Hospital
Leukemia or blood cancers are classified into acute and chronic leukemia’s. Acute leukemia’s are acute lymphoblastic leukemia or ALL and acute myeloid leukemia or AML, whereas chronic leukemia’s are chronic lymphocytic leukemia or CLL and chronic myeloid leukemia or CML. Leukemias are heterogeneous hematologic disease characterized by the proliferation of immature blood cells in the bone marrow, peripheral blood and other organs. ALL is the commonest form of childhood acute leukemia whereas AML is more common amongst adults, Chronic leukemias are also more common in adults and the median age of onset is in the 6th decade.
Risk factors for developing leukemias are old age, exposure to radiation, chemotherapy, petrochemicals, solvents such as benzene, pesticides, ionizing radiation or genetic conditions like Down syndrome, Li-Fraumeni syndrome, neurofibromatosis, Klinefelter syndrome etc.
Common symptoms of leukemias are weakness, fatigue, anemia, gum swelling, organomegaly (liver, spleen), abdominal fullness, bleeding from gum, nose, intestine (melaena), breathlessness, weight loss, fever etc.
The cure rates and survival outcomes for patients with leukemias have improved dramatically over the past few years, particularly amongst children. Improvement is largely owed to advancement in the understanding of molecular genetics and refinement of risk adapted approach in treatment, advent of newer drugs and the use of allogenic hematopoietic stem cell transplant (bone marrow transplant).
In CLL we may adopt an approach of wait and watch in the indolent phase of disease whereas in aggressive phase we may treat with multi-agent chemotherapy. CML patients are treated with oral tablets known as Tyrosine kinase inhibitors and they usually live a long life. Acute leukemias are treated with multiagent chemotherapy followed by bone marrow transplant on remission.