Misr University for Science & Technology

College: Oral and Dental Surgery

Oral and Surgery and Medicine Department

Research Submitted by

Student Name: Mohammed Sayed Khalil

Student ID: 66232

Course name: General Medicine, Skin and Venereal Diseases

Course Code: GMED 402

Research Title: Leukemia

Supervised by:

Name of Supervisor: Dr. Manal Mahmoud Mohammed

Spring 2019 / 2020

1
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ABSTRACT Aberrant production of the immature white blood cells causes leukemia to begin. The
leukemogenesis process includes changes in expressions of various genes and their associated signaling
pathways. Current leukemia therapy treatment protocols can be very successful but they present significant
adverse effects on the patient. Newer methods therefore need to be explored which can help fight the
disease. Plant derived molecules, commonly referred to as phytochemicals, are studs with various properties
to combat disease. We also help fight cancer like leukemia. They exert their action by targeting specific
signaling molecules that are involved in the leukemia cycle. Such phytochemicals behave preferentially as
they only attack the cancer cells, sparing the healthy normal cells. This peculiar feature of these molecules
helps to mitigate therapy side effects. Various in vitro and in vivo studies indicate that the therapy 's efficacy
is improved when phytochemicals are used to treat cancer cells along with existing therapeutic regimens.
Therefore, if phytochemicals are used in combination with current therapeutic protocols, the therapy
outcomes can be improved. However, intense clinical trials are needed to prove the effectiveness of
phytochemicals as an adjuvant. INTRODUCTION Abnormal blood cell proliferation in the bone marrow
and blood forming organs leads to a malignant disease usually referred to as leukemia, which can be graded
according to progression rate. Leukemia can start suddenly (acute) or slowly, and gradually (chronically).
The type of malmignattes is often categorized according to the type of infected blood cell. Throughout the
hematopoiesis cycle, cells belonging to both the myeloid and lymphoid lineages are derived from
hematopoietic stem cells. Malignancy involving myeloid cells, granulocytes (neutrophils, basophils, and
eosinophils) and monocytes (macrophages) leads to myeloid leukemia while it induces lymphocytic
leukemia involving T and B lymphocytes. There are various types of leukemia. Acute myelogenous
leukemia (AML), chronic myelogenous leukemia (CML), acute lymphocytic leukemia (ALL), and chronic
lymphocytic leukemia (CLL) are the major 4 forms. There are other types of leukemia that are normally
rare; these are hairy cell leukemia, prolymphocytic T-cell leukemia, large lymphocytic leukemia, and adult
T-cell leukemia. Excessive build-up of relatively mature but still abnormal white blood cells characterizes
CML. For CML, the median age is 45 to 55 years. In Asian countries CML is a common form of leukemia.
It has more effect on males than females. CLL is the form of leukemia commonly found in the western
world. The median age of diagnosis of this leukemia is 72 years, however a small proportion of patients are
diagnosed below 55 years. ALL is the common type of leukemia in infants under the age of 5. Adults over
50 are also susceptible to ALL though. In the White population Everything prevails over the African

