Leukemia generally describes a group of malignant disorders involving white blood cells, which affect blood-forming tissues, the bone marrow, and the lymph system. It causes malignant leukocytes to become more numerous and hinder the development of normal functional blood cells. Since its initial discovery, the classification has grown to be rather complex and detailed, but all the kinds of this disease can be divided into four types. This essay overviews these four main types together with the symptoms, signs, and ways of treatment for each.
The origin of the disease is still unknown, but it is proven to be caused by a range of different factors, which include genetic and environmental issues. McCance and Huether (2015) claim that “increased risk in adults has been linked to exposure to cigarette smoke, benzene, and ionizing radiation” (p. 1015). Leukemia also tends to repeat in families through generations, is often related to hereditary abnormalities as Down syndrome and immune deficiency disorders. Regardless of their differences and types, all leukemias share similar pathophysiological features that lead to a risk of kidney stones and failure, severe pain in bones, hemorrhages, and other complications, which altogether result in death.
Today leukemias have two basic criteria for differentiation: the type of blood cells and the rate of progression of the disease. According to the latter, there are two types – acute and chronic, where acute leukemia can be described by a high number of immature and nonfunctional cells, whereas chronic has a higher proportion of mature cells, though their functionality is substantially reduced. Considering the type of cells involved, both acute and chronic leukemia is divided into lymphocytic and myelogenous leukemia. Thus, the four main types are acute lymphocytic leukemia (ALL), acute myelogenous leukemia (AML), chronic lymphocytic leukemia (CLL), and chronic myelogenous leukemia (CML).
When patients are diagnosed for ALL, almost all of them suffer from fever, bleeding, fatigue, vomiting, abdominal pain, and weakness. The signs and symptoms can appear suddenly as well as progress slowly, with growing weakness and more frequent occurrences of bleeding. As for AML, researchers note that its “clinical manifestations are usually related to replacement of normal hematopoietic cells in the marrow by leukemic myeloblasts and, to a lesser extent, to infiltration of other organs and tissues” (Lewis et al., 2016, p. 386). AML has almost all the same symptoms as ALL with the addition of mouth sores, anemia, headache, and sternal tenderness.
Chronic leukemia does not usually have abrupt onsets and very characteristic straightforward symptoms; it advances insidiously and can be diagnosed during a routine blood check. CML has a stable phase for several years, with no symptoms early in the disease, and fatigue, weakness, fever, bone pain, weight loss, and increased sweating further on. After that follows an acute aggressive phase, the most characteristic sign of it is the so-called Philadelphia chromosome, which is present in 90-95% of cases of CML and is considered to be its most important indicator. CLL frequently has no symptoms and is usually diagnosed when checking for non-related diseases. Just as the other types, it is accompanied by fatigue, fever, and weight-loss, but only in later stages.
Ways of treatment, though generally the same for all types of leukemia, vary in effectiveness depending on the age of patients and individual cases. For example, chemotherapy is observed to be most successful with ALL in children from 1 to 9 years of age, but infants and adolescents respond to it less positively (VanMeter & Hubert, 2017). Cases of CML tend to be treated with biological therapy to stimulate the immune system as a part of the healing process.
When chemotherapy proves to be ineffective, bone marrow transplantation can be employed, but certain restrictions apply due to the necessity to make total body radiation to prepare for the transplantation. Moreover, it is rather problematic to locate donors because donor availability is limited, and even having donors reduces the range of transplantation usage to adults over 65 due to high toxicity.
Adhering to a proper level of nutrition and hydration makes up a significant part of the treatment because it helps to prevent complications and the formation of kidney stones. According to McCance and Huether (2015), the rates of remission and survival in most forms of leukemia have increased over the last twenty years ranging from 24% for AML to 81% for CLL. As children and adolescents up to 15 years of age with ALL, the statistics show 91% of positive outcomes. These are the results of more efficient chemotherapeutic agents, better blood products, and highly-qualified nursing care. Survival time for patients with acute leukemia has risen because of improved chemotherapy and bone marrow transplants.
Attaining remission is the first concern for professional care, as the character of the disease is not very obvious to an individual, which often allows it to be clinically diagnosed only at the later stages. All four types of leukemia can be treated by a complex of measures, including chemotherapy and transplantation. These methods prove to be effective for different types of leukemia both with adults and children, and they lower mortality rates.
References
Lewis, S. L., Hagler, D., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2016). Clinical companion to medical-surgical nursing: Assessment and management of clinical problems (10th ed.). St. Louis, MO: Elsevier.
McCance, K. L., & Huether, S. E. (2015). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Elsevier.
VanMeter, K. C., & Hubert, R. J. (2017). Gould’s pathophysiology for the health professions (6th ed.). St. Louis, MO: Elsevier.