Between 4,500 and 5,000 people are diagnosed each year in our country with leukemia, a blood cancer caused by an interruption in differentiation or an aberrant differentiation of hematopoietic cells, that is, blood cells with the potential to become in red blood cells, white blood cells, or platelets. Leukemia accounts for less than 5% of all malignant tumors and its prognosis varies greatly depending on the diagnosed leukemia subtype.
Thus, although grouped under the same name, Dr. Adolfo de la Fuente, head of the Hematology Service at MD Anderson Cancer Center Madrid, explains that "there are four very different subtypes of leukemia from a biological and clinical point of view". Incidence rates of the disease also vary significantly with the most common forms being acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL), both with 32% incidence; then there is chronic myeloid leukemia (CML), at 25%, and lastly, acute lymphocytic leukemia (ALL), at 11%.
On the occasion of European Leukemia Week, which is commemorated this week, between June 22 and 28, Dr. de la Fuente aimed to highlight the heterogeneity of a disease that is not well known. "The prognosis will vary enormously depending on the subtype of leukemia that the person has and factors like age, underlying health problems ...", explains the doctor, who also mentions important differences within the same leukemia subtype due to the different genetic mutations that may be present in leukemic cells.
Due to the heterogeneity of leukemia, early detection and assessment of the disease and constant communication with patients and their families are key. "We are talking about a diagnosis that causes fear and distress, so it is important to explain the diagnosis and options to manage the disease and, during the process, to maintain a continuous, open channel of communication," stresses the specialist.
Communication becomes even more important when faced with a diagnosis of chronic lymphocytic leukemia, where starting treatment immediately is no always necessary. "If the disease is not causing symptoms and shows no warning signs or risk of progression, monitoring of the patient can be started without treatment," says the doctor. "This is not only the right thing to do, but it is the best way to help the person, who can spend years being monitored without the need for treatment and without problems due to the disease," he adds.
So, the problem here is not so much managing the disease but explaining to the patient and their relatives why treatment will not begin if there is a confirmed cancer diagnosis. "It must be explained very well so that the person and his/her family do not feel worried and a little lost," says the expert.
New treatment options in the management of leukemia
In recent years, the field of onco-hematology has advanced greatly both in laboratory research and in the approval and commercialization of new treatment options by regulatory authorities in the United States and Europe. "These new advances have substantially changed survival rates and the prognosis of our patients”.
These novelties also provide professionals with more tools with which to manage the disease. "Every day, we apply the latest advances in the diagnosis and study of leukemia, we put into practice management protocols from MD Anderson in Houston, we offer the chance to take part in clinical trials with new molecules, etc.", says Dr. de la Fuente, who recognizes that the greatest need for new advances and improvements is in the management of acute myeloid leukemia and acute lymphocytic leukemia in adults.
In cases of acute leukemia, time in particular is a key factor. "Early assessment and correct study of the situation may be the best strategy to improve the prognosis," stresses Dr. de la Fuente, who also explains that, for that reason, MD Anderson Madrid offers preferential appointments to patients with suspected leukemia to provide access to the first assessment of their situation within a maximum of 48 hours.
What is the difference between chronic leukemia and acute leukemia?
The time it takes for the disease to progress is the main difference between acute and chronic leukemia. "Acute leukemia is characterized by very rapid progression as a result of severe failure in the normal function of the bone marrow," explains Dr. de la Fuente. The patient usually suffers from fatigue due to anemia, fever and / or bleeding. The diagnosis is usually made after blood tests carried out due to the patient’s symptoms. This type of acute leukemia usually requires urgent medical treatment with chemotherapy and hospitalization in an isolation room.
In contrast, chronic leukemia is characterized by slow evolution of the disease. Normally, the patient has no obvious symptoms and the diagnosis is made after a routine blood test. Sometimes, it is not necessary to start treatment immediately and the initial recommendation is close monitoring of the patient.