A.V.

P TRUST PUBLIC SENIOR SECONDARY SCHOOL (CBSE)-2020-2021

(Affiliated to the Central Board of Secondary Education, Delhi, Affi. No :1930358

BIOLOGY PROJECT

PROJECT REPORT ON “LEUKEMIA”

Submitted in partial fulfilment of the requirement of CBSE,

Delhi for the award “Senior Secondary Certificate” in
BIOLOGY for the academic year 2021-2022.

Submitted by : Under the guidance of :

KABILA . I MRS . MANI MEGALA .T

ROLL NUMBER :
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 ACKNOWLEDGEMENT
At the outset, We would like to express our gratitude to the
Almighty, for keeping us in good health all through our school
life.

We, with great pleasure and sincerely record our gratitude to

our school Principal Mrs .PRAMOTHINE MBA.,(PhD)., AVP Trust
Public Senior Secondary School (CBSE) TIRUPUR for allowing
us to pursue this project.

We place our record of sincere gratitude and appreciation to

our project guide Mrs .MANI MEGALA . T M.Sc.,B.Ed., for her
kind cooperation and guidance which enabled us to complete
this project on time.

We take this opportunity to dedicate our project to the faculty

members who were a constant source of motivation and we
express our deep gratitude to their never ending support and
encouragement during this project. Finally, we thank each and
everyone who helped us to complete this project.
 DECLARATION

I, KABILA . I hereby declare that the

project on “LEUKEMIA” by me, under the guidance of
Mrs . MANI MEGALA.T is submitted in partial fulfilment of
the requirement of the award of the CBSE grade XII in the
academic year 2021 - 22.

KABILA . I
 CONTENTS
 INTRODUCTION
 HISTORY
 ETYMOLOGY
 SOCIETY AND CULTURE
 TYPES OF LEUKEMIA
 SIGNS AND SYMPTOMS
 LEUKEMIA FORMATION
 DIAGNOSIS
 DIFFERENTIAL DIAGNOSIS
 RISK FACTOR
 LEUKEMIA CLASSIFICATION
 HOW COMMON IS LEUKEMIA
 LEUKEMIA TREATMENT

 STAGES OF LEUKEMIA TREATMENT

 WHAT OUTCOME CAN I EXPECT IF I HAVE A DIAGNOSIS OF LEUKEMIA
 CAN LEUKEMIA BE CURED
 WHAT QUESTIONS SHOULD I ASK MY DOCTOR AND HEALTHCARE TEAM
AFTER I’VE BEEN DIAGNOSED LEUKEMIA ?
 PREGNANCY
 CLINICAL TRIALS FOR LEUKEMIA
 CONCLUSION
 BIBLIOGRAPHY
 INTRODUCTION

Cancer starts when cells in the body change (mutate)

and grow out of control. Your body is made up of tiny building
blocks called cells. Normal cells grow when your body needs
them. They die when your body doesn't need them anymore.
Cancer is made up of abnormal cells that grow even though
your body doesn’t need them. In most types of cancers, the
abnormal cells grow to form a lump or mass called a tumor.

Leukemia is different from most other cancers.

Leukemia cells don't always form a tumor. This cancer starts in
the bone marrow. The bone marrow is the thick, spongy liquid
inside your bones. It's where new blood cells are made.

Leukemia starts in early forms of blood cells, often

white blood cells, which help fight infections. When you have
leukemia, your body makes too many "bad" blood cells that
don’t work like they should. Instead of forming tumors,
leukemia cells travel in the blood and go all over the body. This
means they can reach almost any organ. Leukemia can cause
problems and be found in many different ways, depending on
which organs are affected.
Bone marrow :
Bone marrow is the soft, spongy tissue in the center
cavity of all bones. It is a limited space where all the different
types of blood cells are made and where nutrients and other
resources are supplied to help these cells grow. Blood cells keep
our body healthy and functioning normally. More specifically,
the different types of blood cells produced in the bone marrow
include:

