What is Leukemia (Blood Cancer)?

Leukemia , which is known as one of the types of blood cancer in the society, is when one of the stem cells, which originates from the bone marrow and produces blood, stops at one stage of its development and begins to multiply uncontrollably, due to the combination of various factors. Leukemia (blood cancer),  also known as leukemia, first takes over the bone marrow and then all the organs. Blood cancer, which affects the bone marrow and lymphatic system, which is the blood production system of the body,   is one of the malignant cancers with a progressive course if not treated. Leukemia; If it occurs due to the uncontrolled increase of mature white blood cells, it has a chronic and slow course. Those that develop due to the uncontrolled increase in immature white blood cells are defined as acute, that is, with a rapid course. Rapidly progressing blood cancers often show sudden onset and give clinical signs and symptoms, especially within 1-2 months. Therefore, a diagnosis should be made as soon as possible and treatment should be started as soon as possible.

​Although the exact cause of leukemia is not known, it is known that exposure to chemicals such as radiation, benzene and pesticides increases the risk of leukemia. Leukemia, one of the most well-known blood cancers, can be successfully treated thanks to targeted smart drugs as well as patient-specific stem cell transplant options.

What are the types of Leukemia (Blood Cancer)?

Leukemia is evaluated in two groups as acute (sudden onset, rapidly progressing) and chronic (slow progressing, chronic). Acute leukemias  are also divided into acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML). Chronic leukemias are also divided into subgroups as Chronic Lymphocytic Leukemia (CLL) and Chronic Myeloid Leukemia (CML).

Among the types of leukemia, acute leukemias  are an extremely aggressive and rapidly progressive disease. If acute leukemia is not diagnosed and treated on time, it may cause the patient to die within days or weeks. Chronic leukemia, on the other hand, can remain silent for a long time with a very slow course and may progress over the years.

What is acute Leukemia?

The incidence of acute leukemia  among  blood cancers is 15-20%. Acute leukemia is the most common type of cancer in children, and it progresses very rapidly. The incidence of acute leukemia, which can be seen at any age, increases with advancing age. Acute leukemia, which manifests itself in a very short time with its signs and symptoms,   occurs as a result of uncontrolled and rapid proliferation of stem cells in the bone marrow, which are responsible for the production of blood cells, by becoming cancerous. In acute leukemia, cancer cells spread very rapidly, first to the bone marrow and then to the whole body. acute leukemia Since white blood cells called leukocytes cannot be produced in patients, severe infections can be seen frequently. Since thrombocyte cells, which are responsible for blood coagulation, cannot be produced, skin bleeding, bleeding from the gastrointestinal tract or severe bleeding in vital organs may be encountered. Anemia, which is the biggest symptom in acute leukemia  , is one of the most easily noticed by patients. In addition, since it spreads to other organs in the body, it can appear as a disorder in any organ. 

Acute leukemia  is divided into two main groups as acute myeloblastic leukemia (AML) and acute lymphoblastic leukemia (ALL), which have many subtypes. Early diagnosis, typing and initiation of treatment is very important against these types of tumors, each of which progresses very rapidly. When symptoms are seen, diagnosis should be made by specialist doctors in specialist oncology centers and appropriate treatment should be planned.

What is chronic Leukemia?

Chronic leukemia  is a type of leukemia that progresses more slowly than acute leukemia. But chronic leukemia  gives better results. There are two basic subgroups of chronic leukemia, which is caused by the failure of mature cells to perform their duties and abnormal proliferation, as chronic lymphocytic leukemia (CLL) and chronic myelocytic leukemia (CML).  

What is lymphocytic Leukemia?

Lymphocytic Leukemia  (CLL) occurs when leukemic cells, which resemble mature normal lymphocytes and protect the body against infections, but fail to function, proliferate in the bone marrow. CLL cells settle in the bone marrow, lymph nodes and blood, resulting in swelling of the lymph nodes and enlargement of the spleen. CLL, which is mostly seen in the 60-70 age range, constitutes 30% of all leukemias. Because the disease progresses very slowly, patients can live for a long time without being diagnosed. After diagnosis, some patients do not need treatment unless CLL causes a problem. The diagnosis of CLL is made by detecting a genetic change specific to the disease with special methods. Chemotherapy and bone marrow transplant in the past. This disease, which is difficult to treat, can be treated very simply today.

What causes Leukemia?

Although the exact cause of leukemia is unknown, scientists think that viral, genetic, environmental or immunological factors play a role. 

Some of these are those;

• Exposure to high levels of radiation

• Exposure to industrial chemicals such as benzene and formaldehyde

• Some of the chemotherapy drugs

• Some genetic diseases (down syndrome, etc.)

• viruses 

However, these risk factors account for a very small proportion of leukemia. No risk factors could be demonstrated in the majority of patients with leukemia.

