August 26, 2025 • 19 mins
Every drop of blood tells a story—and in this episode of The Health Pulse, we decode the complex narrative of leukemia, a cancer of the blood and bone marrow that affects over 60,000 Americans each year. Unlike solid tumors, leukemia spreads through the bloodstream, making it harder to detect but critical to understand.
We explore how abnormal white blood cells crowd out the healthy cells your body needs to fight infections, carry oxygen, and clot blood. You’ll learn the four main types of leukemia—acute vs. chronic, lymphocytic vs. myeloid—and why these classifications matter for treatment and prognosis.
We break down how deceptively ordinary symptoms like fatigue, frequent infections, or easy bruising can mask this condition, and why laboratory testing—from blood counts to genetic profiling—is essential for early detection.
Most importantly, we highlight the revolutionary treatments transforming outcomes: targeted therapies, CAR T-cell therapy, and advanced testing that detects residual disease at levels once thought impossible. This is personalized medicine in action—bringing hope to patients who once had few options.
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Disclaimer: The information provided in this podcast is for informational purposes only and should not be considered medical advice. The content discussed is based on research, expert insights, and reputable sources, but it does not replace professional medical consultation, diagnosis, or treatment. We strive to present accurate and up-to-date information, medical research is constantly evolving. Listeners should always verify details with trusted health organizations, before making any health-related decisions. If you are experiencing a medical emergency, such as severe pain, difficulty breathing, or other urgent symptoms, call your local emergency services immediately. By listening to this podcast, you acknowledge that The Health Pulse and its creators are not responsible for any actions taken based on the content of this episode. Your health and well-being should always be guided by the advice of qualified medical professionals.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Health Pulse, your go-to source for
quick, actionable insights onhealth, wellness and diagnostics
.
Whether you're looking tooptimize your well-being or stay
informed about the latest inmedical testing, we've got you
covered.
Join us as we break down keyhealth topics in just minutes.
Let's dive in.
Speaker 2 (00:26):
Welcome to the Deep Dive.
Today we're exploring a topicthat well.
It can sound a bit heavyleukemia but honestly,
understanding it can be reallyempowering.
Our aim today is to sort of cutthrough the medical jargon,
give you a clearer picture ofthese blood cancers.
So, fundamentally, leukemia isa type of cancer.
Right, it affects your bloodand your bone marrow.
(00:46):
That's the place where all yourblood cells get made.
It kicks off when theseabnormal white blood cells just
start growing out of control.
Yeah, and these cancerous cells?
They don't mature properly andeventually they just crowd out
the healthy cells, you know, theones you need for fighting
infection, carrying oxygen,clotting blood.
The American Cancer Societyactually reports over 60,000 new
leukemia diagnoses in the USeach year, which makes it well,
(01:10):
one of the most common bloodcancers out there.
Speaker 3 (01:12):
And what's interesting about leukemia, what
really sets it apart from, say,many other cancers, is its
nature.
It's systemic, so, unlike asolid tumor you know a lump you
can find leukemia spreadsthrough the bloodstream and the
bone marrow.
It's diffuse, not localized,and that definitely makes
detection and just understandingit a bit more complex.
Speaker 2 (01:30):
Right, that makes sense.
It's everywhere in the system.
But and this is importantdespite that complexity, there's
actually quite a bit of reasonfor optimism now Huge advances
in lab testing, geneticprofiling, targeted therapies
They've really dramaticallyimproved things.
Early diagnosis treatmentoutcomes They've really
dramatically improved things.
Early diagnosis treatmentoutcomes it's much better.
So in this deep dive we'regoing to unpack what leukemia
(01:50):
actually is.
We'll look at the differentforms, how it gets diagnosed and
, crucially, the ongoing rolelab testing plays, not just for
finding it but for monitoring it.
Long term, we want to make sureyou walk away feeling well,
much more informed.
Okay, so let's start by reallycementing what we mean by
leukemia.
Fundamentally, it's cancer ofthe blood-forming tissues,
(02:10):
primarily the bone marrow andalso the lymphatic system.
The key issue isn't just thatabnormal white blood cells
multiply.
It's that they multiplyuncontrollably and they're
dysfunctional.
They just don't do their jobsand they end up overwhelming the
production of healthy bloodcells.
Speaker 3 (02:23):
Exactly, and that disruption in the bone marrow.
It has knock-on effects bigones See.
Healthy bone marrow makes yourred blood cells, your normal
white blood cells and yourplatelets.
In leukemia, the cancerouscells basically hijack that
whole factory.
They suppress the normalproduction.
So you might have this hugenumber of white blood cells
technically, but often they'reimmature, they're blasts and
(02:44):
they can't actually fightinfection, which leaves the body
really vulnerable.
Speaker 2 (02:48):
And you feel that right.
Those blood abnormalitiesdirectly impact daily life, like
if you don't have enough redblood cells.
That's anemia.
You feel constantly tired, weak.
Low platelets mean you bruiseeasily or bleed more from small
cuts.
And because it's a blooddisease, the symptoms can show
up basically anywhere in thebody, which is why lab testing
is just so so critical forcatching it early.
Speaker 3 (03:09):
Yeah, and it's vital to understand.
Leukemia isn't just one singledisease, it's really a group of
cancers.
We categorize them mainly bytwo things how quickly they
develop and which specific typeof blood cell is affected.