Hundreds of billions of new blood cells are produced

in the bone marrow each day, providing your body with a
constant supply of fresh, healthy cells.
 HISTORY
Leukemia was first described by anatomist and
surgeon Alfred-Armand-Louis-Marie Velpeau in 1827. A more
complete description was given by pathologist Rudolf Virchow
in 1845. Around ten years after Virchow's findings, pathologist
Franz Ernst Christian Neumann found that the bone marrow of
a deceased person with leukemia was colored "dirty green-
yellow" as opposed to the normal red. This finding allowed
Neumann to conclude that a bone marrow problem was
responsible for the abnormal blood of people with leukemia.
[citation needed]

By 1900 leukemia was viewed as a family of

diseases as opposed to a single disease. By 1947 Boston
pathologist Sidney Farber believed from past experiments that
aminopterin, a folic acid mimic, could potentially cure
leukemia in children. The majority of the children with ALL
who were tested showed signs of improvement in their bone
marrow, but none of them was actually cured. This, however,
led to further experiments.

In 1962, researchers Emil J. Freireich, Jr. and

Emil Frei III used combination chemotherapy to attempt to
cure leukemia. The tests were successful with some people
surviving long after the tests.
Etymology :
Observing an abnormally large number of white blood
cells in a blood sample from a person, Virchow called the
condition Leukämie in German, which he formed from the two
Greek words leukos , meaning "white", and haima, meaning
"blood".

Society and culture

According to Susan Sontag, leukemia was often
romanticized in 20th-century fiction, portrayed as a joy-
ending, clean disease whose fair, innocent and gentle victims
die young or at the wrong time. As such, it was the cultural
successor to tuberculosis, which held this cultural position until
it was discovered to be an infectious disease. The 1970
romance novel Love Story is an example of this
romanticization of leukemia.
TYPES OF LEUKEMIA :
There are several types of leukemia. They are grouped in
two ways. One way is by how quickly the disease develops and
gets worse. The other way is by the type of blood cell that is
affected.

Leukemia is either acute or chronic. In acute leukemia, the

abnormal blood cells (blasts) remain very immature and
cannot carry out their normal functions. The number of blasts
increases rapidly, and the disease gets worse quickly. In chronic
leukemia, some blast cells are present, but in general, these
cells are more mature and can carry out some of their normal
functions. Also, the number of blasts increases less rapidly than
in acute leukemia. As a result, chronic leukemia gets worse
gradually.

Leukemia can arise in either of the two main types of

white blood cells — lymphoid cells or myeloid cells. When
leukemia affects lymphoid cells, it is called lymphocytic
leukemia. When myeloid cells are affected, the disease is called
myeloid or myelogenous leukemia.
The disease appears in one of four major forms:

Acute lymphocytic leukemia :

(ALL) is the most common type of leukemia in young
children. This disease also affects adults, especially those age
65 and older.

Acute myeloid leukemia :

(AML) occurs in both adults and children. This type of
leukemia is sometimes called acute non lymphocytic leukemia
(ANLL).

Chronic lymphocytic leukemia :

(CLL) most often affects adults over the age of 55. It
sometimes occurs in younger adults, but it almost never affects
children.

Chronic myeloid leukemia :

(CML) occurs mainly in adults. A very small number of
children also develop this disease.
SIGNS & SYMPTOMS :
Leukemia symptoms vary, depending on the type of leukemia.
Common leukemia signs and symptoms include:

Fever or chills

Persistent fatigue, weakness

Frequent or severe infections

Losing weight without trying

Recurrent nosebleeds

Easy bleeding or bruising

Swollen lymph nodes, enlarged liver or spleen

Tiny red spots in your skin (petechiae)

Excessive sweating, especially at night

Bone pain or tenderness

LEUKEMIA FORMATION :
Leukemia begins in the developing blood cells in
the bone marrow. All blood cells start out as hematopoietic
(hemo = blood; poiesis = make) stem cells. The stem cells
undergo multiple stages of development until they reach their
adult form.

