What is leukemia? - Danilo Allegra and Dania Puggioni
Despite advances in medicine,
cancer remains one of the most frightening
diagnoses patients can receive.
What makes it so difficult to cure
is that it's not one illness,
but a family of over 100 diseases
occurring in different types of cells.
And one type of cancer
has the unfortunate distinction
of afflicting children
more than any other type.
This is leukemia,
a cancer that begins in stem cells
found in the bone marrow.
A stem cell is a bit like an infant,
undeveloped but possessing
great potential.
Many stem cells specialize
and become cells of organs,
like the liver, brain and heart.
But in some tissues,
they can continue to divide into new
stem cells throughout development,
and into adulthood in order to frequently
generate new cells
and keep up with the body's needs.
One example is the bone marrow,
where stem cells differentiate
into many types of blood cells.
That includes red blood cells,
which carry oxygen
from the lungs to all tissues,
platelets, which help stop bleeding
by sticking to damaged blood vessels,
and white blood cells,
which patrol the body,
destroying potentially harmful invaders.
Every once in a while,
something goes wrong during
a stem cell's specialization process
and harmful mutations
occur in the cell's DNA.
Cells with compromised DNA
are supposed to self-destruct,
but some damaged cells ignore this order,
replicating uncontrollably,
even as they lose their original function.
These are what we know as cancer cells.
It is not yet clear why leukemia
is the most common childhood cancer,
but one contributing factor may be
that leukemias are often caused
by just one or two DNA modifications,
while most cancers require many of them,
allowing leukemias to arise faster
than other types of cancer.
Moreover, some DNA alterations
can occur in white blood cells
during fetal development,
further increasing the risk
of early leukemia.
But though it affects more children
than any other cancer,
adults constitute the majority
of leukemia patients overall.
Once leukemia strikes, the damaged cells
reproduce in the blood and the bone marrow
until they take up
all available space and resources.
When the bone marrow
can no longer produce
the required amount of functional cells,
the blood becomes depleted.
The lack of red blood cells
means that muscles
don't get enough oxygen,
the reduced number of platelets
is not sufficient to repair wounds,
and the dearth of functional white
blood cells impairs the immune system,
increasing the risk of infections.
To restore the normal
function of the blood,
leukemic cells have to be eliminated.
But because leukemias
are not solid tumors,
they can't be removed surgically.
Instead, the cells are killed
inside the body using various treatments
that include chemotherapy,
a combination of drugs that destroys
quickly multiplying cells.
Unfortunately, this has the side effect
of killing healthy cells,
such as those found in hair follicles
or intestines.
And in some cases, the dosage
required is so high
that it kills all cells
in the bone marrow,
including stem cells.
When this happens, the body is no longer
able to create new blood cells on its own.
Fortunately, outside help can come
in the form of stem cells
from the bone marrow of a donor.
Once transplanted into the patient,
they rapidly repopulate
the bone marrow and the blood.
However, bone marrow transplants
are a complicated process
requiring antigen compatibility
between the donor and recipient
to keep the transplanted cells from
from attacking the patient's own cells
as foreign bodies.
Unlike with blood transplants,
there are thousands of HLA types,
and even siblings and close relatives
may not have compatible bone marrow.
If this is the case, the search
is expanded to a database
containing the genetic makeup of millions
of voluntary bone marrow donors.
The more potential donors there are,
the more patients lives can be saved
through successful transplants.
Leukemia may be a frightening disease,
but there is strength and hope in numbers.