And this classification isabsolutely crucial because the
treatment, the prognosis, itvaries a lot depending on the
type.
Speaker 2 (03:29):
Okay, let's break that down.
First speed of progressionYou've got acute leukemia.
This develops really fast.
It demands immediate, prettyaggressive treatment.
With acute forms you get loadsof these immature blood cells,
those blasts you mentioned.
Totally dysfunctional Symptomsusually hit suddenly and get
worse quickly.
Speaker 3 (03:47):
Right, then the contrast is chronic leukemia.
This progresses much moreslowly.
Sometimes it can go undetectedfor years.
Actually, here the body doesproduce some mature blood cells,
but they're still abnormal.
They might partially functionfor a while.
Very often chronic leukemia isfound by chance, you know,
during routine blood work, whichreally highlights the value of
(04:08):
those regular checkups.
Speaker 2 (04:09):
Okay, so acute, fast, chronic, slow.
Then you mentioned the celltype involved.
So there's lymphocytic leukemiathat specifically targets
lymphocytes.
Those are a type of white bloodcell, key part of our immune
defense right.
Speaker 3 (04:22):
Correct.
And the other main category ismyeloid leukemia, sometimes
called myelogenous leukemia.
This affects the myeloid cells.
Think of these as the parentcells, the progenitors that
normally grow into red bloodcells, platelets and also other
kinds of white blood cells likeneutrophils.
Speaker 2 (04:38):
Got it.
So if you combine those twoways of classifying speed and
cell type, you get the four maintypes.
First, acute lymphoblasticleukemia, or ALL I hear.
This one is most common in kids, but adults can get it too.
It progresses quickly but thegood news is, with fast
treatment it's often verytreatable.
Speaker 3 (04:54):
That's right.
Then there's acute myeloidleukemia AML, generally more
common in adults.
Aml is often linked to certaingenetic changes, and
environmental factors can play arole too.
Then we have chroniclymphocytic leukemia CLL.
This typically affects olderadults.
It's often very slow-growing.
Sometimes doctors might evenuse a watchful waiting approach
before starting active treatment.
Speaker 2 (05:15):
Watchful waiting.
Okay, and the last one.
Speaker 3 (05:18):
Chronic myeloid leukemia, CML.
This one is quite distinctbecause it's specifically linked
to a genetic anomaly called thePhiladelphia chromosome.
Speaker 2 (05:27):
Ah, I've heard of that, that specific mutation
finding.
It has been massive fortreatment, hasn't it?
Speaker 3 (05:33):
Absolutely.
It's been a game changer fortargeted therapies.
Drugs designed to block theactivity driven by that
chromosome have justdramatically improved survival
for CML patients.
It's a real success story inprecision medicine.
Speaker 2 (05:45):
Okay, so that covers the types.
Now, how might someone firstnotice something's wrong?
What are the symptoms youmentioned?
They vary depending on the typeand stage, but mostly related
to those low counts of healthyblood cells.
And because they can come onslowly, especially a chronic
types, lab tests are often thevery first sign.
That's exactly right.
The common early syncyms oftenstem directly from those low
counts and because they can comeon slowly, especially a chronic
types.
Speaker 3 (06:03):
lab tests are often the very first sign.
That's exactly right.
The common early syncyms oftenstem directly from those low
counts.
Persistent fatigue, feelingweak all the time that's usually
anemia from low red blood cells.
Yeah, frequent infections orinfections that are hard to
shake off that points to a lackof functional white blood cells.
Easy bruising or bleeding likenosebleeds or bleeding gums
(06:24):
that's a sign of low platelets.
Pale skin can be another signof anemia.
Shortness of breath, too oftenlinked to low oxygen from the
anemia.
Speaker 2 (06:30):
And this is where it gets tricky, I think, for people
listening.
Other signs can include thingslike swollen lymph nodes, maybe
in your neck, armpits, groin,even bone or joint pain, which
can happen if the bone marrowgets overcrowded with those
abnormal cells, unexplainedweight loss, losing your
appetite, night sweats, maybelow grade fevers.
The critical point here isthese symptoms are incredibly
(06:51):
nonspecific, aren't they?
You could easily think it's theflu, or just stress or a dozen
other things, which is exactlywhy routine blood tests, like a
simple complete blood count, theCBC, are often the most
effective way to catch it early,especially if someone has known
risk factors.
Speaker 3 (07:07):
Which brings us to well, what actually causes
leukemia.
We don't know the exact triggerin every case, but research
points to a mix.
It seems to be a combination ofgenetic mutations, certain
environmental exposures andmaybe factors related to the
immune system.
Identifying these risks canhelp guide screening and maybe
some preventative thinking.
Speaker 2 (07:27):
Okay, let's look at those Genetics first.
We know some inheritedsyndromes increase risk, right
Like Boudin syndrome,Leifermenny syndrome, Fanconi
anemia.
Speaker 3 (07:36):
Yes, those are known associations.
Speaker 2 (07:38):
And specific gene mutations, like that
Philadelphia chromosome and CMLthat directly drives the cancer.
Also, having a close familymember, like a parent or sibling
, with leukemia slightly raisesyour risk, especially for
chronic types like CLL.
Speaker 3 (07:50):
Then there are environmental and lifestyle
factors.
High dose radiation exposure isa clear risk factor.
That could be from previouscancer treatments or less
commonly significantenvironmental exposure,
long-term exposure to certainchemicals.
