Name: Eshani Roy Barman

Class: XII S2
Roll no: 12
Session: 2023-2024
School: Sushila Birla Girls’ School
Topic: Leukemia (Blood cancer)
 Acknowledgements

I would like to thank our Principal, Mrs. Koeli Dey, our Coordinator,
Mrs. Shraddha Jain and our Biology teacher, Mrs Julie De for
assigning such an interesting topic as my project. I have learnt several
interesting and intriguing facts about leukemia and enjoyed gathering
information about it.
Secondly, I would like to thank my parents and peers for their support
and help in this project.

Signature:
 Certificate of Authentication

This is to certify that Eshani Roy Barman, student of class 12 S2 at

Sushila Birla Girls’ School has successfully completed the investigatory
project on the topic "Leukemia” under the guidance of our biology
teacher, Mrs Julie De, upto satisfaction.

The project is absolutely genuine and does not indulge in plagiarism of

any kind. The references taken in this project have been declared at the
end of the project.

Signature:
 Contents

SL No. Subject Page No.

1 Introduction 1-2
2 Age and Sex Distribution 3
3 Signs and Symptoms 4
4 Etiology 5
5 Related Disorders 6
6 Diagnosis 7
7 Possible Complications 8
8 Treatment 9
9 Prevention 11
10 Result/Outcomes 12
11 Case study 13
12 Conclusion 15
13 Bibliography 16
 Introduction

Leukemia, commonly known as blood cancer is a unique type of cancer.

It is characterized by a rapid grow of abnormal blood cells. It is usually
associated with white blood cells but there have been cases of it affecting
red blood cells as well as platelets. It does not form tumors, but gets
formed in the bone marrow. A person suffering from leukemia will have
trouble fighting infections as this cancer affects the white blood cells.
The leukemia cells often jam the bone marrow which prevents it from
producing healthy red blood cells and even platelets. Thus, leukemia is
the most dangerous type of cancer which can travel to any organ and
affect its functioning.
Leukemia is broadly of 4 types-
• acute myeloid leukemia (AML): fast-growing cancer that starts
in myeloid cells—the precursor to red blood cells, platelets (cells
that clot the blood), or white blood cells known as granulocytes;
also known as acute myelogenous or myeloblastic leukemia
• chronic myeloid leukemia (CML): slower-growing cancer that
starts in myeloid cells—the precursor to red blood cells, platelets
(cells that clot the blood), or white blood cells known as
granulocytes; also known as chronic myelogenous or myeloblastic
leukemia
• acute lymphocytic leukemia (ALL): fast-growing cancer that
starts in lymphoid cells, which make different types of white blood
cells; also known as acute lymphoblastic leukemia
• chronic lymphocytic leukemia (CLL): slower-growing cancer
that starts in lymphoid cells, which make different types of white
blood cells; also known as chronic lymphoblastic leukemia

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Survival rates vary substantially by leukemia subtype, ranging from a
current five-year relative survival rate of 27% for adults diagnosed with
AML to 86% for those with CLL, and 66% for children, adolescents, and
young adults diagnosed with AML to 92% for those with ALL

Comparison between blood of a healthy

person vs a person suffering from leukemia

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 Age and Sex Distribution

SEX: -
Men, usually have a higher tendency to suffer from leukemia. 57% of
the cases are associated with males while 43% of the cases are
associated with females.

AGE:-

Studies have shown infants, toddlers and preschool-age children, from

0 to 10 years old, have a slightly higher risk of developing leukemia than
older children and younger adults. The risk is approximately the same
as adults around ages 45 to 49. The risk increases as one crosses 50 years
of age.

Number of cases of leukemia for various age groups and the two
70 genders
60
50
40
CASES

30
20
10
0
0-10 20-30 30-40 40-50 50-60 60-70 70-80
AGE RANGE

male female

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 Signs and symptoms

Signs and symptoms of leukemia may vary with the type of leukemia.
Some common signs and symptoms may include

 Fever or chills
 Persistent fatigue, weakness
 Frequent or severe infections
 Losing weight without trying
 Swollen lymph nodes, enlarged liver or spleen
 Easy bleeding or bruising
 Recurrent nosebleeds
 Tiny red spots in your skin (petechiae)
 Excessive sweating, especially at night
Bone pain or tenderness

PETICHIAE, A COMMONLY OBSERVED SYMPTOM IN A PATIENT

SUFFERING FROM LEUKEMIA

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 Etiology

In general, leukemia is thought to occur when some blood cells acquire

changes (mutations) in their genetic material or DNA. Some of the main
factors which act as the main cause of leukemia are: -

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.

DOWN SYNDROME SMOKING

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 Related disorders

Chronic lymphocytic leukemia (CLL) shares some similar features and

symptoms with other closely related types of leukemia. They all have
one thing in common, they begin in a lymphocyte that becomes
cancerous and accumulates in the blood, bone marrow or spleen.

