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Leukemia, as recently recalled by the president of AIL (Italian Association for the Fight against Leukemia, Lymphomas and Myeloma) Sergio Amadori, are a group of very different diseases. In addition to being classified into acute or chronic, they can be characterized by the involvement of different blood cells.
For this reason, science is looking for the characteristics of each type of disease, in order to find targeted solutions for each individual case. In Acute Myeloid Leukemia, in particular, striking progress has been made in recent years with the identification of genetic markers and the development of smart and targeted drugs.
After thirty years of desert in which only chemotherapy was available, in the last five years a shower of innovative drugs that are radically changing the therapeutic profile of these pathologies.
When it comes to “fulminant” leukemia
The classic example of a fulminant form of leukemia, so defined for the rapidity with which the pathological picture develops, is Acute Promyelocytic Leukemia (APL). It is the most aggressive form of blood cancer.
Those affected by this pathology carry a particular genetic configuration that is acquired in the course of life, and therefore is not determined in a hereditary sense. In fact, a chromosomal translocation takes place. What does it mean? In practice, there is a sort of “exchange” of genetic material between chromosomes 15 and 17.
On the clinical front, the disease appears to be linked in its first manifestations more to the “upheaval” it causes in the different populations of cells produced by the bone marrow than by something specific to the white blood cells. What can be seen at the onset, in fact, is mainly linked to potentially serious bleeding with a low number of platelets (the units that promote coagulation) and to the simultaneous alteration of the normal coagulation control systems.
There are studies that show that at least one in ten people affected by this form of leukemia can suffer from fatal bleeding, such as cerebral hemorrhage, already in the early stages of the disease.
Sometimes just massive bleeding is the first sign of the pathology, which therefore may not even be recognized and therefore addressed on the treatment front. For this reason, we speak of a “fulminant” form: it is an extremely complex picture, especially in the very first days, while then you can proceed with the treatments.
As if that were not enough, a sort of “storm” occurs almost immediately in which the so-called DIC (Disseminated Intravascular Coagulation) comes into play, which can lead to potentially very serious damage to various organs, such as the kidneys, further worsening the situation.
Fulminant leukemia was fatal for Amici’s former competitor, Michele Merlo.
How to deal with it
Obviously, when the picture manifests itself in such a dramatic form in a few hours, the possibilities of treatment are mainly linked to the hope of being able to counteract hemorrhages, such as the cerebral one, which unfortunately are very serious. In short, the disease is very serious in the very first days of onset.
The situation changes when this aggressive form of leukemia “leaves time”. From the first symptoms, in the form of unexplained spontaneous hemorrhages that may lead to bruises and hematomas in the absence of trauma or epistaxis, that is, loss of nosebleeds (it must be said that these pictures are very common and are linked to many other pathological conditions), combined a feeling of profound tiredness and general malaise, the doctor can refer you to a center specialized in hematology where the diagnosis can be made.
At that point, in general terms, the chances of surviving and recovering from this disease, previously less than 20%, today are close to 95% thanks to a targeted therapy, not chemotherapy, based on arsenic trioxide combined with all-trans acid. -retinoic, a derivative of Vitamin A.
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