Benzene is a big one.
It's found in things likegasoline and industrial solvents
.
That's directly linked to AMLand, maybe surprising to some,
(08:14):
smoking it causes genetic damage.
That definitely increasesleukemia risk, particularly for
AML.
Speaker 2 (08:18):
Interesting.
What about medical history orimmune factors?
Speaker 3 (08:21):
Yeah, that's relevant too.
Having had certain types ofchemotherapy or radiation for a
previous cancer can,unfortunately, increase the risk
of developing leukemia later on.
It's a known secondary effectAlso having a weakened immune
system.
So people with HIV, aids ororgan transplant recipients on
immunosuppressants or those withcertain autoimmune conditions
might be more vulnerable.
(08:41):
Even some viruses though thisis rarer, like HTLV-1 or
Epstein-Barr virus, are linkedto specific leukemia subtypes.
Speaker 2 (08:50):
Okay, but it's really important to stress, isn't it,
that many people who getleukemia have none of these
known risk factors?
Speaker 3 (08:56):
Absolutely Crucial point.
Speaker 2 (08:57):
And plenty of people with risk factors never develop
it.
Speaker 3 (09:00):
Correct, which loops back to why things like routine
blood work, cbcs, peripheralsmears remain such vital tools
for early detection forpotentially anyone.
Speaker 2 (09:11):
Right.
So let's say there's asuspicion, maybe based on
symptoms or a routine CBC.
How do doctors confirm it'sleukemia?
This involves moresophisticated lab tests, imaging
and critically looking at thebone marrow itself.
Speaker 3 (09:26):
Exactly, Since the early signs are often in the
blood.
Blood tests are always thestarting point.
The complete blood count, orCBC, is step one, Gives that
detailed picture white cells,red cells, platelets, Abnormal
counts like really high orreally low white cells, Anemia,
low platelets those are thefirst major clues.
Then a peripheral blood smear.
This is where a specialistlooks at the blood cells under a
(09:48):
microscope.
They're checking their shape,their maturity.
They're specifically lookingfor those immature blast cells
which are hallmarks of acuteleukemias.
We also often run biochemicalpanels.
These check things like liverand kidney function, giving a
broader picture of the body'soverall health and helping guide
treatment decisions later.
Speaker 2 (10:04):
So if those blood tests point towards leukemia,
what's next?
The bone marrow tests?
Speaker 3 (10:09):
Yes, bone marrow tests are really the gold
standard for a definitivediagnosis.
This usually involves twoprocedures done together A bone
marrow aspiration, where aliquid sample is drawn, and a
biopsy, where a small core ofthe marrow tissue is taken,
typically from the back of thehip bone.
These samples give doctors adirect look at what's happening
inside the blood factory.
(10:30):
They're absolutely essential toconfirm the diagnosis, figure
out how much disease there isand, really importantly,
classify the exact subtype ofleukemia.
That classification dictatesthe treatment plan.
Speaker 2 (10:43):
And this is where modern medicine gets really
impressive with the advancedtesting for precision.
Oh, absolutely, we're talkingadvanced genetic and molecular
testing.
Speaker 3 (10:51):
Right Cytogenetics looks closely at the chromosomes
in the leukemia cells for anyabnormalities, like finding that
Philadelphia chromosome in CML,which is a specific
translocation, a swapping ofgenetic material between
chromosomes.
Speaker 2 (11:03):
And then flow, cytometry and immunophenotyping.
Speaker 3 (11:07):
Yes, flow cytometry is incredibly powerful.
It helps classify the leukemiasubtype by identifying specific
proteins or markers on thesurface of the cancer cells.
Yeah, gives a very detailedfingerprint of the disease.
Wow.
And finally, molecular testing,using techniques like PCR or
even more advanced nextgeneration sequencing NGS.
This can pinpoint specific genemutations within the leukemia
(11:31):
cells.
Finding these mutations is keybecause it can directly guide
the use of targeted therapies.
We can choose drugs designed toattack those exact genetic
weaknesses.
It makes treatment much morepersonalized and, hopefully,
more effective.
Speaker 2 (11:44):
OK, so once you have that precise diagnosis, subtype
genetic markers and all, whatabout treatment?
You mentioned?
It's highly individualized now,based on type, stage, patient's
age, overall health, thosegenetic details.
Speaker 3 (11:57):
Exactly, and the good news is, because of ongoing
research and therapeuticadvancements, many forms of
leukemia are now highlymanageable.
Some are even curable.
Speaker 2 (12:05):
Let's talk through some of those main treatment
approaches.
Chemotherapy is still a big one, right.
Speaker 3 (12:09):
It definitely remains a cornerstone.
Chemo uses powerful drugs tokill rapidly dividing cells,
which includes cancer cells.
It's often given in cycles,allowing the body some time to
recover in between.
It's particularly vital for theaggressive acute leukemias.
Al and AML often involves usinga combination of different
chemo drugs.
Speaker 2 (12:29):
But then there's targeted therapy, which sounds
much more precise.
It is.
Speaker 3 (12:33):
This is where precision medicine really shines
.
These drugs are designed toattack specific vulnerabilities
found only or mostly in leukemiacells, often linked to those
genetic mutations we find.
Speaker 2 (12:45):
Like the CML example.
Speaker 3 (12:46):
Exactly Tyrosine kinase inhibitors, tkis like
imatinib.