2
Americans. Mortality from ALL occurs mainly in adults. AML is an elderly population disease at the time
of diagnosis, having a median age of 67 years. It is seen more often in the U.S. population. AML is the
most prevalent form of acute leukemia in adults. Leukemia Overview Leukemia is a cancerous condition
of the blood cells characterized by the uncontrollable growth of malignant cells in bone marrow. Often
considered a children’s disease, leukemia affects many more adults than children. Doctors believe the
disease is caused by acquired mutations of the blood cell’s DNA. Statistics collected by the Leukemia and
Lymphoma Society show that there are more than 340,000 individuals living with leukemia that is either
active or in remission in the United States. An estimated 60,000 more people are predicted to get a leukemia
diagnosis in 2016, and more than 24,000 people are likely to die from the disease. The overall five-year
survival rate for the disease has risen to more than four times higher among Caucasians since 1960 (only
data collected since that time). Today, the average survival rate of five years is estimated at more than 60
percent.
Risk Factors of Leukemia Factors which increase the probability of a disease are known as risk factors.
Various family, genetic, lifestyle, and environmental factors are allegedly responsible for leukemia growth.
Smoking habits can be correlated with the occurrence of leukemia although a potential cause of lung and
oral cancer. In an adult, too, leukemia can grow due to exposure to chemicals such as benzene and herbicides
in their workplace. Blood cancer often develops as secondary cancers, i.e. treatment with some
chemotherapeutic drugs and high-dose radiation therapy that increase leukemia. Individuals with
i.e. treatment with some chemotherapeutic drugs and high-dose radiation therapy that increase leukemia.
Individuals with polycythemia vera, critical thrombocythemia, idiopathic myelofibrosis, and
myelodysplastic syndrome are at elevated risk of developing leukemia. Some chronic forms of leukemia
can eventually lead to aggressive forms, too. People with genetic disorders such as Down syndrome, Bloom
syndrome, Klinefelter syndrome, Black Fan-Diamond syndrome, Fanconi anemia, Ataxia-telangiectasia,
Li-Fraumeni syndrome, Neurofibromatosis I, Kostmann syndrome etc. are at elevated risk. HTLV virus
infection can lead to some form of ALL. Leukemia risks may also depend on race or ethnicity, as they are
more prevalent in North America and Europe compared with those in Asia. Family history may also
increase the likelihood of having the condition. Excessive alcohol and drug use can be a leukemia-causing
factor. Obesity is also instrumental in the development of leukemogenesis. Another possible risk factor is
the low frequency electromagnetic field.

Sources Similarity

3
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Symptoms of Leukemia Many types of leukemia can be asymptomatic in its early stages. Leukemia
symptoms depend on whether acute or chronic leukemia is present. Acute forms of leukemia tend to get
worse more quickly than the chronic forms. At its initial stages, acute leukemia shows flu as symptoms
whereas chronic leukemia shows hardly any symptoms. Chronic leukemia is usually found during routine
blood testing. Some of the common signs and symptoms include fatigue, discomfort, loss of appetite, weight
loss, fever, shortness of breath, paleness, palpitations, easy bruising and bleeding, dizziness, susceptibility
to cold, sore throat, nausea, headaches, vision problems, night sweats, joint pain, abdominal discomfort,
etc. Many commonly reported symptoms include experiencing fullness in the belly, purpura, leukocytosis,
anemia, splenomegaly and thrombocytosis. If irregular and immature blood cells accumulate under the skin
or other parts of the body, a malignant condition is developed, called chloroma. Among leukemia patients
will also see leukemia cutis, leukocytoclastic vasculitis and Sweet 's syndrome, or acute febrile neutrophilic
dermatosis. Genes in Leukemia Genes play a significant role in the leukemogenesis cycle. Chromosomal
aberrations and defects in the genes are typical of all types of leukemia. These genetic-level changes affect
key signal transduction pathways which lead to the initiation, promotion and progression of the disease.
DNA methylation and histone alterations contribute to leukemia development. Transcription factors shift
such as FLT3, KIT, NRAS, KRAS, CEBPA, NPM1, PAX5, TCF3, EBF1 etc. Other genes involved in
leukemia include SMAD2, CDK9, MEN1, HDAC1, LCK etc. Individuals are predisposed to developing
leukemia through mutations in other genes; CEBPA, GATA2 and RUNX1 are few such genes. CEBPA
plays a key function in separating myeloid. Persons inheriting germline mutations in this gene are likely to
be vulnerable to acute myeloid leukemia. Mutations of the gene RUNX1 also cause autosomal dominant
family platelet disorder and can lead to myeloid malmignattes. GATA2, a transcription factor, contributes
to the maintenance of hematopoietic stem cell integrity. Myelodysplastic syndrome (MDS) or acute
myeloid leukemia (AML) may result in mutation in this gene. Loss of a tumor suppressor gene located on
chromosome 7 can help cause MDS and AML. MicroRNAs are small non-coding molecules which play a
vital role in silencing RNA and regulating the post-transcription gene. Various microRNAs in leukemia are
known to contribute to pathogenesis by controlling transcriptional oncogenes and tumor suppressor genes.
MIG-17-92 polycistron is strongly expressed in acute leukemia, and contributes to disease progression by
inhibiting normal hematopoietic processes. The affected genes are PTEN, BIM, RASSF2, Web, E2F etc.
MirR-155 and miR-196a & b are other microRNAs that play a crucial role in acute leukemia. MiR-15a/16-
1 has tumor suppressor properties and is expressed in low CLL concentrations. Cytokines are important
immune system regulators, which play a major role in hematopoiesis which cell signaling. Aberrant
cytokine signaling controls leukemia cell proliferation. Many of the cytokines involved are TNF α, IL 2, IL
6 and IL8 interleukins etc. Types of leukemia The major types of leukemia are: • Acute leucemia

