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General classification[ edit ] Clinically and pathologically, leukemia is subdivided into a variety of large groups. The first division is between its acute and chronic forms: Acute leukemia is characterized by a rapid increase in the number of immature blood cells. The crowding that results from such cells makes the bone marrow unable to produce healthy blood cells. Immediate treatment is required in acute leukemia because of the rapid progression and accumulation of the malignant cells , which then spill over into the bloodstream and spread to other organs of the body. Acute forms of leukemia are the most common forms of leukemia in children. Chronic leukemia is characterized by the excessive buildup of relatively mature, but still abnormal, white blood cells. Typically taking months or years to progress, the cells are produced at a much higher rate than normal, resulting in many abnormal white blood cells. Whereas acute leukemia must be treated immediately, chronic forms are sometimes monitored for some time before treatment to ensure maximum effectiveness of therapy. Chronic leukemia mostly occurs in older people, but can occur in any age group. Additionally, the diseases are subdivided according to which kind of blood cell is affected. This divides leukemias into lymphoblastic or lymphocytic leukemias and myeloid or myelogenous leukemias: In lymphoblastic or lymphocytic leukemias , the cancerous change takes place in a type of marrow cell that normally goes on to form lymphocytes , which are infection-fighting immune system cells. In myeloid or myelogenous leukemias , the cancerous change takes place in a type of marrow cell that normally goes on to form red blood cells , some other types of white cells, and platelets. Combining these two classifications provides a total of four main categories. Within each of these main categories, there are typically several subcategories. Finally, some rarer types are usually considered to be outside of this classification scheme. Acute lymphoblastic leukemia ALL is the most common type of leukemia in young children. It also affects adults, especially those 65 and older. Standard treatments involve chemotherapy and radiotherapy. The survival rates vary by age: Chronic lymphocytic leukemia CLL most often affects adults over the age of It sometimes occurs in younger adults, but it almost never affects children. Two-thirds of affected people are men. One subtype is B-cell prolymphocytic leukemia , a more aggressive disease. Acute myelogenous leukemia AML occurs more commonly in adults than in children, and more commonly in men than women. It is treated with chemotherapy. Chronic myelogenous leukemia CML occurs mainly in adults; a very small number of children also develop this disease. Hairy cell leukemia HCL is sometimes considered a subset of chronic lymphocytic leukemia, but does not fit neatly into this category. No cases in children have been reported. HCL is incurable but easily treatable. It is difficult to treat, and the median survival is measured in months. Large granular lymphocytic leukemia may involve either T-cells or NK cells ; like hairy cell leukemia, which involves solely B cells, it is a rare and indolent not aggressive leukemia. Instead, HTLV "immortalizes" the infected T-cells, giving them the ability to proliferate abnormally. They may be pre-cancerous or cancerous. Clonal eosinophilias involve a "clone" of eosinophils, i. This means people with leukemia may easily become bruised , bleed excessively, or develop pinprick bleeds petechiae. White blood cells , which are involved in fighting pathogens , may be suppressed or dysfunctional. This could cause the patient's immune system to be unable to fight off a simple infection or to start attacking other body cells. Because leukemia prevents the immune system from working normally, some patients experience frequent infection , ranging from infected tonsils , sores in the mouth , or diarrhea to life-threatening pneumonia or opportunistic infections. Finally, the red blood cell deficiency leads to anemia , which may cause dyspnea and pallor. Some patients experience other symptoms, such as feeling sick , having fevers, chills, night sweats, feeling fatigued and other flu-like symptoms. Some patients experience nausea or a feeling of fullness due to an enlarged liver and spleen ; this can result in unintentional weight loss. Blasts affected by the disease may come together and become swollen in the liver or in the lymph nodes causing pain and leading to nausea. Uncommon neurological symptoms like migraines , seizures , or coma can occur as a result of brain stem pressure. All symptoms associated with leukemia can be attributed to other diseases. Consequently, leukemia is always diagnosed through medical tests. The word leukemia, which means 'white blood', is