They specifically block theabnormal signal from the
Philadelphia chromosome thattells CML cells to grow
uncontrollably.
Similarly, for AML, we now haveFLT3 inhibitors and IDH
inhibitors for patients withthose specific mutations and for
CLL, drugs like venetoclaxtarget a protein called BCL-2,
(13:08):
which helps those cancer cellssurvive longer than they should.
These drugs essentially tellthe CLL cells it's time to die.
Speaker 2 (13:13):
That's incredible progress.
What about harnessing theimmune system?
Immunotherapy.
Speaker 3 (13:18):
Yes, immunotherapy is revolutionizing treatment
across many cancers, includingleukemia.
One approach uses monoclonalantibodies.
Think of them like guidedmissiles.
Drugs like rituximab can attachspecifically to proteins on
leukemia cells, flagging themfor destruction by the patient's
own immune system.
And then there's a reallygroundbreaking approach called
(13:40):
CAR T-cell therapy.
Here we take a patient's ownimmune cells, p-cells, modify
them genetically in the lab sothey can recognize and attack
the leukemia cells and theninfuse them back into the
patient.
It's shown amazing results,particularly in some
difficult-to-treat relapse casesof CAN-EL and CLL.
We're also seeing more use ofcheckpoint inhibitors.
(14:01):
These drugs work differently.
They essentially release thebrakes on the immune system,
allowing it to recognize andfight the cancer more
effectively.
Speaker 2 (14:08):
And for some patients is stem cell transplant or bone
marrow transplant still anoption.
Speaker 3 (14:13):
Yes, for certain situations, a stem cell or bone
marrow transplant can offer thebest chance for a long-term cure
.
This involves replacing thepatient's diseased bone marrow
with healthy hematopoietic stemcells, usually from a matched
donor.
It's a very intensive procedure, often considered for patients
with high-risk leukemia or thosewho have relapsed after other
(14:34):
treatments.
Speaker 2 (14:34):
It sounds intensive.
Are there big risks?
Speaker 3 (14:37):
There are significant risks, yes, things like serious
infections during the recoveryperiod and graft-versus-host
disease, where the donor immunecells attack the patient's body.
But its potential for cure,especially in younger, fitter
patients, can be profound.
Speaker 2 (14:51):
And throughout all of this, managing side effects and
keeping the patient well mustbe key Supportive care.
Speaker 3 (14:58):
Absolutely paramount.
Supportive care runs alongsideall active treatments.
It focuses on maintainingquality of life and managing
complications.
This includes things like bloodtransfusions for anemia,
platelet transfusions to preventbleeding, antibiotics to treat
or prevent infections,nutritional support, managing
pain.
It's crucial for gettingpatients through potentially
long and tough treatment courses.
Speaker 2 (15:19):
So treatment starts.
Maybe it's chemo targetedtherapy or something else.
Treatment starts, maybe it'schemo targeted therapy or
something else.
Does the lab testing stop there?
Speaker 3 (15:27):
Not at all.
Lab testing plays a continuous,absolutely critical role
throughout treatment and longafter.
It's all about monitoringRegular complete blood counts.
Cbcs are done frequently.
They track the recovery ofnormal blood cells, white cells,
red cells, platelets, showinghow well the bone marrow is
bouncing back and how the bodyis handling the therapy.
Speaker 2 (15:47):
And you're still looking at the cells themselves.
Speaker 3 (15:55):
Yes, peripheral smears continue to be important.
Specialists keep looking forany signs of abnormal or
immature cells that mightsuggest the treatment isn't
working fully, or perhaps eventhat the disease is starting to
return.
Speaker 2 (16:02):
And you mentioned ways to measure disease activity
with even higher precision.
Speaker 3 (16:06):
Right.
We have incredibly sensitivetests now.
Minimal residual disease MRDtesting is a huge advance.
Mrd tests can detect tiny, tinynumbers of leukemia cells that
might remain after treatmentlevels far too low to be seen on
a standard microscope smear oreven cause symptoms.
Speaker 2 (16:22):
yet why is finding those tiny amounts so important?
Speaker 3 (16:26):
Because finding MRD is often the earliest sign that
the leukemia might relapse,might come back.
Detecting allows doctors topotentially adjust treatment,
maybe intensify it or switchtherapies to try and eliminate
those remaining cells beforethey cause a full-blown relapse.
It's crucial for predictingrisk and guiding next steps.
Speaker 2 (16:44):
Makes sense.
Any other markers you track?
Speaker 3 (16:47):
We might also monitor levels of things like LDH,
lactate dehydrogenase and uricacid.
High levels can sometimesindicate rapid cell turnover,
which might happen during activedisease or sometimes even as
treatment kills off lots ofcells.
And those flow cytometry andmolecular tests we talked about
for diagnosis they're oftenrepeated during and after
treatment.
They help confirm the leukemiacells are gone, check if any new
(17:08):
mutations have appeared thatmight cause resistance and
verify if targeted therapies arehitting their mark.
It's a really dynamic ongoingprocess of surveillance.
Speaker 2 (17:17):
Okay, so as we wrap up this deep dive, it's clear
that leukemia is complex.
Speaker 3 (17:21):
It's diverse, definitely Multiple types,
different pathways.
Speaker 2 (17:24):
But the big takeaway seems to be that, thanks to
these incredible advances inunderstanding the biology and
diagnostics and personalizedtreatments, it's becoming
increasingly manageable andoften curable.