First, blood stem cells develop into either myeloid

cells or lymphoid cells. If blood cells were to continue to
develop completely normally, the adult forms of these cells are
as follows:

Myeloid cells develop into red blood cells, platelets, and

certain types of white blood cells (basophils, eosinophils and
neutrophils).

Lymphoid cells develop into certain types of white blood

cells (lymphocytes and natural killer cells).
 As stem cells in bone marrow begin to divide and
multiply, they develop into all the needed types of blood cells. In
patients with leukemia, cell growth goes "haywire," and there
is a rapid growth of abnormal white blood cells.

So inside the bone marrow, blood cells are beginning to

multiply and divide into red blood cells, white blood cells and
platelets. However, if you have leukemia, one of these blood cell
types begins to rapidly multiply, in an out-of-control manner.
These abnormal cells – called leukemia cells – begin to take
over the space inside the bone marrow. They crowd out the
other normal cell types that are trying to develop. This is bad in
a number of ways:

Unlike other blood cell types, the leukemia cells are

abnormal and serve no useful purpose.

The other cell types (red blood cells, white blood cells and
platelets) have very little space and support to continue to
grow and multiply inside the bone marrow.

This results in fewer normal blood cells being made and

released into the blood and more leukemia cells being
made and released into the blood. Without an adequate
amount of normal blood cells, your body’s organs and
tissues will not get the oxygen they need to work properly,
your body won’t be able to fight off infection or clot blood
when needed.
DIAGNOSIS :
There are several symptoms of leukaemia which are similar to
other disorders.
A proper medical examination is necessary.

The tests for diagnosing leukaemia are as follows:

Complete blood count test:

To determine the count of WBCs, RBCs and platelets in
the bloodstream or the formation of any abnormal cells.
There are a number of different tests that can be used to
diagnose leukemia. A complete blood count determines the
numbers of RBCs, WBCs, and platelets in the blood.
Looking at your blood under a microscope can also
determine if the cells have an abnormal appearance.
Tissue biopsy scan:
A test in which a small tissue is taken from the lymph
nodes or bone marrow to identify the presence of leukaemia, its
type and its growth rate.

Genetic abnormality test:

A test to determine the Philadelphia chromosome,
genetic defect present in leukaemia cells.
Staging:
This test helps determine the outlook of the patient based
on the type of leukaemia.

Cytochemist
A test
structure of th
Lumbar puncture:
A test performed by the spinal fluid to identify the
spread of the leukaemia to the central nervous system. Other
methods of diagnosing include CT scan, MRI and ultrasound.

Imaging
Imaging tests are not usually used as a diagnostic method for
leukemia, as blood-related cancers like leukemia don't often
form tumors. It may be helpful, however, in staging some
leukemias, such as CLL.
Differential Diagnosis :
There are some diseases that may resemble leukemia.
Some of these include:
Certain viral infections:
Epstein-Barr virus (the cause of infectious
mononucleosis), cytomegalovirus, and HIV may cause an
elevated number of atypical lymphocytes that are detected
with blood tests.

Myelodysplastic syndromes:
These are diseases of the bone marrow that have a
predilection for developing into AML and are sometimes
referred to as preleukemia
Myeloproliferative disorders:

Conditions such as polycythemia vera, essential

thrombocytosis, and primary myelofibrosis may resemble
leukemia.

Aplastic anemia:
This is a condition in which the bone marrow stops
making all of the types of blood cells.
RISK FACTOR :
Factors that may increase your risk of developing some types of
leukemia include:

PREVIOUS CANCER TREATMENT :

People who've had certain types of chemotherapy and
radiation therapy for other cancers have an increased risk of
developing certain types of leukemia.

GENETIC DISORDERS :
Genetic abnormalities seem to play a role in the
development of leukemia. Certain genetic disorders, such as
Down syndrome, are associated with an increased risk of
leukemia.

EXPOSURE TO CERTAIN CHEMICALS :

Exposure to certain chemicals, such as benzene which is
found in gasoline and is used by the chemical industry is linked
to an increased risk of some kinds of leukemia .

