What is Leukemia

 Leukemia is cancer of the body's blood-forming tissues, including the bone marrow
and the lymphatic system

Leukemia usually involves the

white blood cells
 White blood cells are potent
infection fighters — they normally
grow and divide in an orderly
way, as the body needs them
 But in people with leukemia,
the bone marrow produces
abnormal white blood cells,
which don't function properly

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 Incidence of Leukemia

 In 2010, globally, approximately

281,500 people died of leukemia

 Whereas, In 2012, leukemia developed

in 352,000 people globally and caused
265,000 deaths

 It is the most common type of cancer in

children

 Around 30 percent more men than

women have leukemia

 Leukemia occurs more commonly in

the developed world

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 Cause of Leukemia

 The exact cause of Leukemia is not known

 Different kinds of Leukemia are believed to have different causes

 No single causative agent

 Both inherited and environmental (non-inherited) factors are believed to be involved

 Risk factors include

 Smoking

 Ionizing Radiation

 Some chemicals (such as benzene, prior chemotherapy, radiation)

 Down syndrome

 People with a family history of leukemia are also at higher risk

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 Clinically and pathologically, leukemia is subdivided into a variety of large groups

Acute Leukemia Chronic Leukemia

Incidence Most common forms of leukemia in mostly occurs in older people, but can
children occur in any age group

Progression Rapid increase in the number of Typically taking months or years to

immature blood cells progress

Cells Crowding of immature Blood Cells Excessive build up of relatively

makes the bone marrow unable to mature, but still abnormal, white blood
produce healthy blood cells cells

Treatment Immediate treatment is required sometimes monitored for some time

before treatment to ensure maximum
effectiveness of therapy

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 Symptoms of Leukemia

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 Symptoms of Leukemia

Leukemia symptoms vary, depending on the type of leukemia. Common leukemia signs and
symptoms include:

 Fever or chills
 Persistent fatigue, weakness
 Frequent or severe infections
 Losing weight without trying
 Swollen lymph nodes, enlarged liver or spleen
 Easy bleeding or bruising
 Recurrent nosebleeds
 Tiny red spots in your skin (petechiae)
 Excessive sweating, especially at night
 Bone pain or tenderness

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 Diagnosis Tools

Laboratory Tests
A number of laboratory tests may be used to help diagnose leukemia, determine the type, and
monitor the effectiveness of treatment & recurrence of disease

 Blood tests:
 Complete blood count (CBC) and WBC differential
 To count the number, maturity, and proportion of
different types of cells
 These tests can provide the first evidence of leukemia
and they are often the first tests ordered to diagnose leukemia
 Important tools to monitor the effectiveness of treatment & to detect disease recurrence
 Blood smear:
 Used to follow up a CBC with abnormal white blood cells, red blood cells or platelets, or with
unclear results

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 Other tests:
 Bone marrow aspiration/biopsy
 Done when the health practitioner suspects leukemia
 Involves examination of the marrow sample
(bone and/or fluid) under the microscope
 Helps in evaluating the number, size, and appearance of
each of the cell types as well as the proportions of mature
and immature cells
 If leukemia is present, the type and severity of the disease
& response to treatment can be determined

 Spinal tap (lumbar puncture) and cerebrospinal fluid analysis

 Done to look for leukemia cells in the cerebrospinal fluid (CSF)
 If leukemic cells are seen in the CSF, additional treatment may be necessary

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 Immunophenotyping or phenotyping by flow cytometry
 Helps in diagnosis & classification of leukemia
 Cells from the blood, bone marrow, or lymph nodes are incubated with commercially
generated antibodies which selectively bind to antigens on the surface of leukemia cells or in their
cytoplasm. The antigens act like markers and are detected by flow cytometry

 Cytogenetic tests (FISH and karyotyping).:

 Cytogenetic tests look at chromosome structure and number
 Used to find abnormal chromosomes associated with leukemias, other cancers, and genetic
disorders
 They help diagnosis and differentiate leukemias

 Polymerase chain reaction (PCR):

 Help guide the type or intensity of treatment and/or determine prognosis of certain leukemias
 Might identify the target for therapy (targeted therapy) based on the genetic makeup of the
cancer cells. .