Speaker 3 (17:35):
Yes, the progress has been remarkable journey from
the very first suspicion with aCBC or smear, through the
sophisticated genetic analysisfor diagnosis and treatment
planning, all the way to thatultra sensitive MRD testing for
long-term monitoring.
It's indispensable.
Speaker 2 (17:55):
It really highlights how understanding those early
symptoms, even though they'reoften vague, knowing the risk
factors is such a vital firststep for everyone.
But what really stands out forme, anyway, is the sheer power
of routine lab work, that simpleCBC acting almost like a silent
guard, sometimes picking up thevery first clue that
something's not quite right.
It's honestly a testament tohow far medical science has come
(18:17):
, giving us insights we justdidn't have years ago.
Speaker 3 (18:19):
And this, I think, leads to a really important
question for you, the listener.
Think about it Many of thoseearly leukemia symptoms fatigue,
infections, bruising they caneasily be brushed off, as you
know just having the flu orbeing stressed out, run down and
some chronic forms.
They creep along slowly foryears without obvious signs.
So the question is how might adeeper awareness of your own
(18:43):
body, knowing what's normal foryou, combined with the
availability of these routine,accessible health screenings,
how might that truly change theoutcome if something like
leukemia were to develop For youor maybe for someone you care
about?
How can you use this knowledgewe've discussed today to be a
more informed, more proactiveadvocate for your own health,
maybe even for the health ofpeople around you?
(19:03):
Something to really think aboutadvocate for your own health,
maybe even for the health ofpeople around you Something to
really think about.
Speaker 1 (19:09):
Thanks for tuning into the Health Pulse.
If you found this episodehelpful, don't forget to
subscribe and share it withsomeone who might benefit.
For more health insights anddiagnostics.
Visit us online atwwwquicklabmobilecom.
Stay informed, stay healthy andwe'll catch you in the next
episode.
Welcome to the Health Pulse, your go-to source for
quick, actionable insights onhealth, wellness and diagnostics
.
Whether you're looking tooptimize your well-being or stay
informed about the latest inmedical testing, we've got you
covered.
Join us as we break down keyhealth topics in just minutes.
Let's dive in.
Speaker 2 (00:26):
Welcome to the Deep Dive.
Today we're exploring a topicthat well.
It can sound a bit heavyleukemia but honestly,
understanding it can be reallyempowering.
Our aim today is to sort of cutthrough the medical jargon,
give you a clearer picture ofthese blood cancers.
So, fundamentally, leukemia isa type of cancer.
Right, it affects your bloodand your bone marrow.
(00:46):
That's the place where all yourblood cells get made.
It kicks off when theseabnormal white blood cells just
start growing out of control.
Yeah, and these cancerous cells?
They don't mature properly andeventually they just crowd out
the healthy cells, you know, theones you need for fighting
infection, carrying oxygen,clotting blood.
The American Cancer Societyactually reports over 60,000 new
leukemia diagnoses in the USeach year, which makes it well,
(01:10):
one of the most common bloodcancers out there.
Speaker 3 (01:12):
And what's interesting about leukemia, what
really sets it apart from, say,many other cancers, is its
nature.
It's systemic, so, unlike asolid tumor you know a lump you
can find leukemia spreadsthrough the bloodstream and the
bone marrow.
It's diffuse, not localized,and that definitely makes
detection and just understandingit a bit more complex.
Speaker 2 (01:30):
Right, that makes sense.
It's everywhere in the system.
But and this is importantdespite that complexity, there's
actually quite a bit of reasonfor optimism now Huge advances
in lab testing, geneticprofiling, targeted therapies
They've really dramaticallyimproved things.
Early diagnosis treatmentoutcomes They've really
dramatically improved things.
Early diagnosis treatmentoutcomes it's much better.
So in this deep dive we'regoing to unpack what leukemia
(01:50):
actually is.
We'll look at the differentforms, how it gets diagnosed and
, crucially, the ongoing rolelab testing plays, not just for
finding it but for monitoring it.
Long term, we want to make sureyou walk away feeling well,
much more informed.
Okay, so let's start by reallycementing what we mean by
leukemia.
Fundamentally, it's cancer ofthe blood-forming tissues,
(02:10):
primarily the bone marrow andalso the lymphatic system.
The key issue isn't just thatabnormal white blood cells
multiply.
It's that they multiplyuncontrollably and they're
dysfunctional.
They just don't do their jobsand they end up overwhelming the
production of healthy bloodcells.
Speaker 3 (02:23):
Exactly, and that disruption in the bone marrow.
It has knock-on effects bigones See.
Healthy bone marrow makes yourred blood cells, your normal
white blood cells and yourplatelets.
In leukemia, the cancerouscells basically hijack that
whole factory.
They suppress the normalproduction.
So you might have this hugenumber of white blood cells
technically, but often they'reimmature, they're blasts and
(02:44):
they can't actually fightinfection, which leaves the body
really vulnerable.
Speaker 2 (02:48):
And you feel that right.
Those blood abnormalitiesdirectly impact daily life, like
if you don't have enough redblood cells.
That's anemia.
You feel constantly tired, weak.
Low platelets mean you bruiseeasily or bleed more from small
cuts.
And because it's a blooddisease, the symptoms can show
up basically anywhere in thebody, which is why lab testing
is just so so critical forcatching it early.