4
lymphocyta (ALL). This form of leukemia is most common in young children. In adults too, ALL may
occur. • Acute leukemia myelogena (AML). AML is a form of leukemia common to all. It occurs in kids
and adults. AML is the most common form of adult acute leukemia. • Chronic Leukaemia Lymphocyta
(CLL). With CLL, the most common chronic adult leukemia, you may feel well without requiring care for
years. • Myelogenous chronic leukemia (CML). This form of leukemia affects more the adults. A person
with CML can experience little to no symptoms for months or years before entering a period where the
leukemia cells develop faster. • Other types. Other, rarer types of leukemia exist, including hairy cell
leukemia, myelodysplastic syndromes and myeloproliferative disorders. Treating Leukemia Fortunately,
treatments are available to treat chronic and acute leukemia, and several more are in progress. The doctor
will often recommend a combination of effective therapies to boost the success rate. • Acute Leukemia –
This type of leukemia is often healed, but needs prompt care upon diagnosis of the disease. The doctor must
formulate a successful strategy to cause a remission in which the leukemia cells in the body are absent.
Typically, this is followed up by maintenance or consolidation therapy to which the leukemia cells in the
body are absent. Typically, this is followed up by maintenance or consolidation therapy to prevent a relapse.
• Chronic leukemia-This type of leukemia is less likely to be treated but can be managed to prolong survival
rates and manage symptoms. Some doctors suggest transplantation of stem cells to improve a cure 's future
effectiveness. It is important to get a second opinion before seeking any medication, unless the disease is
extremely aggressive and any delay in care may result in a major undesired outcome. The doctor will
possibly prescribe one or more treatments which will include: • Chemotherapy-Chemotherapy uses drugs
designed to rapidly destroy cancer cells that replicate leukemia. The medication may be administered orally
or intravenously, or into the bloodstream through a catheter. Most chemotherapy treatments are a
combination of more than one drug that often results in severe side effects including hair loss, mouth sores,
vomiting, loss of appetite, nausea, easy bleeding or bruising, fatigue or infection development.

Sources Similarity
Leukemia - Symptoms and causes - Mayo Clinic
other, rarer types of leukemia exist, including hairy cell leukemia, myelodysplastic syndromes and
myeloproliferative disorders.certain genetic disorders, such as down syndrome, are associated with
an increased risk of leukemia. exposure to certain chemicals.
3%
https://www.mayoclinic.org/diseases-conditions/leukemia/symptoms-causes/syc-20374373

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• Biological therapy-This procedure is based on living or synthetic substances and substances obtained from
living organisms. That include the cytokines, tumor vaccines and antibiotics regulating immune system.
Some biological therapies are designed to cause a reaction against specific cancer targets including
monoclonal antibodies. Compared with chemotherapy, these therapies appear to cause less serious side
effects such as tiredness, nausea, body aches and headaches. • Targeted therapy – Medications administered
interfere with functions of cancer cells rather than indiscriminately kill all growing cells. This causes
significantly less damage to normal healthy cells and targets cancerous cells instead to minimize their
growth and metastasizing (spreading) ability. Several targeted therapy drugs include Sprycel (dasatinib)
and Gleevec (imatinib) that may cause side effects include rapid weight gain, bloating, swelling, rash,
muscle cramps, diarrhea, vomiting and nausea. • Radiation therapy-High-energy radiation beams can
destroy cancer cells and kill them. This treatment does, however, cause side effects including diarrhea,
vomiting and nausea. • Stem cell transplant – Once abnormal blood cells are destroyed, intravenous fusion
transplant stem cells can be implanted and kept alive by suppressing the response of the immune system to
the invading new cells using medications or steroids. CONCLUSION Leukemia is a hematopoietic disease
which involves the excessive production of immature blood cells, involving several genes. Genetic-level
changes disrupt the signal transduction pathways involved in carcinogenesis. Both pathways are targeted
by traditional treatment methods, thus stopping the three cancer stages, namely initiation, advancement,
and progression. Existing therapeutic regimens cause undesirable adverse effects on an patient because they
target not only the cancer cells but also the normal cells. Therefore, it is important to explore alternate
means which could help to counter the side effects of treatment.