WALDENSTROM LARGE GRANULAR HAIRY CELL LEUKEMIA B CELL PROLYMPHATIC

MACROGLOBULINEMIA LYMPHOCYTIC LEUKEMIA LEUKEMIA

SMALL CELL LYMPHOCYTIC ACUTE LYMPHOBLASTIC MANTLE CELL LEUKEMIA T CELL PROLYMPHATIC
LEUKEMIA LEUKEMIA LEUKEMIA

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 Diagnosis
 Physical exam- physical signs of leukemia, such as pale skin from anaemia,
swelling of your lymph nodes, enlargement of your liver and spleen and often
formations of red patches on the skin called petechiae.
 Blood tests- By looking at a sample of blood, doctors can determine if one has
abnormal levels of red or white blood cells or platelets — which may suggest
leukemia. A blood test may also show the presence of leukemia cells, though not
all types of leukemia cause the leukemia cells to circulate in the blood. Sometimes
the leukemia cells stay in the bone marrow.
 Bone marrow test- doctors may recommend a procedure to remove a sample of
bone marrow from the hipbone. The bone marrow is removed using a long, thin
needle. The sample is sent to a laboratory to look for leukemia cells. Specialized
tests of leukemia cells may reveal certain characteristics that are used to determine
treatment options.

BLOOD TEST BONE MARROW TEST

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 Possible complications

 Weakened immune system- A weakened immune system may be

caused by a lack of healthy white blood cells, which means the immune
system is less able to fight infection. It can also be caused by many of the
medicines used to treat acute lymphoblastic leukaemia. Having a
weakened immune system makes the patient more vulnerable to
infections. It also means that any infection he/she has is more likely to
cause serious complications. They are also not allowed to get vaccines
which contain active viruses in them like the polio vaccine, oral typhoid
vaccine etc.

 Bleeding-If one has acute leukaemia, they’ll bleed and bruise more
easily because of the low levels of platelets (clot-forming cells) in your
blood. Although heavy bleeding is uncommon, they need to be aware of
the symptoms that can happen in different parts of the body. Bleeding
can happen inside the skull (intracranial haemorrhage), inside the lungs
(pulmonary haemorrhage), inside the stomach (gastrointestinal
haemorrhage)

 Infertility-Many of the medicines used to treat acute lymphoblastic

leukaemia can cause infertility. People who are particularly at risk of
becoming permanently infertile are those who've received high doses
of chemotherapy and radiotherapy in preparation for a stem cell and
bone marrow transplant.

INFERTILITY BRAIN HAEMORRHAGE

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 Treatment

 Chemotherapy- Chemotherapy is the major form of treatment for

leukemia. This drug treatment uses chemicals to kill leukemia cells.
Depending on the type of leukemia the patient has, they may receive a
single drug or a combination of drugs. These drugs may come in a pill
form, or they may be injected directly into a vein.
 Targeted therapy-Targeted drug treatments focus on specific
abnormalities present within cancer cells. By blocking these
abnormalities, targeted drug treatments can cause cancer cells to die.
The leukemia cells will be tested to see if targeted therapy is helpful for
them.
 Radiation therapy-Radiation therapy uses X-rays or other high-energy
beams to damage leukemia cells and stop their growth. During radiation
therapy, you lie on a table while a large machine moves around you,
directing the radiation to precise points on your body.You may receive
radiation in one specific area of your body where there is a collection of
leukemia cells, or you may receive radiation over your whole body.
Radiation therapy may be used to prepare for a bone marrow transplant.
 Bone marrow transplant- A bone marrow transplant, also called a
stem cell transplant, helps re-establish healthy stem cells by replacing
unhealthy bone marrow with leukemia-free stem cells that will
regenerate healthy bone marrow. Prior to a bone marrow transplant,
the patient receives very high doses of chemotherapy or radiation
therapy to destroy their leukemia-producing bone marrow. Then they
receive an infusion of blood-forming stem cells that help rebuild their
bone marrow. They may receive stem cells from a donor or may be able
to use their own stem cells.

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 Immunotherapy- Immunotherapy uses your immune system to fight
cancer. Your body's disease-fighting immune system may not attack
your cancer because the cancer cells produce proteins that help them
hide from the immune system cells. Immunotherapy works by
interfering with that process. They include targeted antibodies,
immunomodulators, adoptive cell therapy etc.
 Engineering immune cells - A specialized treatment called chimeric
antigen receptor (CAR)-T cell therapy takes your body's germ-fighting
T cells, engineers them to fight cancer and infuses them back into your
body. CAR-T cell therapy might be an option for certain types of
leukemia.

