Understand what is acute leukemia

Leukemia is a type of blood cancer that affects white blood cells, which typically fight infection.

Healthy and abnormal white blood cells are produced in the bone marrow, along with other types of cells found in the blood. As far as we know, there is no definitive cause of leukemia, but when abnormal white cells are produced in large amounts, they can take over the bone marrow and spill out into the blood stream, causing the symptoms associated with these diseases; including fatigue, susceptibility to infections and weight loss.

Leukemias can be split into several different subtypes, depending on how fast they progress (acute leukemias develop faster, and chronic leukemias develop slower), or on the type of cells affected (lymphoid or myeloid). The various subtypes of leukemia have different symptoms, and therefore have their own specific treatment regimes.

Symptoms of leukemia can be vague and non-specific, and not everyone experiences the same symptoms before diagnosis. Knowing what to look out for could help you make the decision to visit your doctor sooner.

Early diagnosis saves lives !

Fatigue 

Fatigue is by far the most common symptom experienced by blood cancer patients prior to a diagnosis.

Fatigue is defined as extreme tiredness that results from mental or physical exertion, or illness. Everyone will experience fatigue at some point as it is simply the body’s natural way of showing that rest is needed. However, exhaustion that lasts for prolonged periods of time is not normal.

Below are some signs that you should pay close attention to:

  • Weakness or tiredness that lasts for longer than 2 weeks
  • Weakness or tiredness accompanied by a loss of weight
  • Tiredness that remains even after rest or sleep, it keeps coming back, or is getting worse.
  • You are continually finding yourself more tired than usual or breathless during or after an activity.
  • You’re spending extra time in bed and/or sleeping for unusual amounts of time.
  • You are finding it significant difficulty to concentrate and becoming confused more easily.
  • You have also noticed other symptoms of leukemia or anemia

Infections

About a quarter of  leukemia patients will experience frequent or repeated infections as a symptom prior to their diagnosis. Recurrent infections can occur because your body isn’t producing enough white blood cells to keep your immune system working properly. This means that the you are unable to rapidly destroy any harmful viruses, bacteria or fungi that have made their way into the body.

Infections are associated with signs such as fever, sweating or chills, sore throat and/or cough, redness, swelling or pain around a wound.

Shortness of breath

Approximately one-third of patients will report feeling weak or breathless as a symptom prior to being diagnosed with leukaemia. However, because breathlessness has many possible causes, ranging from a cold, chest infection to lack of fitness or smoking, it can often be mistaken as harmless or simply as a sign of getting older.

Below are some signs that you should pay close attention to:

  • Sudden breathlessness that comes on unexpectedly
  • Breathlessness during everyday activities (that you would normally find effortless)
  • Breathlessness that has lasted for longer than a month or has gradually become more noticeable
  • You have noticed a “sudden drop in fitness”
  • You have also been coughing for three weeks or more
  • You notice other symptoms of leukemia or anemia

Bruising or bleeding

Easily bruising and bleeding is the 4th most common leukemia symptom.

Although bruises from leukemia are very similar to ordinary bruises, there are a few things you can look out for to help spot the difference:

  • They occur in unusual places
  • There are lots of them
  • You can’t explain why they are there
  • They take longer than usual to disappear
  • You have been experiencing excess bleeding

Fever or night sweats

It is certainly not unusual to sweat during the night, especially in the summer when your room or bedding becomes too hot. However, severe night sweats that occur to an extent that your bed sheets or pyjamas become soaking wet, despite sleeping in a cool environment, can sometimes be a sign of leukemia.

Below are some signs that you should pay close attention to:

  • You regularly have night sweats that wake you up at night
  • You have never experienced night sweats before
  • You are having severe night sweats but can’t work out why
  • You also have a fever, a cough or diarrhoea
  • You are experiencing unexplained weight loss alongside your night sweats
  • You are also displaying other symptoms of leukemia

Pain in bones or joints

About a quarter of people experienced bone or joint pain as a symptom prior to their diagnosis. However, this common leukemia symptom can easily be mistaken for conditions such as arthritis or growing pains.

Depending on where it is felt, bone pain can be a sharp pain or a constant dull ache in one or more bones. It differs from muscle or joint pain because it is present regardless of whether you are moving or not. Bone pain caused by leukemia is most commonly felt in the long bones of the arms and legs, or in the ribs and sternum of the rib cage.

Joint pain in the wrists or ankles and swelling of large joints, such as the hips and shoulders, is usually experienced later, sometimes weeks after bone pain first begins.

Weight loss

Unexplained weight loss or loss of appetite can be associated with acute leukemia.