SMOKING :
Smoking cigarettes increases the risk of acute
myelogenous leukemia.
FAMILY HISTORY OF LEUKEMIA :
If members of your family have been diagnosed with
leukemia, your risk of the disease may be increased.
However, most people with known risk factors don't get
leukemia. And many people with leukemia have none of these
risk factors.
LEUKEMIA CLASSIFICATION:
Doctors classify leukemia based on its speed of
progression and the type of cells involved.

The first type of classification is by how fast the leukemia

progresses:

ACUTE LEUKEMIA :
In acute leukemia, the abnormal blood cells are
immature blood cells (blasts). They can't carry out their
normal functions, and they multiply rapidly, so the disease
worsens quickly. Acute leukemia requires aggressive, timely
treatment.

CHRONIC LEUKEMIA :
There are many types of chronic leukemias. Some
produce too many cells and some cause too few cells to be
produced. Chronic leukemia involves more-mature blood cells.
These blood cells replicate or accumulate more slowly and can
function normally for a period of time. Some forms of chronic
leukemia initially produce no early symptoms and can go
unnoticed or undiagnosed for years.
The second type of classification is by type of white blood cell
affected:

LYMPHOCYTIC LEUKEMIA :
This type of leukemia affects the lymphoid cells
(lymphocytes), which form lymphoid or lymphatic tissue.
Lymphatic tissue makes up your immune system.

MYELOGENOUS LEUKEMIA :
This type of leukemia affects the myeloid cells. Myeloid
cells give rise to red blood cells, white blood cells and platelet
producing cells.
HOW COMMON IS LEUKEMIA?
The number of new cases of leukemia diagnosed in
the United States each year is about 14 per 100,000 men and
women or 61,000 new cases per year. It is the tenth most
common cancer according to new cases diagnosed each year.
Leukemia accounts for 3.5% of all new cancer cases in the
United States.

Leukemia is often considered a disease of children,

yet it actually affects far more adults. In fact, the likelihood of
developing this cancer increases with age. Leukemia is most
frequently diagnosed in people 65 to 74 years of age. Leukemia
is more common in men than in women, and more common in
Caucasians than in African-Americans. Although leukemia is
rare in children, of the children or teens who develop any type
of cancer, 30% will develop some form of leukemia.
LEUKEMIA TREATMENT :
Treatments for leukemia depend on the type of
leukemia you have, your age and overall health, and if the
leukemia has spread to other organs or tissues. There are five
common treatment categories. They include:

Chemotherapy:

Chemotherapy are chemicals (medications) given in

pill form, administered through an IV into a vein or a central
line or given in shots under the skin (subcutaneously). The
chemicals kill leukemia cells or stop them from dividing. Usually
a combination of chemotherapy drugs are used. This is the most
common form of treatment for leukemia. Treatment consists of
cycles – a certain number of days of treatment are followed by
days of rest to allow the body to recover. The length of time for
treatment can vary by regimen ranging from six months to
indefinite treatment.
Radiation therapy:
This treatment uses strong beams of energy to
kill leukemia cells or stop them from growing. Radiation is
directed to exact sites in your body where there is a collection
of cancer cells or can be given over your whole body as part of
a hematopoietic cell transplant.

Immunotherapy:
This treatment, also called biologic therapy, uses
certain drugs to boost your body’s own defense system – your
immune system – to fight leukemia. Immunotherapies include
interferon, interleukins and CAR-T cell therapy.
Targeted therapy:

