What is Leukemia?

What is leukemia and is it curable?

What is leukemia and is it curable?

It is very difficult to define the term leukemia unequivocally. Leukemia is a very broad and complex group of diseases of the hematopoietic system, which should be first divided into two subgroups: acute and chronic. Acute leukemias essentially arise from two cell lines: myeloid (non-lymphoblastic acute myeloid leukemias) and lymphoid (acute lymphoblastic leukemias). In recent years, the division of the various subtypes of acute myeloid leukemias is based mainly on common cytogenetic and molecular disorders, and somewhat less on the morphological and cytochemical properties of the cells. The situation is similar with acute lymphoblastic leukemias, where the basis for the differentiation of individual subtypes is primarily immunophenotypic and cytogenetic testing, and only secondarily the morphology of lymphoblasts. Acute leukemias are malignant neoplasms of the white blood cell system characterized by the presence of a clone of transformed cells derived from very early stages of development (myeloblasts and lymphoblasts). These cells usually dominate the bone marrow, peripheral blood, and form infiltrates in various organs. Chronic leukemias, on the other hand, are usually characterized by a much slower course. There are two main proliferative neoplasms in this group – chronic myeloid leukemia-CML and chronic lymphocytic leukemia-CLL. Chronic myeloid leukemia is a clonal proliferative disease of the marrow stem cell caused by the translocation of genetic material between chromosomes 9 and 22 and the appearance of the bcr-abl fusion gene (Philadelphia Ph chromosome). Chronic lymphocytic leukemia is a kind of accumulative disease characterized by the presence of monoclonal, morphologically mature lymphocytes in the peripheral blood, bone marrow and lymphoid organs. The type of leukemia, the age and general condition of the patient as well as the efficiency of vital organs determine the therapeutic procedure. Among patients with acute proliferative diseases of the haematopoietic system, the optimal treatment is intensive cytostatic therapy, including high-dose chemotherapy supported by haematopoietic stem cell transplantation (auto- or allogeneic bone marrow transplant). Such therapeutic procedure allows us to obtain a complete recovery of patients. Patients with chronic myeloid leukemia benefit most from treatment with bcr-abl tyrosine kinase inhibitors (the so-called targeted therapy aimed at eliminating cells with Ph chromosome present), which allows for very deep and long-lasting remission of the disease. On the other hand, in chronic lymphocytic leukemia – a disease typical of elderly patients – the therapeutic procedure is not aimed at full eradication of a clone of neoplastic lymphocytes, but only with the participation of intracorporeal immune surveillance.

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