Acute leukemia
What is it?
Acute leukemias are a heterogeneous group of clonal disorders of hematopoietic stem cells, from which blood cells normally originate. In leukemias, these cells lose the ability to differentiate normally and to respond to proliferation regulatory factors. Leukemic cells are predominantly immature elements (blasts) that accumulate mainly in the bone marrow but can infiltrate all organs.
Acute leukemias are divided primarily into:
- myeloid (acute myeloid leukemia);
- lymphoid (acute lymphoblastic leukemia).
Acute myeloid leukemia (AML) is characterized by the accumulation of myeloid blasts in the bone marrow. Blasts usually invade peripheral blood, more rarely solid tissues. Myeloid sarcoma (MS) is a special form of AML that typically presents extramedullary, particularly in parenchymatous organs or skin, with a "solid" appearance; MS can precede the onset of typical AML by as much as several months and is treated as such.
Acute lymphoblastic leukemia (ALL) is characterized by the accumulation of lymphoid blasts in the bone marrow that can invade peripheral blood and also localize to other organs, including the central nervous system and testes.
Causes and risk factors
The most common symptoms of AML are:
- asthenia
- paleness
- infections
- skin and mucosal bleeding
- fever
- weight loss
- sweating
- bone pain
- neurological signs
- signs of skin and mucosal infiltration
In cases with hyperleukocytosis, symptoms referable to a slowing of microcirculation such as visual disturbances, headache, and neurological symptoms are common.
The symptoms of ALL depend on anemia, infection, and bleeding in the skin and mucous membranes or internal organs. Fever, weight loss, serotonous sweating, bone pain may also be present in this case. The patient may present with lymphadenomegaly and hepato-splenomegaly (enlarged liver and spleen), meningeal and testicular infiltration.
Which are the symptoms?
Prolonged contact with chemicals (e.g., pesticides) and solvents (benzene), previous chemotherapy, exposure to ionizing radiation, and cigarette smoking are all factors associated with increased risk. In most cases, however, no known cause and/or risk factor is recognizable.
How is it diagnosed?
The initial diagnostic approach for all the diseases we focus on involves analyzing peripheral blood and bone marrow samples from various perspectives, including morphology, immunophenotyping, cytochemistry, cytogenetics, and molecular biology. Additionally, any suspected extramedullary disease locations are examined using imaging techniques such as radiology and nuclear medicine, based on clinical indications.
How is it treated?
The therapy of AML and ALL is predominantly medical and involves the administration of chemotherapy drugs in combination or not with new drugs with mechanisms aimed at molecular or antigenic targets. Depending on the patient's prognostic risk, age, and general condition, after initial treatment aimed at achieving disease remission, consolidation with allogeneic, family donor or registry transplantation may be proposed. All patients are offered enrollment in a clinical research protocol when available based on the characteristics of the disease and the patient. Patients who are older and/or ineligible for intensive treatment and transplantation are offered a pattern of continued therapy in monthly cycles with new drugs administered on an outpatient basis.
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