World Blood Cancer Day – Leukaemia

World Blood Cancer Day – Leukaemia

Cancer was the scariest diagnosis that people can hear. May 28 became the world blood cancer day, which is a global day of awareness dedicated to the fight against blood cancer. 

The World Health Organization in 2019 estimated that cancer is the first or second leading cause of death before the age of 70 years in 112 of 183 countries and ranks third of fourth in further 23 countries.1,2 Between 30 and 50%of cancers can currently be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies. Many cancers have a high chance of cure if diagnosed early and treated appropriately. Many of the known risk factors for cancer can be prevented. Tobacco use, infectious agents, unhealthy diet, excess body weight, physical inactivity, and alcohol consumption account for the majority of cancer deaths caused by known factors.3 

According to the Global Cancer Observatory in 2018, World Health Organization reports deaths in Indonesia caused by Leukemia was 11.314 people.

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Figure 1: National ranking of Cancer as a Cause of Death at Ages <70 Years in 2019. The numbers of countries represented in each ranking group are included in the legend. Source: World Health Organization.4

Blood Cyclopedia

Blood is a body fluid in humans that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells. Blood performs many important functions within the body, including:5  

  • Supply of oxygen to tissues (bound to hemoglobin , which is carried in red cells)
  • Supply of nutrients such as glucose, amino acids , and fatty acids 
  • removal of waste such as carbon dioxide, urea , and lactic acid 
  • immunological functions, including circulation of white blood cells , and detection of foreign material by antibodies 
  • Coagulation , the response to a broken blood vessel, the conversion of blood from a liquid to a semisolid get to stop bleeding
  • Messenger functions, including the transport of hormones  and the signaling of tissue damage
  • Regulation of core body temperature

Blood also has 4 main parts:7 

  1. Blood Plasma: is yellowish liquid component of blood that holds the blood cells, proteins and other constituents of whole blood in suspension.6 Plasma function is to transports nutrients, waste products, and proteins, and other molecules responsible for affecting the function of various parts of the body, including regulating body temperature and fluid balance.
  2. Red Blood Cells: the cells responsible for transporting oxygen to lungs and tissue.
  3. White Blood cells: The cells responsible for protecting against infections.
  4. Platelets: The cells that form blood clots and prevent blood loss. 

Blood Cancer Definition

Blood cancer is a complex group of disease linked by their origins in the bone marrow , where blood is produced. Blood cancer arises from abnormalities in the blood cells affect normal blood cell production and function. 

Then, why is there blood cancer ?

It is important to know that every second of every day a person’s body is replenishing its cells, including its blood cells, by making and destroying old ones. A person’s body can make the right number of each type of cell to keep the person healthy. To make blood cells, stem cells(basic material cell) in the bone marrow mature and develop into one of four types(blood plasma, red blood cells, white blood cells, and platelets) of blood cells. 

If the DNA in the stem cells that tells the body how to make blood cells changes (mutates), these blood cells might start to develop abnormality, or fail to die when they should. These are the “cancerous” cells that cause blood cancer. These abnormal blood cells prevent the blood from performing many of its usual functions, like fighting off infections, bringing oxygen to other tissues or helping to repair the body. 

Blood cancer is a complex group of disease linked by their origins in the bone marrow , where blood is produced. Blood cancer arises from abnormalities in the blood cells affect normal blood cell production and function. 

Leukaemia

Leukaemia are a group of hematologic disorders characterized by the dysfunction proliferation and development of leukocytes . They classified as acute or chronic, according to the degree of cell differentiation and as myelocytic  or lymphocytic  according to the predominant type of cell involved. Symptoms are nonspecific and can include fever, fatigue, weight loss, bone pain, bruising, or bleeding. Definitive diagnoses often require bone marrow biopsy , the result of which inform interprofessional treatment ranging from chemotherapy  to stem cell transplantation. 

Leukaemia has 2 major classification and 4 major subtypes.

  • Acute vs Chronic : acute leukemias are characterized by abnormal cells that are less mature, develop quickly, and leave the bone marrow as dysfunctional cells called “blasts (immature cells)”. These blasts crowd out healthy cells in the bone marrow , causing the rapid onset of symptoms. Blasts normally make up 1%$ top 5% of marrow cells, and having more than 20% blasts in the bone marrow is required for a diagnosis of acute leukemia. In contrast, chronic leukemias develop slowly and may take years to develop symptoms. They are composed primarily of more mature and functional cells and there are generally not elevated numbers of blasts.
  • Myeloid vs. Lymphoid : Hematopoietic stem cells  give rise to two types of blood cells: myeloid and lymphoid . Myeloid cells  include monocytes , macrophages , neutrophils , basophils , eosinophils , erythrocytes/red blood cells, and megakaryocytes .   
  • Acute lymphoblastic leukemia (ALL): ALL occurs when primitive white blood cells of lymphoid origin reproduce without developing into normal B and T cells. It is the most common leukemia in pediatrics, accounting for up to 80% of cases in this group vs. 20% of cases in adults.
  • Acute myelogenous leukemia (AML): AML is also characterized by the hyperplasia  of blasts, but in this case, of myeloid origin. It accounts for half of the leukemia cases diagnosed in teenagers and people in their 20s. It is the most common acute leukemia in adults.
  • Chronic lymphocytic leukemia (CLL): CLL occurs when mature but abnormal white blood cells of lymphoid origin undergo hyperplasia, leading to a monoclonal population  of dysfunctional lymphocytes. Most cases occur in people between ages 60 and 70.
  • Chronic myelogenous leukemia (CML): A monoclonal population of self-renewing, dysfunctional myeloid cells (e.g., neutrophils, basophils, eosinophils, macrophages) characterizes CML. Most cases occur in people between ages 25 and 60.