​Other causes of leukemia;

• Long hours of use of technological devices such as tablets and mobile phones by children

• Air pollution

• Additives in foodstuffs

• Chemicals

• Rotten food

What are the symptoms of Leukemia?

Symptoms of leukemia vary depending on the type. Symptoms of blood cancer may have common features with some findings observed in other blood cancers. Due to anemia;

• Paleness,

• Weakness,

• Don't get tired quickly,

• Symptoms such as shortness of breath are observed during exertion.

Symptoms of leukemia (blood cancer) include unexpected bleeding, bruising, and red rashes the size of a pinhead, which do not fade with pressure, as a result of infections that develop due to weakened immune system.

In acute leukemia symptoms, these findings draw attention;

• paleness, fatigue,

• loss of appetite, weight loss,

• night sweats,

• Frequent recurrent fever, infections that cannot be controlled with appropriate treatment,

• bone pain,

• Bleeding under the skin (red rashes as small as a pinhead, easy bruising)

• Nose and gum bleeding, neck and armpit lymph nodes, swelling in the abdomen, swelling in the gums.

The symptoms of blood cancer can be the same as the symptoms of many diseases. Leukemia, which can spread to all organs of the body, may have symptoms similar to those of rheumatic diseases, infectious diseases, hemorrhagic diseases, lymphoma, myeloma and other blood cancers.

What are the symptoms of Leukemia in children?

Considering all childhood cancers, approximately 30 percent of them appear to be leukemia. Childhood cancers and leukemia are frequently seen between the ages of 2-5 or 5-10 years. Although leukemia in children has very extensive clinical findings, some symptoms should be suspected. We can list them as follows;

• rapid weight loss

• Anorexiapale in color

• Long-term persistence or gradual growth of bruises or unexpected glands on the body

• swelling in the abdomen

• joint pains

• Persistent fever that lasts longer than 5 days

Newborn babies can maintain the immune system received from the mother for 6-8 months. Afterwards, it establishes its own immune system until the age of 2. Up to this period, it can be infected 5 times a year. It should not be forgotten that viral infections can trigger leukemia cancers.

One of the causes of leukemia in children is vitamin D deficiency. There are many studies showing that rickets seen at an early age and the resulting vitamin D deficiency are effective on cancer. For this reason, it is very important for children to see the sun in suitable weather conditions and at the hours recommended by the experts. The importance of genetic factors in leukemia should not be overlooked.

How is Leukemia diagnosed? What are the diagnostic methods?

Early diagnosis is very important in leukemia. Leukemia, which affects the reproduction and function of blood cells, matures the cells in the bone marrow and transforms them into erythrocytes, leukocytes or platelets. In leukemia, leukemic cells (blasts) multiply uncontrollably and suppress the development of normal blood cells. Blood and bone marrow tissue samples are taken and examined for diagnosis in line with serious complaints such as infection and bleeding caused by the inability to produce blood. Usually, a simple blood count and examination of blood cells under a microscope are sufficient for diagnosis. However, the definitive diagnosis is made by bone marrow biopsy.​

Acute leukemias constitute approximately 95% of leukemias. 85% of acute leukemias are acute lymphoblastic and 15% are myeloblastic leukemia. Among these, a more positive response is received in terms of treatment for acute lymphoblastic leukemias. Early diagnosis and treatment are of great importance because the life expectancy is longer in children and the success rates are higher compared to adult cancers. 

In order to diagnose leukemia (blood cancer), the patient's history should be listened to. In addition to the examination, it is necessary to carry out examinations with advanced diagnostic methods. 

Medical Examination:

A good physical examination should be made first of all for the person who is suspected of leukemia (blood cancer).​

Appropriate blood studies:

Blood count and necessary biochemical studies​

Bone marrow biopsy:

Bone marrow taken from the hip bone should be examined. Bone marrow biopsy and pathological examination of bone marrow fluid spread on glass.​

Genetic studies:

Genetic studies of leukemia cells from bone marrow or blood samples

How is acute Leukemia diagnosed? 

It is not difficult to diagnose acute leukemia. Acute leukemia can be diagnosed with a simple complete blood count. In complete blood count; The diagnosis of leukemia can be easily made by detecting a decrease in the number of normal blood cells and an increase in the number of cancer cells called “blasts”. With the biopsy taken from the bone marrow, it can be seen that the bone marrow is taken up by the cancer cells. The difficult part in the diagnosis of leukemia is to determine the type of cancer. The “immune phenotypic” method can distinguish between different types of acute leukemia with various cytogenetic and molecular tests.​

Determining the subtype of leukemia is very important as it directly concerns the treatment process. Because there are different treatment methods for all subtypes of leukemia. If the patient has been diagnosed with acute leukemia, risk situations are tried to be determined. When diagnosed with acute leukemia in adults, it is known that more than 70-80% of patients fall into the high-risk group. This means that even if the leukemia is brought under control, it can recur in a very short time.

