Leukemia: learn about the main symptoms, causes and treatments

Leukemia is one of the most common types of cancer in men and women, with 11 thousand new cases estimated between 2020 and 2022, according to data from Inca (National Cancer Institute). Early diagnosis is essential for successful treatment and, therefore, knowing the warning signs of this disease is very important.

This is the objective behind the campaign February Orange which seeks to raise awareness about leukemia and also about the importance of donating bone marrow for treatment.

Recently, the subject gained even more notoriety with the diagnosis of Fabiana Justus, who revealed that she had discovered acute myeloid leukemia, one of the most serious types of the disease.

Next, understand what leukemia is, its main symptoms, how it is diagnosed and why bone marrow donation plays a fundamental role in treatment.

What is leukemia?

Leukemia is a type of cancer that surrounds blood cells mainly white blood cells, but can also affect platelets and red blood cells.

“This cancer originates in the 'blood factory', which is the bone marrow. This 'factory' becomes ill and begins to produce a type of tumor cell that takes up space in the marrow, meaning that normal cells are not produced properly”, explains Roberto Magalhães, hematologist and technical responsible for the leukemia and bone marrow transplant service. from Icaraí Hospital.

There are different types of leukemia , which can be classified as acute (fast growth) or chronic (slow growth) and also by the type of cell affected by the cancer (lymphoid or myeloid). The main types of leukemia are:

• Acute lymphoid leukemia : more common in children and has rapid development;
• Chronic Lymphoid Leukemia : more common in adults, especially over 50 years of age, and their growth is slower;
• Acute Myeloid Leukemia : it is more common in adults and grows quickly;
• Chronic myeloid leukemia : characterized by excessive production of white blood cells, being more common in the elderly.

What are the causes of leukemia?

Yet There is no defined cause for leukemia , but genetic and environmental factors can influence the development of the disease. Like other types of cancer, leukemia arises due to mutations in DNA which can occur spontaneously or due to the influence of external factors, such as exposure to radiation or carcinogens.

“What we know is that mutations and genetic changes occur in the cells of the 'blood factory' itself. When we carry out a more refined investigation, we identify that some of these genetic changes come from family origins, while others are changes acquired throughout life”, explains Roberto.

Among the main external risk factors for the development of leukemia are smoking, exposure to benzene (found in gasoline), ionizing radiation (present in X-rays and gamma rays), chemotherapy and exposure to pesticides.

Main symptoms and warning signs

You leukemia symptoms occur due to the changes that the disease causes in the blood. “The fact that diseased cells occupy the bone marrow ends up interfering with the production of normal cells. Then, red blood cells begin to decrease and this causes anemia”, explains Phillip Bachour, hematologist at the Specialized Oncology Center at Hospital Alemão Oswaldo Cruz. Anemia leads to symptoms such as:

• Fatigue;
• Shortness of breathe;
• Palpitation;
• Headache;
• Weakness;
• Pallor.

Leukemia also interferes with platelet production, which can increase the chances of bleeding , as these cells are involved in the blood clotting process. “When they are too low, it is possible to notice frequent bruising, bleeding gums and the appearance of purple spots on the skin”, adds the hematologist.

Finally, the decrease in the production of white blood cells, responsible for immune defense, increases the risk of infections, which can quickly evolve into a serious condition. That's why, people with leukemia may have recurring infections .

When these symptoms begin to recur or have no identifiable cause, you need to seek medical help. “When there is unexplained anemia, an alteration in white blood cells with serious infections or low platelets in the blood test, with signs of bleeding, there is no doubt that, at this point, it is necessary to see a doctor”, emphasizes Roberto.

How is the diagnosis made?

The main exam that helps in diagnosis of leukemia is the complete blood count . When your result is altered, with a low number of platelets or the identification of blasts (diseased cells) in the blood, leukemia is suspected. In this case, the next step is to perform a bone marrow examination (myelogram ), in which one milliliter of spongy material is removed from inside the bone to examine the cells present in the region.

Once leukemia is confirmed, immunophenotyping is performed, an exam that evaluates the phenotype of diseased cells, that is, their characteristics, to understand the type of cancer present in the blood. “With it, we are able to tell what type of leukemia is, whether it is acute or chronic and what its subtype is. [linfoide ou mieloide]. Therefore, blood immunophenotyping is considered the gold standard for diagnosing leukemia”, says Roberto.

Leukemia treatments

O leukemia treatment varies depending on the type of cancer. Overall, the goal is to destroy the abnormal cells so that the marrow can produce healthy cells again. “Treatment can be carried out with chemotherapy alone or combined with targeted therapy, in some cases”, explains Phillip. Targeted therapy is a treatment that acts directly on tumor cells, causing little damage to normal cells. The treatment possibilities are:

• Acute lymphoid leukemia : induction of remission with chemotherapy, consolidation with previously unused chemotherapy drugs and maintenance (a milder, continuous treatment for several months);
• Acute Myeloid Leukemia : follows the same line as acute lymphoblastic leukemia, but the maintenance phase is only carried out in specific cases;
• Chronic Lymphoid Leukemia : treatment includes chemotherapy, monoclonal antibodies and oral medications;
• Acute Myeloid Leukemia : treatment is carried out with targeted therapy, which inhibits a protein called tyrosine kinase, which is involved in the development of this type of leukemia.

It is worth highlighting that acute leukemias require hospital admission , as they evolve quickly. “Acute leukemias undoubtedly represent a medical emergency. It is necessary for patients to be hospitalized in places with both diagnostic and treatment resources, with true multidisciplinary teams prepared to care for this disease”, highlights Roberto.

When is a bone marrow transplant necessary?

O Bone marrow transplant It is also a possible treatment for some specific cases. “When leukemia has a poor prognosis, that is, it has a high risk of serious complications, a bone marrow transplant is indicated, which can be halogenic. [feito a partir de células da medula de um doador] or autologous [células da medula do próprio transplantado]the latter being rarer”, replies Phillip.

Is leukemia curable?

Yes, the leukemia has a cure . The chances of successful treatment are greater when the diagnosis is made early. Therefore, carrying out routine exams is important to identify the disease in its early stage. “Most patients have a chance of cure. By improving the diagnosis and being able to receive ideal treatment as soon as possible, the patient's chances really increase”, says the hematologist.