Speaker 3 (03:09):
Yeah, and it's vital to understand.
Leukemia isn't just one singledisease, it's really a group of
cancers.
We categorize them mainly bytwo things how quickly they
develop and which specific typeof blood cell is affected.
And this classification isabsolutely crucial because the
treatment, the prognosis, itvaries a lot depending on the
type.
Speaker 2 (03:29):
Okay, let's break that down.
First speed of progressionYou've got acute leukemia.
This develops really fast.
It demands immediate, prettyaggressive treatment.
With acute forms you get loadsof these immature blood cells,
those blasts you mentioned.
Totally dysfunctional Symptomsusually hit suddenly and get
worse quickly.
Speaker 3 (03:47):
Right, then the contrast is chronic leukemia.
This progresses much moreslowly.
Sometimes it can go undetectedfor years.
Actually, here the body doesproduce some mature blood cells,
but they're still abnormal.
They might partially functionfor a while.
Very often chronic leukemia isfound by chance, you know,
during routine blood work, whichreally highlights the value of
(04:08):
those regular checkups.
Speaker 2 (04:09):
Okay, so acute, fast, chronic, slow.
Then you mentioned the celltype involved.
So there's lymphocytic leukemiathat specifically targets
lymphocytes.
Those are a type of white bloodcell, key part of our immune
defense right.
Speaker 3 (04:22):
Correct.
And the other main category ismyeloid leukemia, sometimes
called myelogenous leukemia.
This affects the myeloid cells.
Think of these as the parentcells, the progenitors that
normally grow into red bloodcells, platelets and also other
kinds of white blood cells likeneutrophils.
Speaker 2 (04:38):
Got it.
So if you combine those twoways of classifying speed and
cell type, you get the four maintypes.
First, acute lymphoblasticleukemia, or ALL I hear.
This one is most common in kids, but adults can get it too.
It progresses quickly but thegood news is, with fast
treatment it's often verytreatable.
Speaker 3 (04:54):
That's right.
Then there's acute myeloidleukemia AML, generally more
common in adults.
Aml is often linked to certaingenetic changes, and
environmental factors can play arole too.
Then we have chroniclymphocytic leukemia CLL.
This typically affects olderadults.
It's often very slow-growing.
Sometimes doctors might evenuse a watchful waiting approach
before starting active treatment.
Speaker 2 (05:15):
Watchful waiting.
Okay, and the last one.
Speaker 3 (05:18):
Chronic myeloid leukemia, CML.
This one is quite distinctbecause it's specifically linked
to a genetic anomaly called thePhiladelphia chromosome.
Speaker 2 (05:27):
Ah, I've heard of that, that specific mutation
finding.
It has been massive fortreatment, hasn't it?
Speaker 3 (05:33):
Absolutely.
It's been a game changer fortargeted therapies.
Drugs designed to block theactivity driven by that
chromosome have justdramatically improved survival
for CML patients.
It's a real success story inprecision medicine.
Speaker 2 (05:45):
Okay, so that covers the types.
Now, how might someone firstnotice something's wrong?
What are the symptoms youmentioned?
They vary depending on the typeand stage, but mostly related
to those low counts of healthyblood cells.
And because they can come onslowly, especially a chronic
types, lab tests are often thevery first sign.
That's exactly right.
The common early syncyms oftenstem directly from those low
counts and because they can comeon slowly, especially a chronic
types.
Speaker 3 (06:03):
lab tests are often the very first sign.
That's exactly right.
The common early syncyms oftenstem directly from those low
counts.
Persistent fatigue, feelingweak all the time that's usually
anemia from low red blood cells.
Yeah, frequent infections orinfections that are hard to
shake off that points to a lackof functional white blood cells.
Easy bruising or bleeding likenosebleeds or bleeding gums
(06:24):
that's a sign of low platelets.
Pale skin can be another signof anemia.
Shortness of breath, too oftenlinked to low oxygen from the
anemia.
Speaker 2 (06:30):
And this is where it gets tricky, I think, for people
listening.
Other signs can include thingslike swollen lymph nodes, maybe
in your neck, armpits, groin,even bone or joint pain, which
can happen if the bone marrowgets overcrowded with those
abnormal cells, unexplainedweight loss, losing your
appetite, night sweats, maybelow grade fevers.
The critical point here isthese symptoms are incredibly
(06:51):
nonspecific, aren't they?
You could easily think it's theflu, or just stress or a dozen
other things, which is exactlywhy routine blood tests, like a
simple complete blood count, theCBC, are often the most
effective way to catch it early,especially if someone has known
risk factors.
Speaker 3 (07:07):
Which brings us to well, what actually causes
leukemia.
We don't know the exact triggerin every case, but research
points to a mix.
It seems to be a combination ofgenetic mutations, certain
environmental exposures andmaybe factors related to the
immune system.
Identifying these risks canhelp guide screening and maybe
some preventative thinking.
Speaker 2 (07:27):
Okay, let's look at those Genetics first.
We know some inheritedsyndromes increase risk, right
Like Boudin syndrome,Leifermenny syndrome, Fanconi
anemia.
Speaker 3 (07:36):
Yes, those are known associations.
Speaker 2 (07:38):
And specific gene mutations, like that
Philadelphia chromosome and CMLthat directly drives the cancer.
Also, having a close familymember, like a parent or sibling
, with leukemia slightly raisesyour risk, especially for
chronic types like CLL.
