BLOOD CANCERS 

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Q: What is leukemia? 

A: Leukemia is a type of blood cancer that begins in the bone marrow, where blood cells are produced. It causes the uncontrolled growth of abnormal white blood cells, which crowd out normal blood cells and interfere with their function. Leukemia can be acute (fast-growing) or chronic (slow-growing). 

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Q: What are the different types of leukemia? 

A: There are four main types of leukemia: 

1. Acute Lymphoblastic Leukemia (ALL) – Affects lymphoid cells and progresses rapidly. Most common in children. 

1. Acute Myeloid Leukemia (AML) – Affects myeloid cells and progresses quickly. More common in adults. 

1. Chronic Lymphocytic Leukemia (CLL) – Affects lymphoid cells and progresses slowly. Most common in older adults. 

1. Chronic Myeloid Leukemia (CML) – Affects myeloid cells and progresses slowly at first, but can become more aggressive. 

Other rare leukemias include Hairy Cell Leukemia (HCL), Large Granular Lymphocytic Leukemia (LGL), and Juvenile Myelomonocytic Leukemia (JMML). 

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Q: Who is at risk of developing leukemia? 

A: The exact cause of leukemia is unknown, but certain factors may increase the risk: 

• Age: Some types of leukemia are more common in children (ALL) or older adults (CLL, AML). 

• Genetic mutations: Conditions like Down syndrome and Li-Fraumeni syndrome increase risk. 

• Radiation exposure: Previous exposure to high-dose radiation (e.g., radiation therapy, nuclear accidents). 

• Chemical exposure: Contact with benzene, a toxic chemical found in tobacco smoke, industrial emissions, and some chemicals. 

• Previous chemotherapy: Some cancer treatments can increase the risk of secondary leukemia. 

• Smoking: Associated with a higher risk of AML. 

• Family history: Rare, but a family history of leukemia may increase risk. 

Q: What are the common symptoms of leukemia? 

A: Symptoms depend on the type of leukemia, but common signs include: 

• Fatigue and weakness 

• Frequent infections due to a weakened immune system 

• Fever or night sweats 

• Unexplained weight loss 

• Easy bruising or bleeding (due to low platelets) 

• Shortness of breath 

• Bone or joint pain 

• Swollen lymph nodes or an enlarged spleen/liver 

Some chronic leukemias may not show symptoms in the early stages and are found during routine blood tests. 

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Q: What tests are used to diagnose leukemia? 

A: Leukemia is diagnosed through various tests, including: 

1. Complete Blood Count (CBC) – Measures red and white blood cell levels, along with platelets. 

1. Peripheral Blood Smear – Examines blood cells under a microscope. 

1. Bone Marrow Aspiration & Biopsy – Samples from the bone marrow are analyzed for abnormal cells. 

1. Flow Cytometry (Immunophenotyping) – Identifies specific types of leukemia cells based on protein markers. 

1. Cytogenetic Testing (Karyotyping & FISH) – Detects chromosomal abnormalities like the Philadelphia chromosome (BCR-ABL1 mutation) in CML. 

1. Molecular Testing (Next-Generation Sequencing, qPCR) – Detects specific genetic mutations, guiding targeted therapy choices. 

1. Imaging Tests (CT, MRI, PET Scan) – Used to check if leukemia has spread to organs. 

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Q: How is leukemia treated? 

A: Treatment depends on the type of leukemia, stage, and overall health. Common treatments include: 

Acute Leukemia (ALL, AML) 

• Chemotherapy: The main treatment, often in multiple cycles. 

• Targeted Therapy: Drugs like imatinib (Gleevec) for Philadelphia chromosome-positive ALL. 

• Immunotherapy: CAR-T cell therapy for some high-risk or relapsed ALL cases. 

• Bone Marrow (Stem Cell) Transplant: Replaces damaged bone marrow with healthy donor cells, often used in AML. 

Chronic Leukemia (CLL, CML) 

• Targeted Therapy: 

• Tyrosine Kinase Inhibitors (TKIs): Imatinib, dasatinib, nilotinib (for CML). 

• BTK inhibitors: Ibrutinib, acalabrutinib (for CLL). 

• Chemotherapy: Used in some cases, but newer therapies are preferred. 

• Monoclonal Antibodies: Rituximab, obinutuzumab (for CLL). 

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Q: What is targeted therapy, and how does it work? 

A: Targeted therapy uses drugs that attack specific genetic changes or proteins in leukemia cells while sparing normal cells. Some examples include: 

• TKIs (Tyrosine Kinase Inhibitors) for CML: 

• Imatinib, dasatinib, nilotinib, bosutinib, ponatinib target the BCR-ABL1 fusion gene. 

• BTK inhibitors for CLL: 

• Ibrutinib, acalabrutinib block a protein (Bruton's tyrosine kinase) that helps leukemia cells grow. 

• IDH inhibitors for AML: 

• Ivosidenib, enasidenib target IDH1 and IDH2 mutations in AML. 

• FLT3 inhibitors for AML: 

• Midostaurin, gilteritinib target FLT3-mutated leukemia cells. 

Targeted therapies often have fewer side effects than traditional chemotherapy. 

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Q: What new treatments are available for leukemia? 

A: Some of the newest approaches include: 

• CAR-T Cell Therapy: A cutting-edge immunotherapy that reprograms a patient’s immune cells to attack leukemia cells, approved for some relapsed or refractory B-cell ALL. 

• Bispecific Antibodies (Blincyto®): These target both leukemia cells and immune cells, helping the immune system fight cancer more effectively. 

• Newer TKIs: Asciminib for CML offers an alternative treatment with potentially fewer side effects. 

• Gene Therapy & CRISPR: Early research is exploring gene-editing techniques to correct mutations causing leukemia. 

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Q: What is the survival rate for leukemia? 

A: Prognosis depends on the type and stage of leukemia: 

• ALL: 5-year survival rate ~70-90% in children; ~40-50% in adults. 

• AML: 5-year survival rate ~30-50%; lower in older patients. 

• CML: With TKIs, 5-year survival rate is ~90%. 

• CLL: Can be managed long-term; survival rates depend on mutations and response to therapy. 

Early diagnosis and targeted therapies have significantly improved survival rates. 

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Q: Can leukemia be prevented? 

A: There’s no guaranteed way to prevent leukemia, but some steps may reduce risk: 

• Avoid smoking and exposure to benzene (found in industrial chemicals). 

• Limit radiation exposure when possible. 

• Maintain a healthy lifestyle with a balanced diet and exercise. 

• Regular check-ups for early detection, especially if there’s a family history.