How is Leukemia treated?

The treatment of leukemia concerns many disciplines. It is treated by adult and pediatric hematology specialists in fully equipped hospitals. It is necessary to have an oncology center where leukemia is treated, a well-trained nurse team for chemotherapy administration, a 24-hour blood bank, an infectious diseases specialist, a radiation oncologist and a sophisticated laboratory infrastructure in order to provide radiation therapy when necessary. 

Leukemia is a treatable disease, and the success rate of treatment is increasing day by day with many new methods discovered in recent years. The discovery of new chemotherapeutic agents, targeted molecular drugs and biological drug treatments to daily use, the development of advanced radiotherapy devices, developments related to bone marrow transplantation have led to great strides in prolonging the life span of patients and in the complete treatment of the disease.​

The first treatment method that comes to mind for the treatment of leukemia is chemotherapy. The type, dose and route of administration of chemotherapy drugs may differ according to the type of leukemia. Bone transplantation is another method that comes to mind in the treatment of some types of leukemia. The success rates achieved in the treatment of leukemia in our country are at world standards with both chemotherapy and bone marrow transplantation.

Chronic myeloid leukemias have been largely curable since 2000. Since the disease is well known, drugs that disrupt the mechanism are used. With this treatment, which is called targeted therapy, it prevents myeloid cells that are constantly multiplying in the bone marrow from immature or maturing into the blood. In patients who cannot be controlled with drugs, the most effective treatment method is “allogeneic stem cell transplantation”. Stem cell transplantation is performed with the help of stem cells taken from a tissue compatible sibling, close relative or unrelated volunteer donor. Only supportive treatments are given in the early stages for chronic lymphocytic leukemia (CLL), a type of slowly progressing leukemia. Medications or targeted antibodies (immunotherapy) may be administered in advanced stages or high-risk patients. chronic lymphocytic leukemia, Although it is a disease of advanced age, it can also be seen before the age of 50. Allogeneic stem cell transplantation is one of the treatment options in these high-risk patients.

What you need to know about Leukemia

• Leukemia is more common in men than women.

• It is more common in the white race than in the black and yellow race.

• The incidence of leukemia diagnosis in adults is more than 10 times that of children, and the risk increases with age.

• Childhood leukemia is more common under 4 years of age.

• Genetic predisposition is important in some leukemias.

• It is known that acute leukemia types are more common in genetic diseases such as Down syndrome.

• Exposure to chemicals such as radiation and benzene can also be mentioned in the formation of CML.

• Being treated with chemotherapy for another cancer, smoking and the presence of certain blood diseases are also shown among the causes of leukemia.

• In the United States, 1 person is diagnosed with blood cancer every 4 minutes.

• In 2016, the number of patients newly diagnosed with leukemia was 60 thousand in the USA alone.

• Acute leukemia is the most common type of cancer in childhood with a rate of 35%.

• The probability of a woman or man being diagnosed with leukemia in their entire lifetime is estimated at 1.5%.

• Today, the rate of survival of patients diagnosed with leukemia longer than 10 years has increased 4 times compared to the 70s.

• Between 2006 and 2012, the 5-year survival rate of leukemia patients was 60%.

• 8 out of 10 children diagnosed with leukemia can be cured completely.

What is acute lymphoblastic Leukemia?

Acute lymphoblastic leukemia (ALL) is a type of cancer that affects the blood and bone marrow. It progresses quickly and aggressively and requires immediate treatment. ALL is characterized by an overproduction of immature white blood cells called lymphoblasts or leukemic blasts. Bone marrow produces stem cells that have the ability to develop into three important types of blood cells: red blood cells, white blood cells, and platelets. The bone marrow does not usually release stem cells into the blood until they become fully developed blood cells. However, in acute lymphoblastic leukemia, large numbers of white blood cells are released before they are ready. These are known as blast cells. As the number of blast cells increases, the number of red blood cells and platelet cells decreases. Bone marrow sufficient number of red blood cells, Because they cannot produce normal white blood cells and platelets, people with ALL become more susceptible to anemia, recurrent infections, and bruising and bleeding easily. The blast cells can then spill from the bone marrow into the bloodstream and accumulate in various organs, including the lymph nodes (glands), spleen, liver, and central nervous system (brain and spinal cord). 

ALL can occur at any age, but is more common in young children (0-14 years), accounting for about 60 percent of all cases. ALL is the most common type of childhood leukemia and the most common childhood cancer. Boys are slightly more affected than girls. With treatment these days, most children with ALL improve, while cure rates in adults are more variable.

FREQUENTLY ASKED QUESTIONS ABOUT LEUKEMIA