Speaker 3 (07:50):
Then there are environmental and lifestyle
factors.
High dose radiation exposure isa clear risk factor.
That could be from previouscancer treatments or less
commonly significantenvironmental exposure,
long-term exposure to certainchemicals.
Benzene is a big one.
It's found in things likegasoline and industrial solvents
.
That's directly linked to AMLand, maybe surprising to some,
(08:14):
smoking it causes genetic damage.
That definitely increasesleukemia risk, particularly for
AML.
Speaker 2 (08:18):
Interesting.
What about medical history orimmune factors?
Speaker 3 (08:21):
Yeah, that's relevant too.
Having had certain types ofchemotherapy or radiation for a
previous cancer can,unfortunately, increase the risk
of developing leukemia later on.
It's a known secondary effectAlso having a weakened immune
system.
So people with HIV, aids ororgan transplant recipients on
immunosuppressants or those withcertain autoimmune conditions
might be more vulnerable.
(08:41):
Even some viruses though thisis rarer, like HTLV-1 or
Epstein-Barr virus, are linkedto specific leukemia subtypes.
Speaker 2 (08:50):
Okay, but it's really important to stress, isn't it,
that many people who getleukemia have none of these
known risk factors?
Speaker 3 (08:56):
Absolutely Crucial point.
Speaker 2 (08:57):
And plenty of people with risk factors never develop
it.
Speaker 3 (09:00):
Correct, which loops back to why things like routine
blood work, cbcs, peripheralsmears remain such vital tools
for early detection forpotentially anyone.
Speaker 2 (09:11):
Right.
So let's say there's asuspicion, maybe based on
symptoms or a routine CBC.
How do doctors confirm it'sleukemia?
This involves moresophisticated lab tests, imaging
and critically looking at thebone marrow itself.
Speaker 3 (09:26):
Exactly, Since the early signs are often in the
blood.
Blood tests are always thestarting point.
The complete blood count, orCBC, is step one, Gives that
detailed picture white cells,red cells, platelets, Abnormal
counts like really high orreally low white cells, Anemia,
low platelets those are thefirst major clues.
Then a peripheral blood smear.
This is where a specialistlooks at the blood cells under a
(09:48):
microscope.
They're checking their shape,their maturity.
They're specifically lookingfor those immature blast cells
which are hallmarks of acuteleukemias.
We also often run biochemicalpanels.
These check things like liverand kidney function, giving a
broader picture of the body'soverall health and helping guide
treatment decisions later.
Speaker 2 (10:04):
So if those blood tests point towards leukemia,
what's next?
The bone marrow tests?
Speaker 3 (10:09):
Yes, bone marrow tests are really the gold
standard for a definitivediagnosis.
This usually involves twoprocedures done together A bone
marrow aspiration, where aliquid sample is drawn, and a
biopsy, where a small core ofthe marrow tissue is taken,
typically from the back of thehip bone.
These samples give doctors adirect look at what's happening
inside the blood factory.
(10:30):
They're absolutely essential toconfirm the diagnosis, figure
out how much disease there isand, really importantly,
classify the exact subtype ofleukemia.
That classification dictatesthe treatment plan.
Speaker 2 (10:43):
And this is where modern medicine gets really
impressive with the advancedtesting for precision.
Oh, absolutely, we're talkingadvanced genetic and molecular
testing.
Speaker 3 (10:51):
Right Cytogenetics looks closely at the chromosomes
in the leukemia cells for anyabnormalities, like finding that
Philadelphia chromosome in CML,which is a specific
translocation, a swapping ofgenetic material between
chromosomes.
Speaker 2 (11:03):
And then flow, cytometry and immunophenotyping.
Speaker 3 (11:07):
Yes, flow cytometry is incredibly powerful.
It helps classify the leukemiasubtype by identifying specific
proteins or markers on thesurface of the cancer cells.
Yeah, gives a very detailedfingerprint of the disease.
Wow.
And finally, molecular testing,using techniques like PCR or
even more advanced nextgeneration sequencing NGS.
This can pinpoint specific genemutations within the leukemia
(11:31):
cells.
Finding these mutations is keybecause it can directly guide
the use of targeted therapies.
We can choose drugs designed toattack those exact genetic
weaknesses.
It makes treatment much morepersonalized and, hopefully,
more effective.
Speaker 2 (11:44):
OK, so once you have that precise diagnosis, subtype
genetic markers and all, whatabout treatment?
You mentioned?
It's highly individualized now,based on type, stage, patient's
age, overall health, thosegenetic details.
Speaker 3 (11:57):
Exactly, and the good news is, because of ongoing
research and therapeuticadvancements, many forms of
leukemia are now highlymanageable.
Some are even curable.
Speaker 2 (12:05):
Let's talk through some of those main treatment
approaches.
Chemotherapy is still a big one, right.
Speaker 3 (12:09):
It definitely remains a cornerstone.
Chemo uses powerful drugs tokill rapidly dividing cells,
which includes cancer cells.
It's often given in cycles,allowing the body some time to
recover in between.
It's particularly vital for theaggressive acute leukemias.
Al and AML often involves usinga combination of different
chemo drugs.
Speaker 2 (12:29):
But then there's targeted therapy, which sounds
much more precise.
It is.
Speaker 3 (12:33):
This is where precision medicine really shines
.