If your doctor suspects you may have leukemia, they will conduct a variety of tests to confirm this. The tests may include a full blood count, bone marrow biopsy, and other general health tests and infection screening

Acute Lymphoblastic Leukemia (ALL)

ALL is a type of acute leukemia that affects a specific type of blood stem cell called lymphoblasts – these are the precursors of some white blood cells. These cells are produced in the bone marrow and, when they are abnormal, they multiply excessively preventing the production of other types of blood cells. The reduced number of healthy white blood cells, red blood cells and platelets results in the symptoms experienced by patients, such as fatigue, bleeding/bruising, and infections.

Despite certain risk factors being associated with ALL, there is no definitive cause. ALL is more common in young children but adults are affected too. Symptoms can be vague but they do include enlarged lymph nodes, enlarged liver or spleen and joint pains. Treatment can include chemotherapy, immunotherapy, targeted therapy, radiation therapy or stem cell transplant.

Acute Myeloid Leukemia (AML)

AML is a type of acute leukemia that affects young myeloid cells. Normal myeloid cells will mature into red blood cells, some types of white blood cells and platelets. If abnormal, myeloid cells can grow excessively and overcrowd the bone marrow, preventing the production of healthy cells, and therefore causing symptoms commonly experienced by AML patients, such as fatigue, bleeding/bruising and infections.

Despite many risk factors being associated with AML, there is no definitive cause. AML is more common in older people, and affects men and women in a similar way. AML can progress from myelodysplastic syndrome (MDS) or myeloproliferative neoplasms (MPN), which is why these diseases are often referred to when discussing acute leukemias. Like ALL, symptoms can be vague, but include bone pain, enlarged liver or spleen and swollen gums. Treatment can include chemotherapy or stem cell transplant.

Acute Promyelocytic Leukemia (APL)

APL is a rare form of AML. It affects promyelocytes, which develop into granulocytes, a type of white blood cell. There is no definitive cause for APL, but most people with the disease have a faulty gene in the leukemia cells called PML/RARA. There is also a slightly higher risk of developing APL if you have received treatment for other types of cancer. APL is treated in a very different way to AML because the usual treatments for AML may seriously affect blood clotting in these patients. Treatment can include all-trans retinoic acid (ATRA), anthracyclines, arsenic trioxide (ATO), and blood, platelet or plasma transfusion.

If you want to know more, here is a presentation –> ALAN Acute Leukemia training

There are also trustworthy resources you can use to learn more about acute leukemia, and to guide decisions as a patient, carer or family/friend. See our resources page for more information.

 

The type of treatment you receive will depend on the type of acute leukemia you have. As the disease can progress rapidly, it is likely that you will discuss treatment options with your doctor within the first few days after diagnosis. At this time, it is important that you make every effort to fully understand your diagnosis, the treatment options available and how they will impact your life. You should contact your professional healthcare team to discuss any questions you may have, as well as to clarify anything you may not understand about your diagnosis.

Some of the strategies being used to treat acute leukemia are :

  • Chemotherapy – drugs that destroy abnormal and rapidly dividing cells. Chemotherapy is usually administered intravenously (in the vein)
  • Radiation therapy – high-energy radiation that destroy cancer cells. It is typically only used in advanced or metastatic leukemia
  • Targeted therapy – drugs that target specific mutated genes or proteins
  • Immunotherapy – drugs that boost the immune system, enabling them to kill cancer cells more effectively
  • Stem cell transplant – replacement of bone marrow from either yourself or a donor. This encourages the production of healthy white blood cells
  • Clinical Trials – clinical trials can enable you to access the most cutting-edge treatments as they are designed to determine which treatments are the most effective in specific patient group. These trials will define the best standard of care for patients

NOTE: This is not intended to be medical advice and, as every individual case differs, ALAN recommends you consult your hematologist/clinician if you have questions or concerns.

Also, as the situation surrounding COVID-19 and vaccination is evolving rapidly, always refer to your governmental websites.

What is COVID-19?

COVID-19 is the disease associated with severe acute respiratory syndrome coronavirus
(SARS-CoV-2). SARS-CoV-2 is a new strain of coronavirus that had not been identified in humans prior to December 2019. There are different types of coronaviruses and, although they mostly circulate among animals, some can also infect humans.

The COVID-19 outbreak that started in late 2019 was declared a pandemic by the World Health Organization on 11 March 2020. This is the first pandemic caused by a coronavirus.

