Abnormal proliferation of blood cells due to defective medullary heamatopoetic stem cells is called leukemia.
In Layman terms, defective bone-marrow causes uncontrolled multiplication and abnormal growth of cells that are components of blood causing blood cancer.
TYPES AND CLASSIFICATION
Based on speed of progression and maturity level of most cells, most of the Leukemia can be categorised into
- Acute – Fast progressing, takes weeks to few months, most of the cells are blast cells (immature cells), requires immediate treatment, commonly seen in children.
- Chronic – Relatively slow progressing, takes months to years, has relatively mature cells, patient usually under observation before commencing any aggressive treatment, Common in elderly people.
There are some leukemias which do not follow fixed pattern, even the presentation of symptom may vary in different individual, also there are cases where in they change the classical course and speed of progression.
Based on types of cells involved, most of the Leukemia can be categorised into
- Lymphoid (Lymphocytic) – Precursors of Lymphocytes are involved. It is further classified as per which lymphocytes are involved wether B-cells or T-cells.
- Myeloid(Non-Lymphocytic) – Precursors of RBC, Non-Lymphocyte WBC and Platelets are involved.
A Lymphoid or Myeloid leukemia can Either Acute or Chronic as described below
- Acute – Lymphoblastic(ALL)
- Chronic – Lymphocytic (CLL)
- Acute – Myeloid (AML)
- Chronic – Myeloid (CML)
Acute Lymphoblastic Leukemia (ALL) –
When there are multiple mutations in the locus that controls cell proliferation, cell maturation and cell death of precursor cells of Lymphocytes, called Lymphoblast, then this results in ALL. ALL can be of T cell type or B cell type.
Genes associated with ALL –
- KMT2A – Infant ALL – onset before 10yr of age
- PAX5 – Inherant Autosomal Dominant
- ETV6 – Inherant Autosomal Dominant
Certain syndromes that increases risk of ALL
- Down’s Syndrome
- Bloom Syndrome
- Fanconi Anaemia
- X-Linked agamaglobulinaemia
- Neurofibromatosis Type 1
- Li-Fraumani Syndrome
- Paroxysmal Nocturnal Heamoglobinuria
- Severa Combined Immunodeficiency
- Costmann Syndrome
- Ataxia Telangiectasia
- Schwachmann Daimond Syndrome
SUBTYPES OF ALL
- Precursor B-cell ALL
- Precursor T-cell ALL
- Mature B-cell ALL (also called Burkitts Leukemia due to its similarity with Burkitts Lymphoma)
- Acute Biphenotypic Leukemia.
Acute Myeloid Leukemia (AML)
It is an Acute Non-Lymphocytic type of malignanacy that involves myeloblast cells(precursor of monocytes and granulocytes).
In AML, there are mutations in genes responsible for maturation and differentiation of the myeloblast cell, so the cell freezes in undifferentiated and immature state. When this type of mutations are combined with mutations in genes controlling proliferation in same cell, it results in clonning of immature undifferentiated cells resulting in AML.
Genes associated with AML
Subtypes of AML
Subtypes of AML are classified based on staging of maturation i.e. at which stage the msturation of the cell is arrested and how is the general behaviour of cells and which genes are involved.
- Undifferentiated Acute Myeloblastic Leukemia
- Acute Myeloblastic Leukemia with Minimal Maturation
- Acute Myeloblastic Leukemia with Maturation
- Acute Pro-Myelocytic Leukemia (APL)
- Acute Myelomonocytic Leukemia
- Acute Myelomonocytic Leukemia with Eosinophilia
- Acute Monocytic Leukemia
- Acute Erythroid Leukemia
- Acute Megakaryoblastic Leukemia
Adult T-Cell Leukemia
Blast Crisis of CML
Chronic Lymphocytic Leukemia (CLL)
- B-cell Pro-Lymphocytic Leukemia(B-PLL)
- T-Cell Pro-Lymphocytic Leukemia(T-PLL), T-PLL doesnt completely fit into this category.
Large Granular Lymphocytic Leukemia(LGLL)
Chronic Myeloid Leukemia (CML)
- Chronic Granulocytic Leukemia
- Juvenile CML
- Chronic Neutrophillic Leukemia
- Chronic Myelo-Monocytic Leukemia(CMML)
- Atypical CML (aCML)
Chronic Eosinophillic Leukemia
Few other types, preleukemias and syndromes that cannot be classified in above category
- Clonal Eosinophilia
- Other Myelodysplastic Syndromes
- Other Myeloproliferative Syndromes
Leukemia is caused due to mutations in genes that are associated with proliferation, differentiation, growth, maturation and cell death of blood cells. With different types of mutations responsible for different types of leukemia.
These genetic mutations can be inherited or acquired due to multiple reasons of which few known risk factors are
- Exposure to certain chemicals (e.g. benzene, petrochemicals, hair-dyes, agent orange herbicide, certain insecticides)
- Radiation – ionising radiations and doubtedly non-ionising radiations too.
- Smoking and tobacco use.
- Prior alkylating chemotherapy for some other form of malignancy.
- Viruses – Human T-cell Lymphotropic Virus – 1 HTLV-1 is associated with Adult T-cell Leukemia and Hepatitis C is associated with CLL
- Diseases and Syndromes – Down’s Syndrome, Kline Felter syndrome, Fanconi Anaemi, Ataxia-Telangiectasia or Louis-Bar Syndrome, Myelodysplastic syndrom, Myeloproliferation syndrome.
Few of these factor are seen responsible for specific type of cancer (eg HTLV1 causes Adult T-cell Leukemia, Tobacco and Down’s Syndrome increases risk of AML).
SIGNS AND SYMPTOMS
Symptoms may vary in different types of leukemia, different individuals and different stages of disease.
- Tired feeling
- Paleness due to anaemia
- Shortness of breath
- Headache, lethargy, stiffness of neck
- Loss of appetite
- Weight loss
- Tendency to catch infection too frequently
- Fever usually due to secondary infections
- Painful long bones
- (Heamorrhagic diathesis) easily bleeds and frequent ecchymosis and petechiae (bruises).
- Painless lymphomegaly (Enlarged lymphnodes)
- Hepatospleenomegaly – can easily palpate liver and spleen due to its increased size.
- Fibrosis of bone marrow
- Chloroma or Leukemia Cutis or myeloid sarcoma or granular sarcoma or extramedullary myeloid tumour
- Swollen painfull and bleeding gums
- Sweet’s Syndrome
- Pitting Oedema
- Enlarged Testis
- Mediastinal mass
- Cranial nerve Paralysis if CNS is involved
- Increased blood cell count , WBC or RBC or Platelets, depending on type with most if the cells immature and lacking differentiation.
- Complete Blood Count
- Bone Marrow Biopsy
- Lymph Node Biopsy
HOMEOPATHIC TREATMENT WITH INDICATED HOMEOPATHIC MEDICINES
- Arsenicum Album
- Hekla lava
- Carica Papaya
- Cinchonna Officinalis
- Thuja Occidentalis
- Baryta Carbonica
- Calcarea Phosphorica
- Ruta Graveolens
- Calcarea Fluorica
- Calcarea Carbonica
- Symphytum Officinalis
- Hyocyamus Niger