This treatment uses drugs that are focused on a

specific features of leukemia cells. Targeted therapies work by
blocking the ability of leukemia cells to multiply and divide,
cutting off the blood supply needed for the cells to live, or killing
the cells directly. Targeted therapy is less likely to harm normal
cells. Examples of targeted therapy include monoclonal
antibodies (such as inotuzumab [Besponsa®], gemtuzumab,
[Mylotarg®], rituximab [Rituxan®], ofatumumab [Arzerra®],
obinatuzumab [Gazyva®, Gazyvaro®], alemtuzumab
[Campath®, MabCampath®]) and tyrosine kinase inhibitors
(such as imatinib [Gleevec®], dasatinib [Sprycel®], nilotinib
[Tasigna®], ponatinib [Iclusig®]), ruxolitinib [Jakafi®],
fedratinib [Inrebic®], gilteritinib [Xospata®], midostaurin
[Rydapt®], ivositinib [Tibsovo®], ibrutinib [Imbruvica®],
venetoclax [Venclexta®]).
Hematopoietic cell transplant (also known as
stem cell or bone marrow transplant):
This procedure replaces the cancerous blood-
forming cells that have been killed by chemotherapy and/or
radiation therapy with new, healthy hematopoietic cells. These
healthy cells are taken from you (before exposure to chemo or
radiation therapy) or from a donor’s blood or bone marrow
and are infused back into your blood. Healthy hematopoietic
cells grow and multiply forming new bone marrow and blood
cells that develop into all the different types of cells your body
needs (red blood cells, white blood cells and platelets). In the
case where the cells are taken from a different person (donor),
the new immune system recognizes the cancer cells as foreign
and kills them (similar to other immunotherapies).
Stages of leukemia treatment :
Some leukemia treatment is delivered in three phases.
Each phase has a specific goal.

Induction therapy:
It is the first phase. Its goal is to kill as many leukemia cells
as possible in the blood and bone marrow to achieve remission.
In remission, blood cell counts return to normal levels, no
leukemia cells are found in the blood and all signs and
symptoms of disease are gone. Induction therapy usually lasts
four to six weeks.
Consolidation (also called intensification) :

It is the second phase, begins after leukemia is in

remission. The goal of this phase is to kill any remaining
undetected leukemia cells in the body so the cancer does not
return. Consolidation therapy is usually given in cycles over
four to six months. Children with standard-risk ALL are usually
treated with drugs such as methotrexate, 6-mercaptopurine (6-
MP), vincristine, L-asparaginase, and/or prednisone, but
regimens differ among cancer centers.

Children with high-risk leukemia (because of gene or

chromosome changes in the leukemia cells, for example, or
because there is still minimal residual disease after induction)
generally get more intense chemo.
Maintenance therapy :
It is given to kill any leukemia cells that may have
survived the first two treatment phases. The goal of
maintenance therapy is to prevent the return of leukemia
(relapse). Treatment usually lasts for about two years.

(Treatment can be also directed at the brain and

spinal cord [the central nervous system] during each of these
phases. This is done to kill cancer cells that hide in these areas
of the body where the chemotherapy cannot reach. These
“hidden” cancer cells are a reason leukemia comes back or
relapses.)

Other leukemia treatments do not have phases and

are given indefinitely. They are continued as long as they are
working to combat the leukemia and the patient is tolerating
the treatment well.
What outcome can I expect if I have a diagnosis
of leukemia?
While this seems like a straight-forward question, the
answer is a little more complicated. It’s understandable that
you want to know if you or your loved one will survive a
diagnosis of leukemia. Unfortunately, it’s difficult to make
general predictions. There are many factors to consider that
affect your chance of recovery, including:

 Chromosomal abnormalities or mutations. The genetic

alterations seen inside of leukemia cells are the most
important predictor of outcome.
 Age. Generally, the younger the patient is at the time of
diagnosis, the better the outcome.
 Patient’s general health. The better the overall health, the
better the outcome.
 Type of blood cell/subtype of leukemia involved.
 Red blood cell, white blood cell and platelet blood counts at
time of diagnosis.
 Response to initial treatment: Is the leukemia in remission?
Has the leukemia been treated before and has now come
back? Did the leukemia not respond to treatment?
 Collection of leukemia cells in areas not easily reached by
chemotherapy. This is the case when the leukemia cells are
found in the spinal fluid.
The general good news is that although the number of new
cases of leukemia in the United States has remained relatively
steady or slightly increased
Types of Leukemia ALL
since
AML
the 1970s,
CLL
survival rate
CML
has
also improved.
5- year survival rate* 68.60% 28.30% 85.10% 69.20%