Sources Similarity

6
 Table of Contents

Content Page
List of Figures 8
Acknowledgment 9
Abstract 10
Introduction 10
Leukemia Overview 11
Risk Factors of Leukemia 12
Symptoms of Leukemia 13
Genes in Leukemia 14
Types of leukemia 15
Treating Leukemia 16
Summary 19
References 20

7
 List of Figures

Figure Title Page

No.
Figure 1 Difference between normal and abnormal blood cells 7
(Leukemia)
Figure 2 Symptoms of Leukemia 9
Figure 3 Stem cell transplant 13

8
 Acknowledgment

All praise to ALLAH whose guidance and the power have given me strength to
finish this work.

I would like to express my very great appreciation to my faculty and my great

university Misr university for science and technology and I would like to offer my
special thanks to our professors for them Advices and teaching us online in way
similar to lecture attendance which make great help in understanding the subjects, I
am particularly grateful for the Medicine department as they was always in contact
with us by great lectures helped us to study from home in the hard days of that
pandemic which provided me with very valuable information to achieve that
research.

I would like to thank my Dr. Manal Mahmoud Mohammed for their assistance to
study from home
My special thanks are extended to all the staff in my faculty as they are a great part
of the white military against the pandemic.

9
ABSTRACT

Aberrant production of the immature white blood cells causes leukemia to begin.
The leukemogenesis process includes changes in expressions of various genes and
their associated signaling pathways. Current leukemia therapy treatment protocols
can be very successful but they present significant adverse effects on the patient.
Newer methods therefore need to be explored which can help fight the disease. Plant
derived molecules, commonly referred to as phytochemicals, are studs with various
properties to combat disease. We also help fight cancer like leukemia. They exert
their action by targeting specific signaling molecules that are involved in the
leukemia cycle. Such phytochemicals behave preferentially as they only attack the
cancer cells, sparing the healthy normal cells. This peculiar feature of these
molecules helps to mitigate therapy side effects. Various in vitro and in vivo studies
indicate that the therapy 's efficacy is improved when phytochemicals are used to
treat cancer cells along with existing therapeutic regimens. Therefore, if
phytochemicals are used in combination with current therapeutic protocols, the
therapy outcomes can be improved. However, intense clinical trials are needed to
prove the effectiveness of phytochemicals as an adjuvant.

INTRODUCTION

Abnormal blood cell proliferation in the bone marrow and blood forming organs
leads to a malignant disease usually referred to as leukemia, which can be graded
according to progression rate. Leukemia can start suddenly (acute) or slowly, and
gradually (chronically). The type of malmignattes is often categorized according to
the type of infected blood cell. Throughout the hematopoiesis cycle, cells belonging
to both the myeloid and lymphoid lineages are derived from hematopoietic stem
cells. Malignancy involving myeloid cells, granulocytes (neutrophils, basophils, and
eosinophils) and monocytes (macrophages) leads to myeloid leukemia while it
10
induces lymphocytic leukemia involving T and B lymphocytes. There are various
types of leukemia. Acute myelogenous leukemia (AML), chronic myelogenous
leukemia (CML), acute lymphocytic leukemia (ALL), and chronic lymphocytic
leukemia (CLL) are the major 4 forms. There are other types of leukemia that are
normally rare; these are hairy cell leukemia, prolymphocytic T-cell leukemia, large
lymphocytic leukemia, and adult T-cell leukemia. Excessive build-up of relatively
mature but still abnormal white blood cells characterizes CML. For CML, the
median age is 45 to 55 years. In Asian countries CML is a common form of
leukemia. It has more effect on males than females. CLL is the form of leukemia
commonly found in the western world. The median age of diagnosis of this leukemia
is 72 years, however a small proportion of patients are diagnosed below 55 years.
ALL is the common type of leukemia in infants under the age of 5. Adults over 50
are also susceptible to ALL though. In the White population Everything prevails
over the African Americans. Mortality from ALL occurs mainly in adults. AML is
an elderly population disease at the time of diagnosis, having a median age of 67
years. It is seen more often in the U.S. population. AML is the most prevalent form
of acute leukemia in adults.

