Disease Description (Causes and Symptoms)
- Definition and pathophysiology: A blood cancer in which normal blood cells in the bone marrow become malignant, causing abnormal white blood cells (leukemia cells) to proliferate excessively and inhibit the production of normal red blood cells, platelets, and white blood cells. Depending on its form, it is divided into acute (rapid progression, predominance of immature cells) and chronic (slow progression, predominance of mature cells), and is classified as myeloid (myeloid lineage) or lymphoid (lymphoid lineage).
- Main causes and risk factors: No single clear cause is known. High-dose radiation, chemicals such as benzene, previous chemotherapy (such as alkylating agents), and some genetic predispositions and genetic disorders (e.g., Down syndrome) are associated with it. Some cases of chronic myeloid leukemia (CML) are caused by BCR‑ABL rearrangement (the Philadelphia chromosome).
- Main symptoms: Fever, fatigue, weakness, weight loss, frequent infections, a tendency to bleed (easy bruising, bleeding gums, nosebleeds), symptoms of anemia (dizziness, shortness of breath), enlargement of the liver and spleen, enlarged lymph nodes, bone pain or joint pain, vomiting, nausea, and central nervous system symptoms (such as seizures). As the disease progresses, complications related to organ infiltration and bone marrow failure may occur.
Treatment Methods
- Acute leukemia (e.g., AML, ALL)
- Standard treatment: Induction of remission (intensive chemotherapy) → consolidation therapy after confirming remission (additional chemotherapy) → consideration of allogeneic hematopoietic stem cell transplantation (allo‑HSCT) according to risk and genotype.
- Supportive care: Transfusions (red blood cells and platelets), prevention and treatment of infections (antibiotics and antifungal agents), use of growth factors (G‑CSF), and prevention of tumor lysis syndrome (fluids and uric acid-lowering drugs/rasburicase).
- Side-effect management: Mucositis, vomiting, hair loss, and the risk of infection/bleeding due to bone marrow suppression.
- Chronic leukemia (e.g., CML, CLL)
- CML: BCR‑ABL-targeted therapies (tyrosine kinase inhibitors; imatinib (Gleevec), dasatinib (Sprycel), nilotinib (Tasigna), etc.) are the first-line standard. Second- or third-generation TKIs or transplantation may be considered in cases of resistance or intolerance. Treatment strategies vary according to the disease phase (chronic, accelerated, or blast phase).
- CLL: Observation (for asymptomatic, low-risk disease) or targeted therapy (such as BTK inhibitors), chemotherapy and antibody therapy, with transplantation considered when necessary.
- General lifestyle management and precautions
- Infection prevention (handwashing, avoiding crowded places, caution with raw foods), bleeding prevention (caution with activities involving sharp objects and medications), fertility preservation counseling (before chemotherapy), and vaccination (inactivated vaccines are recommended; live vaccines are generally prohibited).
- Monitoring
- Frequent blood tests (CBC), and bone marrow and genetic (molecular) tests (e.g., BCR‑ABL PCR, FLT3, NPM1, etc.) to monitor treatment response and relapse (MRD).
Checkpoints Before an Outpatient Visit (Including Suggested Items to Bring and Questions)
- Items to bring (recommended)
- A list of medications currently being taken (including prescription and nonprescription drugs and supplements), and allergy records
- Copies of recent test results (blood tests, bone marrow tests, imaging findings, etc.)
- A record of changes in symptoms (fever, bleeding, changes in urination or bowel movements, shortness of breath, etc.) and when they began
- A history of recent transfusions, hospitalizations, antibiotic administration, and vaccinations
- For women, the date of the most recent menstrual period, pregnancy status, and childbirth and breastfeeding status
- Items to show the doctor during the outpatient visit
- Recent CBC trends (a table of values, if possible), and photographs of symptoms suspected to be medication side effects (such as skin bleeding)
- Examples of questions to check yourself during the outpatient visit (notes to make before the appointment)
- Have I had a fever in the past few days? Have I been bleeding or bruising easily? When did shortness of breath or severe fatigue begin?
- Have I recently taken antibiotics, steroids, or immunosuppressants?
- Is there a possibility of sexual intercourse-related pregnancy, or do I wish to preserve fertility (eggs/sperm)?
Examples of General Questions to Ask the Doctor
- Could you tell me exactly what type of leukemia this lesion (or blood test result) indicates? (Including its form and genetic mutations)
- What is the recommended standard treatment, and what short- and long-term side effects are expected?
- What lifestyle measures should I follow to prevent infection and bleeding during treatment?
- If hematopoietic stem cell transplantation is needed, please explain when it would be performed and its risks and benefits.
- What factors determine the prognosis (survival rate and likelihood of remission)?
Examples of Disease-Specific Questions
- (Genetic-related) Does my leukemia have specific genetic mutations (e.g., BCR‑ABL, FLT3, NPM1, TP53, etc.)? If so, how do they affect treatment selection and prognosis?
- (Transplant-related) Is allogeneic hematopoietic stem cell transplantation recommended given my current condition? If so, when is the optimal timing, and what preparations are needed (finding a donor and managing side effects)?
Additional information: Diagnosis and treatment vary according to the individual patient's type (AML/ALL/CML/CLL, etc.), molecular genetic findings, age, and underlying diseases. Please discuss specific test results and treatment plans with the hematology specialist in charge of your care.