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The
leukemias are a group of diseases characterized by the presense of malignant abnormal cell
lines in the blood and bone marrow. These disorders are categorized according to the type
of cells produced and the clinical course of the disease. In contrast to the leukemias, in
the case of lymphomas, the study of the blood usually appears essentially
unremarkable. However, abnormal cell lines are found in the bone marrow and lymph nodes.
Symptoms
Presentation can occur with pallor (paleness), fatigue, bleeding, fever, bone pain,
adenopathy (swelling of the glands), arthralgias, and hepatosplenomegaly (increase in the
size of the liver and spleen).
Types of Leukemia
I. Acute leukemias in childhood
A. Acute lymphoblastic leukemia (ALL). Peak incidence occurs in children under 5. About
two-thirds of children under age 10 can be cured, but prognosis with relapse is poor.
B. Acute myelogenous leukemia (AML). Presentation is similar to that of ALL.
II. Chronic leukemias in adults
A. Chronic myelogenous leukemia (CML).
CML may be a disease that may not be first noted but can then progress to an acute phase
over a period of weeks to years. Ninety to 95% of cases test positive for the Philadelphia
chromosome.
B. Chronic lymphocytic anemia (CLL).
C. Hairy cell leukemia.
III. Acute leukemias in adults
A. Acute lymphoblastic leukemia (ALL).
Patients older than age 10 are considered high risk because adult ALL appears to be a
clinically different entity from that occurring in childhood, with adults and children
older than age 10 having an overall poorer prognosis.
B. Acute myelogenous leukemia (AML).
Median age at diagnosis of AML is about 60 years.
Types of Lymphoma
1. Hodgkin's Lymphoma usually presents itself with swollen glands in the neck, and then
spreads across the lymph nodes. It is characterized by a typical type of cell which may be
observed in biopsy.
2. Non-Hodgkin's Lymphomas. All other lymphomas are included in this category. They can be
classified as low, intermediate, or high grade on the basis of their malignancy.
Diagnosis
1. Characteristic appearance in bone marrow biopsy.
2. Characterisic appearance in peripheral blood smear (for leukemias).
3. Possible presense of chromozone abnormalites, such as Philadelphia chromosome (in the
case of CML).
4. Possible presense of decrease or increased red blood cell count, white blood cell
count, platelets.
Treatment
1. Treatment is multidrug chemotherapy (often with busulfan, alpha-interferon,
hydroxyurea, chlorambucil or cyclophosphamide, alone or in combination with other agents,
such as prednisone, vincristine, or doxorubicin), sometimes with medication given in the
central nervous system fluid and cranial irradiation.
2. Treatment is possible bone marrow transplantation.
3. In certain conditions, no treatment is given when the patient is asymptomatic.
4. Spleen removal or spleen irradiation.
Complications
1. Some of the complications subsequent to chemotherapy are:
a. Anemia (decreased red blood cell count)
b. Thrombocytopenia (decreased platelets)
d. Infection
e. Metabolic disturbances
(1) Electrolyte imbalance (especially low potassium)
(2) Calcium and phosphate abnormalities
(3) Elevated serum glucose
(4) Decreased renal function
(5) Elevated uric acid
f. Sepsis (generalized infection) is a common cause of death.
g. Bone marrow transplant complications
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