Leukemia Overview

Leukemia is a cancerous condition of the blood cells characterized by the

uncontrollable growth of malignant cells in bone marrow. Often considered a
children’s disease, leukemia affects many more adults than children. Doctors believe
the disease is caused by acquired mutations of the blood cell’s DNA.

Statistics collected by the Leukemia and Lymphoma Society show that there are
more than 340,000 individuals living with leukemia that is either active or in
remission in the United States. An estimated 60,000 more people are predicted to

11
get a leukemia diagnosis in 2016, and more than 24,000 people are likely to die from
the disease. The overall five-year survival rate for the disease has risen to more than
four times higher among Caucasians since 1960 (only data collected since that time).
Today, the average survival rate of five years is estimated at more than 60 percent.

Fig.1: Difference between normal and abnormal blood cells (Leukemia)

Risk Factors of Leukemia

Factors which increase the probability of a disease are known as risk factors. Various
family, genetic, lifestyle, and environmental factors are allegedly responsible for
leukemia growth. Smoking habits can be correlated with the occurrence of leukemia
although a potential cause of lung and oral cancer. In an adult, too, leukemia can
grow due to exposure to chemicals such as benzene and herbicides in their
workplace. Blood cancer often develops as secondary cancers, i.e. treatment with
some chemotherapeutic drugs and high-dose radiation therapy that increase
leukemia. Individuals with polycythemia vera, critical thrombocythemia, idiopathic
myelofibrosis, and myelodysplastic syndrome are at elevated risk of developing

12
leukemia. Some chronic forms of leukemia can eventually lead to aggressive forms,
too. People with genetic disorders such as Down syndrome, Bloom syndrome,
Klinefelter syndrome, Black Fan-Diamond syndrome, Fanconi anemia, Ataxia-
telangiectasia, Li-Fraumeni syndrome, Neurofibromatosis I, Kostmann syndrome
etc. are at elevated risk. HTLV virus infection can lead to some form of ALL.
Leukemia risks may also depend on race or ethnicity, as they are more prevalent in
North America and Europe compared with those in Asia. Family history may also
increase the likelihood of having the condition. Excessive alcohol and drug use can
be a leukemia-causing factor. Obesity is also instrumental in the development of
leukemogenesis. Another possible risk factor is the low frequency electromagnetic
field.

Symptoms of Leukemia

Many types of leukemia can be asymptomatic in its early stages. Leukemia

symptoms depend on whether acute or chronic leukemia is present. Acute forms of
leukemia tend to get worse more quickly than the chronic forms. At its initial stages,
acute leukemia shows flu as symptoms whereas chronic leukemia shows hardly any
symptoms. Chronic leukemia is usually found during routine blood testing. Some of
the common signs and symptoms include fatigue, discomfort, loss of appetite,
weight loss, fever, shortness of breath, paleness, palpitations, easy bruising and
bleeding, dizziness, susceptibility to cold, sore throat, nausea, headaches, vision
problems, night sweats, joint pain, abdominal discomfort, etc. Many commonly
reported symptoms include experiencing fullness in the belly, purpura, leukocytosis,
anemia, splenomegaly and thrombocytosis. If irregular and immature blood cells
accumulate under the skin or other parts of the body, a malignant condition is
developed, called chloroma. Among leukemia patients will also see leukemia cutis,

13
leukocytoclastic vasculitis and Sweet 's syndrome, or acute febrile neutrophilic
dermatosis.