CHEMOTHERAPY RADIATION THERAPY

TARGETED THERAPY

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 Prevention

There is no hard-set method of preventing leukemia but the

following ways can help in reducing the risks of getting it.
 Being a non-smoker
 Having a balanced diet
 Avoiding breathing in chemicals like benzene and
formaldehyde.
 Regular exercises
 Keeping a check on our family health history
 Going for regular health checkups
 Leading a healthy lifestyle

BENZENE

BALANCED DIET
FORMALDEHYDE

EXCERCISES HEALTHY LIFESTYLE

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 Result and Outcomes

The cure rates and survival outcomes for patients with ALL have
improved over the past few decades. Today, nearly 90 percent of adults
diagnosed with ALL achieve a complete remission, which means that
leukemia cells can no longer be seen in the bone marrow with a
microscope. Still, despite high remission rates, relapses still commonly
occur in adults and survival rates for adult patients remain at
approximately 20 to 40 percent. However, these rates can vary
significantly, depending on the patient’s ALL subtype and other
prognostic factors.

From 2010 to 2016, the five-year relative survival rates overall were

 ALL – 72.1 percent overall, 92.5 percent for children and adolescents
younger than 15 years, and 94.4 percent for children younger than 5
years
 AML – 29.8 percent overall and 70.6 percent for children
and adolescents younger than 15 years
 CLL – 88.6 percent
 CML – 71.7 percent*

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 Case Study
 A 26-month-old boy, Mr Anuv Sen patient who was admitted to
the AMRI hospital presenting with neutropenia associated with
anaemia and thrombocytopenia. There was no history of any
haematological disorder. On examination; the patient had pallor
and splenic enlargement, measuring 23 cm in ultrasonography.
 Physical examination was otherwise unremarkable. The patient
had been suffering from recurrent febrile episodes and nocturnal
sweats with weakness and fatigue. Morphology and
Immunophenotyping Peripheral blood cells were examined by an
automated hematologic analyser.
 Peripheral blood smear examination showed normocytic
normochromic red blood cells including few nucleated red blood
cells, white blood cells showed left, shift with significant number of
blasts that suggestive of acute leukemia. Many giant platelets and
platelet aggregates were seen.
 The leukocyte differential count was eosinophils 5%, lymphocytes
62%, and neutrophils 31%and band forms 1%. Coagulation tests
showed a prolonged prothrombin time of 16.3 sec (reference range,
10.2 to 13.8), a normal activated partial thromboplastin time, a
normal fibrinogen and an increased D-dimer concentration of 4.96
mg/mL (reference range, 0 to 0.35).
 Bone marrow smears were stained with Wright-Giemsa and
analyzed according to routine clinical laboratory procedures. Bone
marrow aspiration and biopsy showed increased abnormal
megakaryocytic, Mono-lobated and multinucleated megakaryocytic
with hyper chromatic and pleomorphic nuclei were seen and
showed the leukemic cells were positive for CD13, CD33, CD42 and
CD61 and negative for CD3, CD5, CD7, CD20, CD22 and human
leukocyte antigen-DR. The biochemical parameters such as uric
acid, bilirubin, creatinine, liver enzymes were normal. Serum LDH
was slightly raised. The diagnosis was confirmed as AML-M7 as the

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 blasts were positive for CD42 and CD61 (megakaryocyte specific
antigen) along with myeloid markers CD13 and CD33.
 Based on this diagnosis and with respect to the patient’s severely
compromised overall condition, therapy withal-trans retinoic acid
(ATRA, 10 mg/kg) was initiated, followed by cytarabine- and
anthracycline-based induction polychemotherapy.
 The patient underwent chemotherapy for the 4 months. After
chemotherapy he was advised to have a diet of proteins like
chicken, lentils, soy, eggs; fruits and vegetables; low fat dairy like
milk, cheese and nutritious fats like olive oil, nuts, seeds, almond
butter or peanut butter. He was advised to avoid sugary sweetened
beverages, food; food which had trans fat such as chips, boxed cake
mixes, fried food.
 He was advised to at least walk 15-30 mins everyday along with 15-
30 mins cardio exercises.
 In case he felt nauseated he was prescribed these medicines
palonosetron or ondansetron tablets.

BONE MARROW BIOPSY PERIPHERAL BLOOD SMEAR

HEALTHY SPLEEN VS ENLARGED SPLEEN

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 Conclusion
Trials involving patients with leukemia have typically reported findings
only through 3 or 4 years of follow-up. The meeting at which the reports
in this supplement were presented provided a unique opportunity to
examine updated data and thereby gain insights into the actual
prospects for long-term survival.
From patients who achieved complete remission, 60% of them failed in
the first year. This finding highlights an important point, namely, that
half the patients are lost during their first year of remission. The relapse
rate remains fairly constant during the second year, falls off between the
second and third years, then decreases abruptly. The number of patients
who relapse after 5 years is almost negligible.
Leukemia if early detected can be cured and rates of remission is reduced
in that case. However, there are cases such as childhood acute lymphatic
leukaemia, which has a high potential for cure although it cannot be
detected early. Such technology needs to be found or such a test should
be developed which allows early detection of all types of leukemia even
in children.

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 Bibliography

 www.lls.org
 www.cancer.org
 www.mayoclinic.com
 NCERT biology

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