Leukemia: symptoms, causes, treatment

In France, leukemia affects 9,000 to 10,000 people per year, mainly adults. But they still represent 29% of cancer cases diagnosed in children under 15. Dr. Christophe Willekens, hematologist at the Gustave Roussy Institute, explains its main characteristics in detail.

SUMMARY :

Leukemias are cancers du sang : they affect the cells of the bone marrow at the origin of the white blood cells that can be observed on a blood test (leukocytes). “The origin of the word leukemia comes from the very old observation of blood which has turned white, in connection with an excess of white blood cells in the blood”says Dr. Christophe Willekens, hematologist at the Gustave Roussy Institute in Villejuif.

In the normal state, the precursor cells of white blood cells are found in the bone marrow and will “mature” to become type white blood cells myeloid (such as polynuclears) or lymphoids (lymphocytes). In the case of leukaemia, more or less mature white blood cells, of the lymphoid or myeloid lineage are produced in too great a mass and can take the place of normal cells and prevent them from accomplishing their tasks. “In the majority of cases, it is an excess of white blood cells in the blood.continues the hematologist.

What are the different types of leukemia?

There is not a leukemia, but leukaemias”, says Dr. Willekens straight away. And the four main types are:

  • The acute lymphoblastic leukemia (LAL) ;
  • The acute myeloblastic leukemia (LAM) ;
  • The chronic lymphocytic leukemia (LLC) ;
  • The chronic myeloid leukemia (LMC).

Acute leukemias will be those which manifest themselves most quickly and which will require rapid or even immediate treatment.indique le Dr Willekens. In the case of chronic leukemia, in particular chronic lymphoid leukemia, management is most often purely outpatient (that is to say that we enter the hospital in the morning and we leave it in the evening, editor’s note) during simple consultations.”

In adults, the most common leukemias are chronic lymphocytic leukemia and acute myeloblastic leukemia.

Leukemia: who is affected?

Overall, chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML) and acute myelogenous leukemia (AML) affect people more elderly people, from 60/70 years old. “These are mainly diseases related to the aging of bone marrow cellsMen are also more affected than women.

Children are mostly affected by acute lymphoblastic leukemia. The incidence then drops drastically and rises again around the age of 60 to 65.

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What are the symptoms of leukemia?

Although there are different types of leukemia, some common symptoms are related to a invasion of the bone marrow resulting in a defect in the production of certain blood cells. “In the event of a defect in the production of red blood cells, you can have anemia, i.e. fatigue, shortness of breath or pallor in the skin.indique le Dr Willekens. In the event of platelet deficiency, bleeding often occurs in the nose, gums or digestive tract. Finally, when you lack white blood cells, you can have serious or repeated infections..”

Other symptoms are related toexcess white blood cells and tumor mass : “We can see an increase in the size of the lymph nodes or an increase in the size of the spleen, or pain in the left flank”says the specialist.

Finally, an excess of white blood cells can cause leukostasis syndrome: the blood will be more viscous, which can cause respiratory or neurological disorders (only in the case of acute leukemia).

Do we know the causes of leukemia?

We know that benzene (a substance now banned) can be responsible for cases of leukaemia., says the specialist. L’exposure to chemotherapy or radiation therapy in the case of the treatment of another cancer can also promote its appearance, in particular for acute myeloblastic leukaemia.

A person will also be more at risk of getting leukemia if there is a case in their family, even if the genetic predispositions are rare.

Finally, theexposure to ionizing radiation or pesticides – especially in the case of chronic lymphocytic leukemia – can increase the risks.

Leukemia: how is the diagnosis made?

Leukemias are most of the time discovered incidentally, during a blood test carried out as part of a systematic assessment., indique le Dr Willekens. †Do not hesitate to consult when you notice abnormalities in the results of the blood test.”

Then, in the majority of leukaemias, a myelogram will have to be carried out, or a bone marrow puncture at the level of the sternum or the iliac bone with an analysis of the bone marrow taken. This will establish the identity card of the disease.

Leukaemia: what treatment exists?

The treatments will vary greatly depending on the type of leukemia. “Some leukemias will only be followed by follow-up consultations every three to six months, in particular chronic lymphocytic leukemia, and in two thirds of cases, there is no need for therapeutic intervention., says the specialist. But sometimes (about a third of cases), treatment is necessary: ​​it is implemented on an outpatient basis and consists of oral treatment or day hospital treatment.

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For chronic myeloid leukemia, the management is also outpatient. “Patients receive tablets with a tyrosine kinase inhibitor, a targeted treatment, which will directly target the abnormality responsible “continues the hematologist.

In the case of acute leukaemias, the treatment will depend on age and ability to undergo heavy treatment. “In a young subject, we will proceed to intensive chemotherapy in hospital more or less urgently. Once this treatment has worked and the patient is in remission, we will continue with either chemotherapy alone or chemotherapy followed by a bone marrow transplant from a donor.explains the doctor.

In elderly patients, a great revolution is underway. Until then, the treatments provided a response in 30% of patients and survival was often less than a year. But over the past one or two years, treatments have evolved, and nearly two-thirds of patients respond favorably to treatment. “Chemotherapy combined with a targeted therapy tablet will cause leukemic cell death”indique le Dr Willekens.

In children, chemotherapy works very well because they are better able to absorb and tolerate the treatment.

What is the vital prognosis for leukaemia?

What life expectancy? Even if there is still progress to be made, particularly for acute leukemia, we are experiencing a real therapeutic revolution. “Today, leukemias are treated better and betterrejoices the specialist. Enormous progress has taken place in the last ten years and the survival of certain leukemias is equivalent to that of the general population.

In chronic myeloid leukemia,vast majority of patients are in complete remission. “Today it is no longer the cure that we have to manage, but rather the toxicity of the drug to ensure a good comfort of life for the patient “he continues.

In children, the five-year survival rate is close to 90%selon le Dr Christophe Willekens.

Our speaker:

  • Dr. Christophe Willekens, hematologist at the Gustave Roussy Institute in Villejuif

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