Fig.2: Symptoms of Leukemia

Genes in Leukemia

Genes play a significant role in the leukemogenesis cycle. Chromosomal aberrations

and defects in the genes are typical of all types of leukemia. These genetic-level
changes affect key signal transduction pathways which lead to the initiation,
promotion and progression of the disease. DNA methylation and histone alterations
contribute to leukemia development. Transcription factors shift such as FLT3, KIT,
NRAS, KRAS, CEBPA, NPM1, PAX5, TCF3, EBF1 etc.

14
Other genes involved in leukemia include SMAD2, CDK9, MEN1, HDAC1, LCK
etc. Individuals are predisposed to developing leukemia through mutations in other
genes; CEBPA, GATA2 and RUNX1 are few such genes. CEBPA plays a key
function in separating myeloid. Persons inheriting germline mutations in this gene
are likely to be vulnerable to acute myeloid leukemia. Mutations of the gene RUNX1
also cause autosomal dominant family platelet disorder and can lead to myeloid
malmignattes. GATA2, a transcription factor, contributes to the maintenance of
hematopoietic stem cell integrity. Myelodysplastic syndrome (MDS) or acute
myeloid leukemia (AML) may result in mutation in this gene. Loss of a tumor
suppressor gene located on chromosome 7 can help cause MDS and AML.

MicroRNAs are small non-coding molecules which play a vital role in silencing
RNA and regulating the post-transcription gene. Various microRNAs in leukemia
are known to contribute to pathogenesis by controlling transcriptional oncogenes
and tumor suppressor genes. MIG-17-92 polycistron is strongly expressed in acute
leukemia, and contributes to disease progression by inhibiting normal hematopoietic
processes. The affected genes are PTEN, BIM, RASSF2, Web, E2F etc. MirR-155
and miR-196a & b are other microRNAs that play a crucial role in acute leukemia.
MiR-15a/16-1 has tumor suppressor properties and is expressed in low CLL
concentrations.

Cytokines are important immune system regulators, which play a major role in
hematopoiesis which cell signaling. Aberrant cytokine signaling controls leukemia
cell proliferation. Many of the cytokines involved are TNF α, IL 2, IL 6 and IL8
interleukins etc.

Types of leukemia

The major types of leukemia are:

15
  Acute leucemia lymphocyta (ALL). This form of leukemia is most common
in young children. In adults too, ALL may occur.
 Acute leukemia myelogena (AML). AML is a form of leukemia common to
all. It occurs in kids and adults. AML is the most common form of adult acute
leukemia.
 Chronic Leukaemia Lymphocyta (CLL). With CLL, the most common
chronic adult leukemia, you may feel well without requiring care for years.
 Myelogenous chronic leukemia (CML). This form of leukemia affects more
the adults. A person with CML can experience little to no symptoms for
months or years before entering a period where the leukemia cells develop
faster.
 Other types. Other, rarer types of leukemia exist, including hairy cell
leukemia, myelodysplastic syndromes and myeloproliferative disorders.

Treating Leukemia

Fortunately, treatments are available to treat chronic and acute leukemia, and several
more are in progress. The doctor will often recommend a combination of effective
therapies to boost the success rate.

 Acute Leukemia – This type of leukemia is often healed, but needs prompt
care upon diagnosis of the disease. The doctor must formulate a successful
strategy to cause a remission in which the leukemia cells in the body are
absent. Typically, this is followed up by maintenance or consolidation therapy
to prevent a relapse.
 Chronic leukemia-This type of leukemia is less likely to be treated but can be
managed to prolong survival rates and manage symptoms. Some doctors
suggest transplantation of stem cells to improve a cure 's future effectiveness.