Trustful information and available resources

https://acuteleuk.org/resources/

Additional information:

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

https://www.fda.gov/emergency-preparedness-and-response/counterterrorism-and-emerging-threats/coronavirus-disease-2019-covid-19

https://ec.europa.eu/info/live-work-travel-eu/coronavirus-response_en

https://vaccination-info.eu/en/covid-19/covid-19-facts

Live Worldwide COVID-19 Situation: https://qap.ecdc.europa.eu/public/extensions/COVID-19/covid-19.html#global-overview-tab

Vaccination

What type of approval processes did COVID-19 vaccines undergo?

Due to the existing public health emergency, COVID-19 vaccines went through an accelerated development process but were still subject to the rigorous evaluation methods used by the various health authorities. These vaccines were, and are still, evaluated against the same high standards as any other medicine.

It is important to understand that while the approval for the COVID-19 vaccines was accelerated, vaccines with similar mechanisms of action have been in development for years. The current
COVID-19 vaccines were developed using existing research.

Additional information

https://ec.europa.eu/info/live-work-travel-eu/coronavirus-response/safe-covid-19-vaccines-europeans/how-are-vaccines-developed-authorised-and-put-market_en

https://www.fda.gov/emergency-preparedness-and-response/counterterrorism-and-emerging-threats/coronavirus-disease-2019-covid-19

https://www.australia.gov.au/covid19vaccines#

COVID-19 vaccines: development, evaluation, approval and monitoring: https://www.ema.europa.eu/en/human-regulatory/overview/public-health-threats/coronavirus-disease-covid-19/treatments-vaccines/vaccines-covid-19/covid-19-vaccines-development-evaluation-approval-monitoring

How do the COVID-19 vaccines work?

Vaccines teach our immune system to recognise and protect us from COVID-19 if/when we get infected with the virus.

The BioNTech/Pfizer and Moderna vaccines are mRNA vaccines. These vaccines use genetic material, called mRNA, which, after injection, enters your cells (note: this genetic material does not enter the innermost part of your cells called the nucleus nor your DNA). The cells then translate the mRNA into proteins that look like the proteins found on the surface of the COVID-19 virus. These proteins then enter your bloodstream, where the body recognises them as foreign and generates an immune response. Therefore, if you contract COVID-19 after receiving the vaccination, your body will recognise the virus and be able to respond quickly to fight the infection.

The AstraZeneca/Oxford and Janssen vaccines use a different approach and use something called viral vectors. These vaccines are made using an inactive adenovirus, which serves as a shell to carry DNA genetic material into your cells (note: this genetic material does not enter the innermost part of your cells called the nucleus nor your DNA). This DNA is then made into mRNA and then into proteins that look like the proteins found on the surface of the COVID-19 virus. These proteins then enter your bloodstream where the body recognises them as foreign and generates an immune response. Therefore, if you contract COVID-19 after receiving the vaccination, your body will recognise the virus and be able to respond quickly to fight the infection.

None of these vaccines contain live viruses and there is no risk of catching COVID-19 (or adenovirus) from the vaccine.

Additional information:

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/how-they-work.html

https://www.who.int/news-room/feature-stories/detail/how-do-vaccines-work

https://youtu.be/0AssZJ0N2Ls

COVID-19 vaccines key facts: https://www.ema.europa.eu/en/human-regulatory/overview/public-health-threats/coronavirus-disease-covid-19/treatments-vaccines/vaccines-covid-19/covid-19-vaccines-key-facts

How effective are these vaccines?

It is important to understand that while each vaccine has different efficacy, they all offer protection against hospitalisation and/or death from COVID-19. Also, given the timing, population, and location of where each vaccine was studied, it is impossible to compare their efficacy and judge any one vaccine to be either inferior or superior to any other.

It is also important to remember that a vaccine with lower effectiveness can still save thousands of lives and prevent millions of cases of COVID-19.

Each of the COVID-19 vaccines was tested in thousands of patients of varying ethnicities and some with medical conditions, for example, lung and heart disease. Acute leukemia patients were not specifically included in these clinical trials nor is there any data on the efficacy of these drugs in the acute leukemia population. It has been suggested that these vaccines may be less effective in immunocompromised patients, but this has yet to be proved and this should not be a reason to forgo immunisation.

ALAN recommends you discuss this matter with doctor/hematologist if you have any questions or concerns.

What COVID-19 vaccines are approved for use in immunocompromised patients?

Despite several vaccine candidates being in phase II/III clinical trials, no current clinical trial of a
COVID-19 vaccine has published data on immunocompromised patients. Thus, the efficacy and safety of a SARS-CoV-2 vaccine has not been established in the different immunocompromised patient populations. There are no data that preferentially support one vaccine over another in this or any population.

