Secrets of blood: how to fight leukemia in Russia
World Leukemia Day is celebrated on September 24. This is one of the most dangerous oncohematological diseases: even in the last century, more than half of patients died from blood cancer. Today, leukemias are being successfully treated, and patients can go into remission and lead the same lifestyle. Izvestia found out how to recognize leukemia in children and adults, and how the disease is treated in Russia.
What are the non-obvious signs of leukemia?
Frequent nosebleeds or uterine bleeding, the appearance of small pinpoint hemorrhages under the skin may be signs of leukemia, a blood cancer. Gayane Tumyan, Head of the Department of Oncohematology at the N. N. Blokhin National Research Medical Center of Oncology of the Russian Ministry of Health, told Izvestia about this.
As the doctor explained, the disease is often caused by damage to the bone marrow, the organ where all blood cells are produced, and the production of red blood cells, white blood cells and platelets suffers. This is reflected in the clinical picture of the patient.
— If the level of platelets decreases, that is, the cells that protect us from bleeding, a person faces increased bleeding. Sometimes the disease is first detected at the dentist — during tooth extraction, unusually severe bleeding may occur, which becomes the reason for the examination," Gayane Tumyan noted.
Lack of white blood cells leads to frequent infections: sore throats, pneumonia, severe acute respiratory viral infections. The patient may complain of a prolonged fever for no apparent reason, and already a blood test shows changes characteristic of leukemia.
At the same time, a decrease in red blood cells manifests itself as anemia: weakness, dizziness, fatigue, pallor.
If these symptoms occur, the patient should undergo a general blood test. If atypical or blast cells are found in it, which normally should not be there — that is, very young immature cells that usually remain in the bone marrow — this becomes a signal for an urgent referral to a hematologist," the Izvestia interlocutor emphasized.
Other non-obvious signs of the disease may be excessive bleeding after dental procedures or minor injuries, as well as unusually severe infections or an "unexplained fever" that is not always immediately noticed. With all these symptoms, a doctor's consultation is also required.
What is leukemia and how is it treated?
Leukemias are a large group of diseases of the hematopoietic system. In the modern understanding, they are manifested by malignant neoplasms of lymphoid, hematopoietic and related tissues, which means that not only the bone marrow can be affected, but there may also be so—called "extra-cerebrospinal" forms of leukemia. According to WHO, they affect 2-3% of all cancer patients in the world. In Russia, about four to five thousand people get sick per year.
— Leukemia is one of the most dangerous oncohematological diseases: the course can be lightning—fast and require immediate initiation of therapy. As a rule, multi-stage therapy is required, and in some cases, bone marrow transplantation," Gayane Tumanyan notes.
Historically, before the advent of specialized drugs (mid-20th century), untreated patients with acute leukemia died on average within 2-3 months after diagnosis. The cause was severe infections or massive bleeding associated with inhibition of normal bone marrow function. However, the situation has changed today: the patient's age, type of leukemia, and related factors play an important role.
–– If we talk about adult patients with acute myeloid leukemia, modern treatment methods can achieve remission in about 75-80% of patients. However, there are forms of the disease with an extremely unfavorable prognosis, for example, leukemias that have arisen after previous chemotherapy. In such patients, the two—year survival rate may not exceed 10%, says Tumyan.
In the case of acute lymphoblastic leukemia, the prognosis is worse in adults than in children. In children, the five-year survival rate is reached in about 95% of cases, while in adults the overall survival rate is about 60%. At the same time, much depends on the specific variant of the disease — there are subtypes with a more favorable outcome and those where the prognosis is initially unfavorable.
How does leukemia manifest in children?
Acute lymphoblastic leukemia is considered the most common variant of leukemia in children and adolescents, with 3-4 cases per 100,000 people per year, Alexandra Naumova, a pediatric oncologist at the Russian Children's Clinical Hospital of the Russian Ministry of Health, tells Izvestia.
–– Of all the tumor diseases of the hematopoietic system in children, ALL occurs in 75-80%. Children can get sick at any age, but the peak incidence in childhood occurs at the age of 2-5 years. Boys get sick a little more often than girls," Naumova notes.
According to the doctor, the symptoms of leukemia in children have many masks: from respiratory infection to complex diseases. At this time, blast cells multiply and accumulate in the bone marrow, preventing the functioning of normal blood cells. Because of this, the child develops pale skin and rapid heartbeat - as manifestations of anemia.
–– Platelet deficiency leads to minor hemorrhages on the skin and mucous membranes, increased bleeding (bleeding from the gums, nasal, intestinal bleeding), bruising ("bruises"). Due to a lack of white blood cells, frequent episodes of acute respiratory viral infections with high fever develop. Tumor intoxication can manifest itself as weakness, fatigue, loss of appetite, weight loss," says the doctor.
As the disease progresses, tumor cells fill the bone marrow, and the child may experience pain in the bones and joints. In addition, blast cells can accumulate in the lymph nodes, causing their enlargement, in the liver and spleen, also causing their enlargement and, in some cases, abdominal pain.
–– It is important that the symptoms are not specific only to ALL and can occur in many other diseases. Therefore, if the presence of blasts in the blood is suspected, according to the results of a general blood test, a complete hospital examination is necessary, including various bone marrow examinations. The diagnosis is confirmed when more than 25% of blast cells are found in the bone marrow," the Izvestia interlocutor emphasizes.
Treatment of leukemia
Today, world medicine considers acute leukemia to be a curable disease. Modern programs are aimed not just at prolonging life, but specifically at remission of the patient, Gayane Tumyan notes.
–– It is important to take into account that acute leukemia is very heterogeneous, that is, it consists of different types and types. There are two large groups — myeloid (they develop from bone marrow cells) and lymphoblastic (they develop from cells that form lymphocytes), and there are dozens more subtypes inside them. According to the current WHO classification, there are already 46 variants of acute leukemia, and each of them has its own prognosis and requires a special approach," says Gayane Sepugovna.
According to her, the situation has changed primarily due to the development of diagnostics. Previously, doctors could rely only on more "crude" methods, morphology and cytochemistry, but today they have at their disposal molecular genetic diagnostic options, as well as immunophenotyping, a method that allows determining the type of cells by their special "markers" on the surface using special antibodies.
–– We have a much better understanding of the "portrait" of a tumor cell, we can determine in advance how the disease will proceed, and choose the optimal treatment strategy. And, most importantly, to control the tumor population during treatment," Tumyan notes.
In recent years, so-called hypomethylating agents have come into practice, which help to "turn on" normal genes in cells and thereby slow down the growth of malignant blood cells. Such drugs are especially important for the treatment of elderly patients when aggressive chemotherapy is not possible. A special place is occupied by a large group of drugs that relate to non-therapeutic treatment - this is a large group of drugs with different mechanisms of action: some "activate" the immune system, others "block" a particular gene.
–– And, of course, various cell therapy options. This is not only bone marrow transplantation, but also, for example, lymphocytes with a chimeric antigen receptor, "natural killers" and others. The Blokhin Cancer Center has received a license to produce such cells — it is the only center in Russia that can provide such medical care to both children and adults," says Deputy Director of the Research Institute of Pediatric Oncology and Hematology at the N. N. NMITS of Oncology. Kirill Kirgizov Blokhina, — today our center has accumulated extensive experience in the treatment of patients with leukemia of all age groups, including patients with congenital leukemia and children in the first year of life
Thus, the interlocutor of Izvestia concludes, Russian medicine has really gone from a disease that was considered almost fatal to a state where the patient has a chance for a full-fledged healthy life.
Переведено сервисом «Яндекс Переводчик»
