Advancements in Leukemia Treatment: A Conversation with Prof. Dr. Barış Malbora
Today, advancements in science and medicine have ushered in a hopeful era in the fight against leukemia. Leukemia is a type of cancer that affects the body's blood cells and often develops silently, yet profoundly impacts life upon diagnosis. However, thanks to the research conducted by scientists and the dedication of healthcare professionals, significant strides are being made in combating leukemia. Innovative treatment methods, genetic research, and programs aimed at improving patients' quality of life are igniting a new light of hope in the fight against leukemia. This news article reflects the courage and determination of those who are persistently advancing in this field, highlighting the latest developments and successes in leukemia treatment. We asked Pediatric Hematology and Oncology Specialist Prof. Dr. Barış Malbora about the latest developments in the fight against leukemia, the symptoms and treatment methods of the disease, and the responsibilities of society in this area.
Serpil Dokurel / Posta.com.tr | Leukemia is a type of cancer characterized by the rapid and uncontrolled proliferation of blood cells. This uncontrolled proliferation occurs in the bone marrow, the soft, spongy tissue inside our bones where most of the body's blood is made. Leukemia cells are typically immature, or still-developing, leukocytes (white blood cells). The term leukemia comes from the Greek words “leukos” (white) and “haima” (blood). So, how is leukemia diagnosed?
Pediatric Hematology and Oncology Specialist Prof. Dr. Barış Malbora notes that, unlike other cancers, leukemia typically does not form a distinct mass that shows up in radiological imaging tests. He lists the types of leukemia as follows: "There are many types of leukemia; some are more common in children, while others are more frequent in adults."
Leukemia begins in the bone marrow, the soft, spongy tissue in the inner cavities of your bones where your body's blood cells are made.
SILENT DANGER STARTS IN THE BONE MARROW BUT DOES NOT FORM A DISTINCT MASS!
Prof. Dr. Barış Malbora states that leukemia often progresses silently. "Leukemia does not form a distinct mass in radiological imaging tests. This feature distinguishes it from other types of cancer. The disease has various types, and treatment methods are determined based on the type of leukemia and other factors," he said. "Leukemia begins in the bone marrow, where the body's blood cells are produced, and blood cells go through a series of stages until they reach full maturity."
"There are many types of leukemia. Some are more common in children, while others are more frequent in adults," says Prof. Dr. Barış Malbora, emphasizing that treatment depends on the type of leukemia and other factors.
Leukemia begins in the bone marrow, the soft, spongy tissue in the inner cavities of your bones where your body's blood cells are made. Blood cells go through many stages until they reach their fully mature forms.
RANKING FIRST AMONG CHILDHOOD CANCERS
Childhood leukemias rank first in terms of incidence among cancers. Prof. Dr. Malbora said the following about the types of leukemia seen in childhood:
"Unlike in adults, the vast majority of childhood leukemias are acute leukemias; acute lymphoblastic leukemia (ALL) is more frequently observed. It occurs with an incidence of 3-4 per 100,000 per year. The incidence of acute lymphoblastic leukemia especially increases between the ages of 2 and 5. It is detected more often in boys than in girls. In children and adolescents, acute myeloid leukemia (AML) accounts for 20% of leukemias. The annual incidence of AML is 5-7 per million. The first two years are the ages with the highest incidence. The frequency increases again during adolescence. It is observed in equal proportions in girls and boys."
ALCOHOL AND RADIATION EXPOSURE DURING PREGNANCY INCREASE THE RISK!
Malbora states that there is no identifiable risk factor that can explain the development of leukemia in most children. "However, in some cases, inherited and acquired predisposing risk factors can be identified. Alcohol consumption by the mother during pregnancy, foods containing topoisomerase II inhibitors, certain viral infections, exposure to radiation, some drugs, organic substances like petroleum products and benzene, and pesticides can lead to leukemia. Various chromosomal abnormalities create a predisposition to leukemia. Children with Down syndrome, in particular, are known to be predisposed to AML," he said.
PAY ATTENTION TO BONE PAIN AND PALE SKIN APPEARANCE!
"The initial symptoms of acute leukemia are short-lived and can vary," Malbora continued. "Patients are often brought in due to loss of appetite, weakness, fatigue, irritability, intermittent fever, bone pain, and pallor. As the disease progresses, signs of bone marrow failure and bone pain become more pronounced. Due to organ involvement, there can be enlarged lymph nodes, liver, spleen, and testes, as well as respiratory distress and nervous system symptoms.
