Leukemia: Symptoms, Treatments, and Life Expectancy.

Leukemia means a shape the cancer you sang. We distinguish leukemia chronic, lymphoid leukemia, acute leukemia, myeloid. Depending on the form of leukaemia, symptoms different. In question, a genetic anomaly which affects the bone marrow and blood. What causes leukemia? What are the signs? Which is life expectancy with leukemia?

Definition: what is leukemia?

Leukemia is a form of cancer you sang. It is manifested by the proliferation of young cells in the bone marrow and blood. “In general, these are young, immature cells, which do not yet know how to do anything. They should normally have matured and become adults, differentiated into normal red blood cells, platelets and white blood cells, and thus ensured the transport of oxygen, coagulation and the defense of our body against microbes… But blocked at this stage of immaturity, they do not perform these functions, invade the bone marrow, block it and prevent it from creating normal, functioning blood cells”explains Professor Paul Coppo, hematologist at Saint-Antoine Hospital (Paris).

Who can get leukemia?

The disease can occur at any age, but we observe two peaks: during childhood and after 60.

What are the different forms of leukemia?

There are several forms of leukemia, depending on the degree of maturity of the abnormal cells, and the molecular abnormalities.

► The acute leukemia evolves very quickly, and its complications can be very quickly dangerous. This is a medical emergency, requiring the patient to be hospitalized quickly.

► There are other forms of leukemia, such as chronic leukemias, which are found in adults only. In this case, the malignant cells are generally well differentiated and the symptoms appear late, less noisily.

► The leukemia is called myeloid (or myeloblastic) or lymphoid (lymphoblastic) depending on the level of blocking of differentiation of the leukemic cell. They are two very different types of leukemia. In children, the majority of leukemias are of the lymphoblastic type, whereas in adults, leukemias are mainly myeloblastic.

► Lymphoid leukemia

► Leukemia in the child

What causes leukemia?

Leukemia is caused by occurrence of genetic abnormalities that disrupt bone marrow cells, called stem cells. These cells are normally the source of blood cells which must perform essential functions (transport oxygen, coagulate, defend the body against microbes). These genetic abnormalities prevent the stem cell from growing and generate mature blood cells. “Ces genetic abnormalities are not linked to heredity : these are abnormalities acquired during life”, says Professor Coppo. On the other hand, certain constitutional genetic pathologies (trisomy 21 and Fanconi’s disease for example) can promote the occurrence of acute leukemia. “In adults, the occurrence of leukemia can be favored by a occupational exposure to chemicals such as benzene, found in solvents, glues, paints…”. A chemotherapy for cancer can, sometimes years later, also promote the onset of leukaemia.

What are the first symptoms of leukemia?

Leukemia is accompanied, in its first phase, by fever, recurrent infections (pneumonia, bronchitis, persistent angina despite antibiotics, etc.), fatigue linked to anemia, weight loss. Blood clotting hurting, bruising or bleeding abnormal may appear. Patients may present with lymph nodes, skin involvement and even cerebral.

“In general, the patient goes to his doctor when the first symptoms arise and that is where the disease is diagnosed, on a blood test“, says Professor Coppo. Diagnosis is made by performing a complete blood count, NFS, showing, depending on the type of leukemia, a decrease or an increase in the number of white blood cells, a decrease in red blood cells and platelets. A bone marrow examination (myelogram) helps confirm the diagnosis and type of leukemia by analyzing bone marrow cells. These cells are taken under local anesthesia from the sternum or the iliac bone. A genetic and molecular analysis of leukemic cells makes it possible to better specify the type of leukemia and its prognosis.

What are the treatments for leukemia?

“After the diagnosis, the patient is quickly admitted to hospital in a blood disease ward. The hospitalization is done in a sterile sector in order to avoid any infection while waiting for the normal white blood cells to reappear after the treatment.

► Chemotherapy is then administered intravenously. It aims to destroy young and diseased cells that proliferate in the bone marrow and blood. “We then wait a few weeks, usually four to six weeks, for the production of healthy cells to resume.” Throughout this period, the patient is weakened because he has very few normal blood cells.. It is monitored several times a day in order to quickly diagnose an infection which would require antibiotics. It also requires blood transfusions.

► This treatment can subsequently be combined with a bone marrow transplant. “The donor can be a sibling, or someone on the bone marrow donor registry. More recently, marrow transplant techniques have improved, and even relatives can sometimes donate their marrow.” “Without treatment, the course of acute leukemia is rapidly fatal : the leukemic cells invade all the bone marrow, the blood, then most of the organs”ajoute Paul Coppo.

What is the life expectancy with leukemia?

► In childrenleukemia often has a good prognosis: more than 80% of children with acute lymphoblastic leukemia are cured permanentlyand less than 20% relapse.

► In adults, the results are less satisfactory: a very small number of leukemias has a good prognosis. Treatments are heavier, have side effects, and relapses are more frequent than in children. “While there is still a lot of progress to be made to improve the management of leukemia, recent strategies or those under development bring immense hope. In recent years, new therapeutic strategies helped to improve the historically poor results. These consist of using therapeutic antibodies capable of specifically targeting leukemic cells in order to bring them closer to our cells of the immune system, and to destroy them (technique of so-called bispecific antibodies). We are also now able to better “arm” our immune system so that it destroys diseased cells more effectively (a technique known as CAR-t cells). Finally, small molecules have been developed so that they can specifically inhibit proteins responsible for leukemia (so-called targeted therapies), says Professor Coppo. “Patients die most often because they become unable to fight off infections that can be devastating..” Death may also be related to severe bleeding.

Thanks to Pr Paul Coppo, hematologist at Saint-Antoine Hospital (Paris).