derived from the characteristic high white blood cell count that presents in most afflicted patients before treatment. The high number of white blood cells are apparent when a blood sample is viewed under a microscope , with the extra white blood cells frequently being immature or dysfunctional. The excessive number of cells can also interfere with the level of other cells, causing further harmful imbalance in the blood count. Some leukemia patients do not have high white blood cell counts visible during a regular blood count. This less-common condition is called aleukemia. The bone marrow still contains cancerous white blood cells which disrupt the normal production of blood cells, but they remain in the marrow instead of entering the bloodstream, where they would be visible in a blood test. For an aleukemic patient, the white blood cell counts in the bloodstream can be normal or low. Aleukemia can occur in any of the four major types of leukemia, and is particularly common in hairy cell leukemia. The few known causes, which are not generally factors within the control of the average person, account for relatively few cases. The different leukemias likely have different causes. Leukemia, like other cancers, results from mutations in the DNA. Certain mutations can trigger leukemia by activating oncogenes or deactivating tumor suppressor genes , and thereby disrupting the regulation of cell death, differentiation or division. These mutations may occur spontaneously or as a result of exposure to radiation or carcinogenic substances. Diet has very limited or no effect, although eating more vegetables may confer a small protective benefit. This predisposition is demonstrated by family histories and twin studies. In some cases, families tend to develop the same kinds of leukemia as other members; in other families, affected people may develop different forms of leukemia or related blood cancers. The International Agency for Research on Cancer expert working group undertook a detailed review of all data on static and extremely low frequency electromagnetic energy, which occurs naturally and in association with the generation, transmission, and use of electrical power. Diagnosis is usually based on repeated complete blood counts and a bone marrow examination following observations of the symptoms. Sometimes, blood tests may not show that a person has leukemia, especially in the early stages of the disease or during remission. A lymph node biopsy can be performed to diagnose certain types of leukemia in certain situations. Following diagnosis, blood chemistry tests can be used to determine the degree of liver and kidney damage or the effects of chemotherapy on the patient. When concerns arise about other damage due to leukemia, doctors may use an X-ray , MRI , or ultrasound. These can potentially show leukemia's effects on such body parts as bones X-ray , the brain MRI , or the kidneys, spleen, and liver ultrasound. CT scans can be used to check lymph nodes in the chest, though this is uncommon. Despite the use of these methods to diagnose whether or not a patient has leukemia, many people have not been diagnosed because many of the symptoms are vague, non-specific , and can refer to other diseases. For this reason, the American Cancer Society estimates that at least one-fifth of the people with leukemia have not yet been diagnosed. Some are also treated with radiation therapy. In some cases, a bone marrow transplant is effective. Additionally, treatment must prevent leukemic cells from spreading to other sites, particularly the central nervous system CNS e. In general, ALL treatment is divided into several phases: Induction chemotherapy to bring about bone marrow remission. For adults, standard induction plans include prednisone , vincristine , and an anthracycline drug; other drug plans may include L-asparaginase or cyclophosphamide. For children with low-risk ALL, standard therapy usually consists of three drugs prednisone, L-asparaginase, and vincristine for the first month of treatment. Consolidation therapy or intensification therapy to eliminate any remaining leukemia cells. There are many different approaches to consolidation, but it is typically a high-dose, multi-drug treatment that is undertaken for a few months. Patients with low- to average-risk ALL receive therapy with antimetabolite drugs such as methotrexate and 6-mercaptopurine 6-MP. High-risk patients receive higher drug doses of these drugs, plus additional drugs. CNS prophylaxis preventive therapy to stop the cancer from spreading to the brain and nervous system in high-risk patients. Maintenance treatments with chemotherapeutic drugs to prevent disease recurrence once remission has been achieved. Maintenance therapy usually involves lower drug doses, and may continue for up to three years.
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