Is a third dose needed?

The approved vaccines have shown a high level of efficacy at preventing severe illness from coronavirus. However, the same is not true for people with certain immune conditions, including those living with a rare disease, representing a population of several million European citizens and many more worldwide. Figures show that antibody response after two doses was insufficient in transplant recipients (varied between 17% and 45%), dialysis patients and people taking an immuno-suppressive treatment.

In Europe, France is setting an example by handing out third shots of the two-dose vaccines to cancer and other immunocompromised patients. Israel has also begun offering a third dose of the Pfizer-BioNTech vaccine to people with a compromised or impaired immune response, including cancer patients and transplant recipients, to protect the most vulnerable and prevent hospitalisations and serious illness.

Will booster doses of COVID-19 vaccines be needed?

It is currently too early to say if booster doses will be needed.

There is not yet enough data to understand how long protection from COVID-19 vaccines lasts, so the need for additional doses of the vaccines is not known.

In addition, the impact of the spread of virus variants needs to be considered.

Do the COVID-19 vaccines protect against variants?

The scientific community and regulators are closely monitoring how SARS-CoV-2 (the virus that causes COVID-19) changes over time, and how well COVID-19 vaccines can protect people against COVID-19 caused by any new variants of the virus that appear.

The regulators have asked all COVID-19 vaccine developers to investigate whether their vaccine can offer protection against any new variants identified.

How soon after receiving a vaccine am I considered to be protected? How long does protection last?

With vaccines that require two doses, you are not considered protected until sometime after the second dose. Therefore, it is important to continue to limit your risk of catching or transmitting COVID-19 before you get your second shot.

Also getting the COVID-19 vaccine does not ensure full immunity, therefore, you must still physically distance, wear a mask, and wash your hands. (It is also important to remember that there is not enough data to know how the vaccines reduce transmission of COVID-19 from one person to another.) v

The length of time of protection that each vaccine offers is not yet known but is under investigation.

What are the side effects of the COVID-19 vaccines?

Studies investigating the COVID-19 vaccine were done on many patients and showed there is a very low risk of serious side effects from all four vaccines. The most common side effects were chills, headache, pain (generalised body pain or at the injection site), fever, nausea, tiredness and/or redness, and swelling at the injection site. Most of the side effects were considered mild or moderate and resolved within a day or two after the vaccination.

On rare occasions, people developed severe allergic reactions (anaphylaxis) soon after receiving a vaccine. Therefore, COVID-19 vaccines should be given under close medical supervision to monitor potential allergic reactions. Anyone with a history of severe allergic reactions can still receive these vaccines, but they should first consult their doctor to discuss the risks and benefits of the vaccine.

For more information ALAN recommends you discuss this matter with your local health authorities and/or your treating physician.

Can a different vaccine be used for the second dose?

There is not yet enough data on mixing COVID-19 vaccines to enable health authorities to make a definitive recommendation on using a different COVID-19 vaccine for the second dose.

However, there are good scientific grounds to expect such a ‘mix and match’ approach (officially, a ‘heterologous vaccination strategy’) to be safe and effective. It has been used successfully with other vaccines.

How does the COVID-19 vaccine affect treatment for acute leukemia?

There is no evidence that the vaccine will have any interactions with the medicines used to treat acute leukemia. However, some drugs used during intensive treatment may weaken the immune system. As a result, patients undergoing intensive therapy may not respond as well to the COVID-19 vaccine. Despite this, it is still recommended to get the vaccine.

For more information ALAN recommends you discuss this matter with doctor/hematologist to determine their options.

Published recommendations by medical societies

https://www.hematology.org/covid-19/ash-astct-covid-19-and-vaccines

https://ehaweb.org/covid-19/covid-19-recommendations/

https://www.esmo.org/covid-19-and-cancer/covid-19-vaccination

https://bsbmtct.org/wp-content/uploads/2021/01/BSBMTCT-SARS-CoV-2-vaccination-statement-12Jan2021-FINAL.pdf

https://www.ebmt.org/sites/default/files/2021-01/COVID%20vaccines%20version%203.04%20with%20table.pdf.pdf

Which COVID-19 vaccines are approved and where?

Coronavirus vaccine tracker: https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html#pfizer

Live status

COVID-19 vaccination tracker: https://qap.ecdc.europa.eu/public/extensions/COVID-19/vaccine-tracker.html#uptake-tab

Tracking COVID-19 vaccination worldwide: https://edition.cnn.com/interactive/2021/health/global-covid-vaccinations/