16
It is important to get a second opinion before seeking any medication, unless the
disease is extremely aggressive and any delay in care may result in a major undesired
outcome. The doctor will possibly prescribe one or more treatments which will
include:

 Chemotherapy-Chemotherapy uses drugs designed to rapidly destroy cancer

cells that replicate leukemia. The medication may be administered orally or
intravenously, or into the bloodstream through a catheter. Most chemotherapy
treatments are a combination of more than one drug that often results in severe
side effects including hair loss, mouth sores, vomiting, loss of appetite,
nausea, easy bleeding or bruising, fatigue or infection development.
 Biological therapy-This procedure is based on living or synthetic substances
and substances obtained from living organisms. That include the cytokines,
tumor vaccines and antibiotics regulating immune system. Some biological
therapies are designed to cause a reaction against specific cancer targets
including monoclonal antibodies. Compared with chemotherapy, these
therapies appear to cause less serious side effects such as tiredness, nausea,
body aches and headaches.
 Targeted therapy – Medications administered interfere with functions of
cancer cells rather than indiscriminately kill all growing cells. This causes
significantly less damage to normal healthy cells and targets cancerous cells
instead to minimize their growth and metastasizing (spreading) ability.
Several targeted therapy drugs include Sprycel (dasatinib) and Gleevec
(imatinib) that may cause side effects include rapid weight gain, bloating,
swelling, rash, muscle cramps, diarrhea, vomiting and nausea.

17
 Radiation therapy-High-energy radiation beams can destroy cancer cells and
kill them. This treatment does, however, cause side effects including diarrhea,
vomiting and nausea.
 Stem cell transplant – Once abnormal blood cells are destroyed, intravenous
fusion transplant stem cells can be implanted and kept alive by suppressing
the response of the immune system to the invading new cells using
medications or steroids.

Fig.3: Stem cell transplant

18
CONCLUSION

Leukemia is a hematopoietic disease which involves the excessive production of

immature blood cells, involving several genes. Genetic-level changes disrupt the
signal transduction pathways involved in carcinogenesis. Both pathways are targeted
by traditional treatment methods, thus stopping the three cancer stages, namely
initiation, advancement, and progression. Existing therapeutic regimens cause
undesirable adverse effects on an patient because they target not only the cancer cells
but also the normal cells. Therefore, it is important to explore alternate means which
could help to counter the side effects of treatment.

REFERENCES

19
1. Kondo M. Lymphoid and myeloid lineage commitment in multipotent
hematopoietic progenitors. Immunol Rev. 2010 Nov; 238(1): 37–46.

2. Haouas H, Haouas S, Uzan G, Hafsia A. Identification of new markers

discriminating between myeloid and lymphoid acute leukemia. Hematology. 2010
Aug; 15(4):193-203.

3. Redaelli A, Stephens JM, Laskin BL, Pashos CL, Botteman MF. The burden and
outcomes associated with four leukemias: AML, ALL, CLL and CML. Expert Rev
Anticancer Ther. 2003 Jun; 3(3): 311-329.

4. Laneuville P, Barnett MJ, Bélanger R, Couban S, Forrest DL, Roy DC, et al.
Recommendations of the Canadian Consensus Group on the Management of
Chronic Myeloid Leukemia. Curr Oncol. 2006 Dec; 13(6): 201–221.

5. Radivoyevitch T, Jankovic GM, Tiu RV, Saunthararajah Y, Jackson RC, Hlatky

LR, et al. Sex differences in the incidence of chronic myeloid leukemia. Radiat
Environ Biophys. 2014 Mar; 53(1): 55–63.

6. Shanafelt TD, Rabe KG, Kay NE, Zent CS, Jelinek DF, Reinalda MS, et al. Age
at Diagnosis and the Utility of Prognostic Testing in Patients with Chronic
Lymphocytic Leukemia (CLL). Cancer. 2010 Oct 15; 116(20): 4777–4787.

7. Parikh SA, Rabe KG, Kay NE, Call TG, Ding W, Schwager SM, et al. Chronic
lymphocytic leukemia in young (≤ 55 years) patients: a comprehensive analysis of
prognostic factors and outcomes. Haematologica. 2014 Jan; 99(1): 140–147.

8. Inaba H, Greaves M, Mullighan CG. Acute lymphoblastic leukaemia. Lancet.

2013 Jun 1;381(9881):1943-1955.

20