Understanding Acute Leukemia: Causes, Symptoms, and Treatment Options

Question. Briefly describe Acute Leukemia.
Or
Describe the etiology, clinical features and management of acute leukemia.

Answer. Acute leukemia is defied as an uncontrolled growth of immature hemopoietic cells at the exposure normal marrow tissue.

Etiology Of Acute Leukemia

Radiation: Association between radiationinduced genetic damage to the hemopoietic progenitors and development of myelodysplasia and acute leukemia is seen after nuclear disease.
Chemical and drugs: Chronic benzene exposure and use of cytotoxic and immunosuppressive agents.
Oncogens and cytogenic abnormalities
Genetic factors, i.e. genetic disorders such as Down’s syndrome, Klinefelter’s syndrome, etc.
Viruses: Infection by human lymphotrophic virus (HTLV1).

Acute Leukemia: Causes, Symptoms, and Treatment Options

Etiology Of Acute Leukemia

Clinical Features Of Acute Leukemia

Symptoms due to anemia, i.e. tiredness, weakness and marked pallor.
Hemorrhagic manifestation: Petechiae, bleeding from gums and nose, persistent bleeding after tooth extraction.
Infection: It causes infective lesions of mouth and throat, i.e.
ulceration of mouth and pharynx, herpes simplex infection of face and infection of respiratory tract such as bronchitis and pneumonia.
Symptoms of cellular hyperviscosity
There are tissue deposits of leukemic cells causing gum hypertrophy which is common in myelomonocytic and monocytic variety of AML.
Lymphadenopathy and splenomegaly are common in acute lymphoid leukemia.
Signs of organ infitration are present, i.e.
CNS: Meningeal involvement occurs in children with acute lymphocytic leukemia.
Skin: Bluish nodules or dusky red patches are present.
Kidneys: Presence of kidney failure.
Other sites: Testes, ovary, liver, gut and serous membranes such as pleura and peritoneum.
Bone pain are present i.e. tenderness of sternum, osteolytic bone lesions and pathologic fractures may occur.
Constitutional symptoms, i.e. fever, malaise and prostration.
Roth’s spot, i.e. presence of white central retinal hemorrhages in acute myeloid leukemia

Acute Leukemia Symptoms and Treatment

Management Of Acute Leukemia

Chemotherapy Of Acute Leukemia

Induction phase: Initial high dose chemotherapy in order to reduce leukemic cells below the levels of morphogenic detection

Treatment Regimen for Acute Lymphoblastic Leukemia

Vincristine 1.4 mg/m2 IV weekly for 4 weeks.
Prednisolone 60 mg/day for 4 weeks.
L- Asparaginase 50–200 ku/kg IV for 4 weeks.
Daunorubicin 30 mg/m2 IV daily for two weeks.

Treatment Regimen for Acute Myeloid Leukemia

Daunorubicin IV alternate days 3 doses.
Cytosine arabinoside IV BD for 10 days
Thioguanine oral BD for 10 days.
In this, blood transfusion and platelet transfusion are required.
CNS prophylaxis: Intra thecal methotrexate is given in acute lymphoblastic leukemia
Consolidation: Another dose of chemotherapy to reduce leukemic burden

In Acute Lymphoblastic Leukemia

IV daunorubicin
IV cytosine arabinoside
IV Etoposide
Methotrexate, 6 thioguinine
Dexamethasone

In Acute Myloid Leukemia

High dose IV Cytosine arabinoside is given
Maintenance: Low dose chemotherapy for 18 months to 2 years

In Acute Lymphoblastic Leukemia

Oral Prednisolone
IV Vincristine
Oral 6 mercaptopurine
Oral Methotrexate

In Acute Myeloid Leukemia

Post remission therapy is given, i.e. myeloablative therapy followed by bone marrow transplantation in relapse or those with highrisk chromosomal changes.

Bone marrow transplantation Of Acute Leukemia

In Acute Lymphoblastic Leukemia
Allogenic bone marrow transplantation is an option in acute lymphocytic leukemia patients entering first remission who have an HLA identical sibling, provided the sibling is fi and is less than 55 years.

In Acute Myeloid Leukemia
In adult patienthigh dose chemotherapy with autologus transplantation of hemopoietic stem cells derived from peripheral blood or bone marrow can be done.

Supportive Care Of Acute Leukemia

Hemoglobin level should not allow falling below 8 g/dL by transfusing 4 units of packed RBCs. This is done to avoid anemia.
If bleeding is present, then there is transfusion of pooled or single donor platelets.
Good nursing, prophylactic gastrointestinal tract decontamination, antibiotics and attntion to flid balance are given to prevent infections.
If disseminated intravascular coagulation is present, then firinogen replacement, platelet transfusion twice daily and anticoagulants are given.
Pneumocystis jiroveci pneumonia is a risk during the treatment of acute lymphocytic leukemia maintenance therapy.
Hyperuricemia is prevented by adequate hydration and pretreatment with allopurinol which should be continued till peripheral blood is cleared of blast cells.