Several Risk Factors are associated with a higher risk of developing leukemia: Exposure to ionizing radiation is associated with an increased risk of multiple subtypes of leukemia; Exposure to benzene is a risk factor for leukemia in adults, particularly AML12; Previous exposure to chemotherapy, especially alkylating agents  and topoisomerase inhibitors , increase the risk for acute leukemia later in life10,11 ; A history of any hematologic malignancy is a risk factor for subsequently developing another subtype of leukimia13; Viral Infections (e.g., human T-cell leukemia virus, Epstein Barr virus) are linked with subtypes of ALL13;Several genetic syndromes (e.g., Down syndrome, Fanconi anemia() , Bloom syndrome , Li-Fraumeni syndrome ) are associated with an increased risk of AML and ALL14.

Diagnosis

Leukaemia and other blood cancers are usually not easily caught. The symptoms of it are not special so we also consider other differential diagnoses. One must rule out infection, drug effects, vitamin/micronutrient deficiencies, and other myelodysplastic disorders that can cause abnormalities in blood cell lines. These some of condition that you must be considered due to abnormalities on your blood count: B12 and folate deficiencies, Copper deficiencies, Viral infections (e.g., HIV, Cytomegalovirus, Epstein Barr virus), Drugs (chemotherapeutic agents, valproic acid, ganciclovir , myocophenolate mofetil ), Autoimmun  conditions (e.g., systemic lupus erythematosus

Treatment

We must understand that cancer is not one disease, but many, influenced by genetic mutations that affect both disease development and treatment options. For blood cancer, there are 2 main model therapies. 1called Curative therapy and the other one called Palliative therapy. 

Chemotherapy and radiotherapy was included in curative and palliative treatment to cure blood cancer. Curative therapies aim to cure the disease. These treatments eliminate the blood cancer cells, whereas palliative treatments ease the pain caused due to symptoms, but not actually remove the cancer.  

Now, the advance technology, science, and medication has been approved to help the treatments for blood cancer such as CAR-T , CRISPR technologies , PARP inhibitors . We also hope that every kid and adult who has this kind of disease can be manageable and we can also reduce the recurrence.

Refferences

  1. World Health Organization (WHO). Global Health Estimates 2020: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2019. WHO; 2020. Accessed December 11, 2020. who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death
  2. Bray F, Laversanne M, Weiderpass E, Soerjomataram I. The ever-increasing importance of cancer as a leading cause of premature death worldwide. Cancer. In press.
  3. Jemal,Ahmedin. Torre,Lindsey. Soerjomataram, Isabelle. Bray, Freddie. The Cancer Atlas. American Cancer Society. 2019. P 18
  4. Sung, H, Ferlay, J, Siegel, RL, Laversanne, M, Soerjomataram, I, Jemal, A, Bray, F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021: 71: 209- 249. https://doi.org/10.3322/caac.21660
  5. https://en.wikipedia.org/wiki/Blood Access: 26 May 2021
  6. https://en.wikipedia.org/wiki/Blood_plasma Access: 26 May 2021
  7. https://www.yalemedicine.org/conditions/blood-cancers#:~:text=Leukemia%3A%20Your%20doctor%20will%20obtain,be%20examined%20under%20a%20microscope. Access: 26 May 2021
  8. State of the Nation: Blood Cancer in Australia. Final Report to the Leukaemia Foundation. February 2019. Page 1-2
  9. Lyengar V, Shimanovsky A. Leukemia. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560490/
  10. Bispo JAB, Pinheiro PS, Kobetz EK. Epidemiology and Etiology of Leukemia and Lymphoma. Cold Spring Harb Perspect Med. 2020 Jun 01;10(6)
  11. Miranda-Filho A, Piñeros M, Ferlay J, Soerjomataram I, Monnereau A, Bray F. Epidemiological patterns of leukaemia in 184 countries: a population-based study. Lancet Haematol. 2018 Jan;5(1):e14-e24.)
  12. Snyder R. Leukemia and benzene. Int J Environ Res Public Health. 2012 Aug;9(8):2875-93.
  13. Davis AS, Viera AJ, Mead MD. Leukemia: an overview for primary care. Am Fam Physician. 2014 May 01;89(9):731-8.
  14. Stieglitz E, Loh ML. Genetic predispositions to childhood leukemia. Ther Adv Hematol. 2013 Aug;4(4):270-90.)