During a physician's examination, there are usually pallor, weakness, bruising on the skin, subcutaneous bleeding, bleeding in the mouth and gums, enlarged lymph nodes, liver, spleen, and testes, and bone or joint pain. There can even be difficulty breathing due to severe enlargement of lymph nodes within the chest."
'BONE MARROW EXAMINATION IS A MUST FOR A DEFINITIVE DIAGNOSIS'
Prof. Dr. Malbora said that a bone marrow examination must be performed to confirm the diagnosis. "Thanks to technical and scientific developments, the diagnosis of childhood leukemias (bone marrow cancer, blood cancer) can be made more easily today compared to previous years. In our country, the diagnosis and treatment of these diseases can be done under the same conditions as in Western countries. Results from simple blood tests can alert us about leukemia. A complete blood count often shows a higher number of white blood cells than normal. But it should also be known that sometimes the counts can be within normal limits or even below normal. The blood of patients suspected of having leukemia should be spread on a slide and evaluated under a microscope. Most of the time, this method reveals leukemia cells, which we call blasts. A bone marrow examination must be performed to confirm the diagnosis. The bone marrow sample taken can be examined under a microscope, and leukemic cells can be diagnosed," he explained.
85% OF PATIENTS RECOVER WITH CHEMOTHERAPY
Prof. Dr. Malbora said the following about the treatment process: "As pediatric blood disease and cancer physicians, we feel lucky. Because our children have a greater survival rate compared to adults and respond better to treatment. One of the biggest reasons for this is that adults with leukemia, with age, also have more diseases such as heart, lung, liver, and kidney diseases, diabetes, and hypertension, and may have a history of alcohol and smoking use.
Approximately 85% of leukemias seen in childhood recover with chemotherapy alone. The remaining 15-20% require a bone marrow transplant after a relapse of the disease or due to a predisposition to relapse after chemotherapy. Today, in addition to chemotherapy, biological treatment methods called immunotherapy have been included in the leukemia treatment process. In this treatment, certain drugs are used to strengthen the body's defense system (our immune system) to fight leukemia. Immunotherapy helps our immune system identify cancer cells and produce more immune cells to fight them."
WHAT SUPPORT SERVICES ARE AVAILABLE FOR CHILDREN WITH LEUKEMIA AND THEIR FAMILIES?
Prof. Dr. Malbora stated, "As with every cancer patient, patients diagnosed with leukemia and their families have a great need for social, economic, and psychological support from the moment of diagnosis until the end of treatment. First, the entire society needs to know that this patient is not contagious."
"Another point is economic support for these families," Malbora continued. "Our country's social security institution fully covers all treatment costs for these patients. This applies to both state and private hospitals. For this reason, I can easily say that we are more fortunate than many other countries. Unfortunately, however, economic problems are not limited to hospital treatment costs. Many patients, especially those living in rural areas, have to live away from home for a while because they need to be treated at larger city hospitals. This also brings with it housing and certain logistical problems.
Throughout the treatment, all patients need a large number of blood products. The inability to meet these needs carries vital risks for our patients. For this reason, it is our duty as healthy volunteers to help our patients with the provision of blood products such as erythrocytes (red blood) and platelets (clotting platelets). We should act with this sensitivity, thinking that one day that blood product may be needed for ourselves or our closest loved ones."
CAUSES DIVORCE AMONG PARENTS
Malbora explained that family problems can occur after diagnosis. "Another problem is that the frequency of divorce is higher among the parents of newly diagnosed patients with diseases like leukemia. Inability to accept the illness, loss of their social life comfort, and sometimes accusing each other of the cause of the disease with a wrong perception are common problems we encounter. With these accusations, the partnership of the parents can be seriously shaken, and the frequency of divorce increases. At this point, it is obvious how important social and psychological support can be," he explained.
GREAT STRIDES HAVE BEEN MADE IN LEUKEMIA TREATMENT FROM THE 19TH CENTURY TO THE PRESENT DAY
Prof. Dr. Malbora said that the survival rate for leukemia patients is close to 90% today. "Great strides have been made in leukemia treatment from the 19th century, when leukemia was first described, to the present day. While almost all of these patients were lost until the beginning of the twentieth century, today the survival rate has reached 90%. The increase in the variety and effectiveness of the drugs used in leukemia treatment has played a significant role here," he said.