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 Non Laboratory Tests

 Computerized tomography (CT), Magnetic Resonance Imaging (MRI), Chest x-rays,

or Positron Emission Tomography (PET) scans are sometimes used to look for signs of
the disease (tumors and masses of cells) in areas such as the chest

 Other imaging scans, like ultrasound, may also be used to evaluate the status of
body organs such as the spleen, liver, and kidney

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 Treatment

 Specific treatment depends on the type of leukemia, severity, and symptoms

 The goals of treatment are
 to address the cell shortages that are causing symptoms
 induce remission
 if possible, kill all of the abnormal white blood cells, allowing normal cells to
develop and restore normal bone marrow function

 CHEMOTHERAPY
 Administration of drugs that kill rapidly dividing cells
 Chemotherapy may be taken orally in pill or tablet form,
or it may be delivered via a catheter or intravenous line
directly into the bloodstream

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 RADIOTHERAPY
 uses high energy radiation to target cancer cells
 used in the treatment of leukemia that has spread
to the brain, or it may be used to target the spleen or
other areas where Leukemia cells have accumulated

 BIOLOGICAL THERAPY
 Help the immune system recognize abnormal cells and then attack them
 Include antibodies, tumor vaccines, or cytokines
 Monoclonal antibodies are antibodies that react against a specific target

 TARGETED THERAPY
 Drugs that interfere with one specific property or
function of a cancer cell
 This means there is less damage to normal cells
 Targeted therapies are given in pill form or by injection
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  STEM CELL TRANSPLANT

 Procedure to replace the diseased bone marrow with healthy

bone marrow

 High doses of chemotherapy and/or radiation are given to

destroy leukemia cells along with normal bone marrow

 Then, transplant stem cells are delivered by an intravenous

infusion

 Stem cells travel to the bone marrow & begin producing new blood cells

 There are two main types of stem cell transplants:

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 Autologous
 More commonly done
Source of  Collected from the patient themselves
Stem Cells
Process  Stem cells are removed from the
patient's blood, harvested, frozen and
stored until needed
 Then given back to the patient after
he/she has received high dose
chemotherapy and/or radiation therapy to
destroy the cancer cells
Advantage  Lower incidence of infection
 No immmunosuppression required
 No HLA matching required
Disadvantage  Cannot be used in Genetic / Acquired
diseases where cells are injured
 Have higher risk of relapse
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Allogeneic
 Less commonly done
 Cells are taken from a matching donor
 Donors may include a relative/family
member (e.g., sibling), unrelated individual,
or saved umbilical cord blood
 The patient undergoes a human
leukocyte antigens (HLA) test - the patient’s
blood and tissue type with blood samples
from the donor are compared
 Stem cells come from a healthy donor
with no malignant cells
 Lower risk of relapse
 Difficult to find a matching donor
 Risk of Graft vs Host Disease
 Treatment related mortality is higher
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 Supportive Treatment

 Because many of the treatments for leukemia deplete normal blood cells, increasing the
risk for bleeding and infection, supportive treatments may be needed to help prevent
these complications of treatment

 It is also needed to help minimize and manage unpleasant side effects of medical or
radiation therapy

 Types of supportive and preventive treatments that can be used for patients undergoing
treatment for leukemia include the following:
-- Vaccines against the flu or pneumonia
-- Blood or platelet transfusions
-- Anti-nausea medications
-- Antibiotics or antiviral medications to treat or prevent infections
-- White blood cell growth factors to stimulate white blood cell production
-- Red cell growth factors to stimulate red blood cell production
-- Intravenous injections of Immunoglobulins to help fight infections

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 Complications of Leukemia

 Frequent infections, bleeding and GVHD (Graft vs Host Disease) in recipients of stem
cell transplants
 Weight loss and anemia
 Relapse or a progression of the disease after a remission
 3% to 5% of cases of CLL may transform into an aggressive lymphoma
 Autoimmune hemolytic anemia
 People with CLL are also more likely to develop second cancers and other blood
disorders and blood cancers

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  Tumor Lysis syndrome is a condition caused by the rapid death of cancer cells when
treated. The rapid destruction of the leukemia cells leads to the release of large
amounts of phosphate, which further causes metabolic abnormalities and can lead to
kidney failure

 Children who receive therapy for ALL may experience late adverse effects including
-- Central Nervous System (CNS) impairment
-- Slowing of growth
-- Infertility
-- Cataracts
-- Increased risk for other cancers

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 Prognosis

 The success of treatment depends on the type of leukemia and the age of the person
 Outcomes have improved in the developed world
 Outcomes depend on whether
-- it is acute, which is generally more severe, versus chronic
-- the specific abnormal white blood cell type
-- the stage of progression
-- the grade- degree of tissue abnormality;
-- the presence of proximal and/or distant metastasis / lymph node / bone
marrow infiltration
-- the availability of current therapies and the skills of the health care team

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Thank you