Number of deaths per

The National
100,000 persons Cancer0.4Institute reports
2.8 the following
1.2 survival
0.3

data for the four main types of leukemia:

Death is highest among 65-74 65+ 75+ 75+
those aged

Table legend:
ALL = acute lymphocytic leukemia; AML = acute myelogenous
leukemia; CLL = chronic lymphocytic leukemia; CML = chronic
myelogenous leukemia
* survival compares patients diagnosed with cancer vs people of
CAN LEUKEMIA BE CURED?
From a scientific standpoint, “cured” is a hopeful
goal, yet is somewhat difficult to define in the field of cancer.
Are you “cured” after five years of being free of cancer? After 10
years? Does cure mean that you no longer have any negative
effects on the quality of your life from your treatment?

Cancer researchers usually are more comfortable

talking about achieving long-term remission if you have a
diagnosis of cancer. Children and teens, younger adults, people
in good health with few other illnesses generally have the best
outcomes. Acute lymphoid leukemia represents one of the most
dramatic success stories in cancer treatment. According to the
Leukemia & Lymphoma Society, nearly 90% of children and
40% of adults diagnosed with ALL can expect a long-term
remission.

The answer to “am I cured of my leukemia” will best

be answered by your healthcare team over a long period of
time. Your team will work closely with you to develop the best
treatment plan for your specific type of leukemia and will
carefully follow you for many years to come.
What questions should I ask my doctor and healthcare
team after I’ve been diagnosed with leukemia?

Some of the questions to ask your doctor and team may

include:

 What type of leukemia do I have? In what type of cell? Is it

a fast- or slow-growing kind of cancer?
 What if I want to have children? What are my options for
preserving my fertility?

 What are my treatment options?

 What are the benefits and risks of each type of treatment?
 What treatment plan is best suited for me? Why?
 When should treatment begin?
 How long will treatment (and each stage of treatment)
last?
 How long will I be in the hospital?
 What are the side effects of treatment? What can be done
to prevent or lessen these side effects?
Pregnancy :
Leukemia is rarely associated with pregnancy, affecting only
about 1 in 10,000 pregnant women. How it is handled depends
primarily on the type of leukemia. Nearly all leukemias
appearing in pregnant women are acute leukemias. Acute
leukemias normally require prompt, aggressive treatment,
despite significant risks of pregnancy loss and birth defects,
especially if chemotherapy is given during the developmentally
sensitive first trimester.Chronic myelogenous leukemia can be
treated with relative safety at any time during pregnancy with
Interferon-alpha hormones. Treatment for chronic lymphocytic
leukemias, which are rare in pregnant women, can often be
postponed until after the end of the pregnancy.
CLINICAL TRIALS FOR LEUKEMIA :
 Leukemia & Lymphoma Society [Clinical Trial Support
Center.]

 National Cancer Institute. [Clinical Trials Information for

Patients and Caregivers.]

 American Cancer Society. [Clinical Trials.]

 National Institutes of Health. [Clinical Trials.gov.]

 Cancer Trials at Cleveland Clinic.

 CONCLUSION
In end it is all about how we take care of our bodies,
our diet plays a big role in our well being and staying healthy.
As stated above leukemia cancer is a very dangerous disease.
We should take proper precaution to prevent this disease.
Doctors are taking several measures to prevent this cancer
from spreading in human body. If leukemia cancer is not taken
care in its early stages it may prove fatal to human body.

As we can see from this research, leukemia is a serious

complication that is commonly seen in United States. Patients
can achieve complete remission in many cases of leukemia,
however, it is also common to relapse with reduced survival
rate. Treatments can be very harmful to our body and although
many patients benefit from it, palliative care may be the only
option left for some patients. There are many treatments that is
being developed for clinical trials and we are hopeful to see
improvement in increasing survival rate for leukemia.
BIBLIOGRAPHY
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