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General Practice 2023

Acute leukemia: what é, symptoms and treatment

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Acute leukemia: what é, symptoms and treatment
Acute leukemia: what é, symptoms and treatment

Acute leukemia is a blood disorder that occurs due to changes in the bone marrow, which starts releasing poorly mature white blood cells into the bloodstream, and a large amount of immature cells is also identified in the bone marrow. According to the type of white blood cell affected, that is, the cell lineage affected, acute leukemia can be classified as myeloid or lymphoid, which can be differentiated through laboratory tests.

Acute leukemia is more common in children and young adults and is characterized by the presence of more than 20% of blasts in the blood, which are young blood cells, and by the leukemic gap, which corresponds to the absence of intermediate cells between mature blasts and neutrophils.

Treatment of acute leukemia is done through blood transfusions and chemotherapy in a hospital environment until clinical and laboratory signs related to leukemia are no longer detected.

Types of acute leukemia

Acute leukemia can be classified into two main types according to the type of cell that is affected:

  • Acute myeloid leukemia (AML), in which cells of the myeloid lineage, which is the lineage responsible for giving rise to leukocytes, among other blood cells. This type of leukemia can be classified into some subtypes according to the immature cells circulating in the blood and bone marrow characteristics;
  • Acute lymphocytic leukemia (ALL), in which cells of the lymphoid lineage are affected, resulting in the appearance of immature lymphocytes in the bloodstream.

It is important that the type of acute leukemia is identified so that the best treatment can be started soon afterwards, preventing the development of complications and increasing the chances of cure.

Symptoms of acute leukemia

The main characteristic of this type of leukemia is the rapid development, so that the symptoms can appear and evolve in a short space of time, the main ones being:

  • Weakness, tiredness and indisposition;
  • Bleeding from the nose and/or purple spots on the skin;
  • Increased menstrual flow and tendency to nosebleeds;
  • Fever, night sweats and weight loss for no apparent reason;
  • Bone pain, cough and headache.

In the presence of these signs and symptoms, it is important that the doctor is consulted so that tests are carried out to help confirm the cancer, identify the type and, thus, initiate the most appropriate treatment.

Causes of acute leukemia

Acute leukemia occurs as a result of changes in the bone marrow, which result in the release of immature cells into the bloodstream, which may be lymphoid or myeloid lineage.

The alterations in the bone marrow that result in leukemia are related to genetics, and alterations in the FLT-3, NPM1, IDH and PML-RARA genes can be identified in the case of acute myeloid leukemia, for example. The genetic cause of acute lymphocytic leukemia is still not well understood, however it seems to be related to DNA changes caused by exposure to radiation, previous chemotherapy treatment or genetic diseases.

Furthermore, AML-related mutations can also be favored by the use of immunosuppressive drugs, genetic diseases, radiation exposure and chemotherapy, for example.

How the diagnosis is made

The diagnosis of acute leukemia must be made by the doctor from the initial assessment of the signs and symptoms presented, and it is also important that tests are carried out to assess the general he alth of the person, as well as to check for any signs of leukemia. Thus, the main tests that may be indicated in case of suspected leukemia are:

  • Complete blood count, which indicates leukocytosis, thrombocytopenia and the presence of several young cells (blasts), either myeloid or lymphoid lineage;
  • Biochemical tests, such as uric acid and LDH levels, which are usually increased due to the increased presence of blasts in the blood;
  • Coagulogram, in which fibrinogen production, D-dimer and prothrombin time are verified;
  • Myelogram, in which the characteristics of the bone marrow are verified.

In addition to these tests, the hematologist may also request mutation research using molecular techniques, such as NPM1, CEBPA or FLT3-ITD, in order to indicate the best form of treatment.

Treatment for acute leukemia

Treatment for acute leukemia is defined by the hematologist and/or oncologist according to symptoms, test results, age of the person, presence of infections, risk of metastasis and recurrence. Treatment time may vary, with symptoms starting to decrease after 1 to 2 months of starting multidrug therapy, for example, and treatment may last about 3 years.

Treatment for acute myeloid leukemia can be done through chemotherapy, which is a combination of drugs, platelet transfusion and the use of antibiotics to reduce the risk of infections, as the immune system is compromised. Regarding the treatment for acute lymphocytic leukemia, it can be done through multidrug therapy, which is done with high doses of drugs to eliminate the possible risk of the disease reaching the central nervous system.

If the disease recurs, bone marrow transplantation can be chosen because, in this case, not everyone benefits from chemotherapy. Understand when bone marrow transplantation is indicated.

Is acute leukemia curable?

Cure in leukemia refers to the absence of signs and symptoms characteristic of leukemia within 10 years after the end of treatment, without relapses.

In relation to acute myeloid leukemia, cure is possible, due to several treatment options, however, with advancing age, curing or controlling the disease may be more difficult; the younger the person, the greater the chance of cure.

In the case of acute lymphocytic leukemia, the possibility of cure is greater in children, about 90%, and 50% of cure in adults up to 60 years of age, however, to increase the chances of cure and avoid recurrence of the disease, it is important that it is discovered as soon as possible and the treatment started soon after.

Even after starting treatment, the person should undergo periodic examinations to check whether or not there is a recurrence and, if there is, resume treatment immediately so that the chances of complete remission of the disease are greater.

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