These drugs are designed toattack specific vulnerabilities
found only or mostly in leukemiacells, often linked to those
genetic mutations we find.
Speaker 2 (12:45):
Like the CML example.
Speaker 3 (12:46):
Exactly Tyrosine kinase inhibitors, tkis like
imatinib.
They specifically block theabnormal signal from the
Philadelphia chromosome thattells CML cells to grow
uncontrollably.
Similarly, for AML, we now haveFLT3 inhibitors and IDH
inhibitors for patients withthose specific mutations and for
CLL, drugs like venetoclaxtarget a protein called BCL-2,
(13:08):
which helps those cancer cellssurvive longer than they should.
These drugs essentially tellthe CLL cells it's time to die.
Speaker 2 (13:13):
That's incredible progress.
What about harnessing theimmune system?
Immunotherapy.
Speaker 3 (13:18):
Yes, immunotherapy is revolutionizing treatment
across many cancers, includingleukemia.
One approach uses monoclonalantibodies.
Think of them like guidedmissiles.
Drugs like rituximab can attachspecifically to proteins on
leukemia cells, flagging themfor destruction by the patient's
own immune system.
And then there's a reallygroundbreaking approach called
(13:40):
CAR T-cell therapy.
Here we take a patient's ownimmune cells, p-cells, modify
them genetically in the lab sothey can recognize and attack
the leukemia cells and theninfuse them back into the
patient.
It's shown amazing results,particularly in some
difficult-to-treat relapse casesof CAN-EL and CLL.
We're also seeing more use ofcheckpoint inhibitors.
(14:01):
These drugs work differently.
They essentially release thebrakes on the immune system,
allowing it to recognize andfight the cancer more
effectively.
Speaker 2 (14:08):
And for some patients is stem cell transplant or bone
marrow transplant still anoption.
Speaker 3 (14:13):
Yes, for certain situations, a stem cell or bone
marrow transplant can offer thebest chance for a long-term cure
.
This involves replacing thepatient's diseased bone marrow
with healthy hematopoietic stemcells, usually from a matched
donor.
It's a very intensive procedure, often considered for patients
with high-risk leukemia or thosewho have relapsed after other
(14:34):
treatments.
Speaker 2 (14:34):
It sounds intensive.
Are there big risks?
Speaker 3 (14:37):
There are significant risks, yes, things like serious
infections during the recoveryperiod and graft-versus-host
disease, where the donor immunecells attack the patient's body.
But its potential for cure,especially in younger, fitter
patients, can be profound.
Speaker 2 (14:51):
And throughout all of this, managing side effects and
keeping the patient well mustbe key Supportive care.
Speaker 3 (14:58):
Absolutely paramount.
Supportive care runs alongsideall active treatments.
It focuses on maintainingquality of life and managing
complications.
This includes things like bloodtransfusions for anemia,
platelet transfusions to preventbleeding, antibiotics to treat
or prevent infections,nutritional support, managing
pain.
It's crucial for gettingpatients through potentially
long and tough treatment courses.
Speaker 2 (15:19):
So treatment starts.
Maybe it's chemo targetedtherapy or something else.
Treatment starts, maybe it'schemo targeted therapy or
something else.
Does the lab testing stop there?
Speaker 3 (15:27):
Not at all.
Lab testing plays a continuous,absolutely critical role
throughout treatment and longafter.
It's all about monitoringRegular complete blood counts.
Cbcs are done frequently.
They track the recovery ofnormal blood cells, white cells,
red cells, platelets, showinghow well the bone marrow is
bouncing back and how the bodyis handling the therapy.
Speaker 2 (15:47):
And you're still looking at the cells themselves.
Speaker 3 (15:55):
Yes, peripheral smears continue to be important.
Specialists keep looking forany signs of abnormal or
immature cells that mightsuggest the treatment isn't
working fully, or perhaps eventhat the disease is starting to
return.
Speaker 2 (16:02):
And you mentioned ways to measure disease activity
with even higher precision.
Speaker 3 (16:06):
Right.
We have incredibly sensitivetests now.
Minimal residual disease MRDtesting is a huge advance.
Mrd tests can detect tiny, tinynumbers of leukemia cells that
might remain after treatmentlevels far too low to be seen on
a standard microscope smear oreven cause symptoms.
Speaker 2 (16:22):
yet why is finding those tiny amounts so important?
Speaker 3 (16:26):
Because finding MRD is often the earliest sign that
the leukemia might relapse,might come back.
Detecting allows doctors topotentially adjust treatment,
maybe intensify it or switchtherapies to try and eliminate
those remaining cells beforethey cause a full-blown relapse.
It's crucial for predictingrisk and guiding next steps.
Speaker 2 (16:44):
Makes sense.
Any other markers you track?
Speaker 3 (16:47):
We might also monitor levels of things like LDH,
lactate dehydrogenase and uricacid.
High levels can sometimesindicate rapid cell turnover,
which might happen during activedisease or sometimes even as
treatment kills off lots ofcells.
And those flow cytometry andmolecular tests we talked about
for diagnosis they're oftenrepeated during and after
treatment.
They help confirm the leukemiacells are gone, check if any new
(17:08):
mutations have appeared thatmight cause resistance and
verify if targeted therapies arehitting their mark.
It's a really dynamic ongoingprocess of surveillance.
Speaker 2 (17:17):
Okay, so as we wrap up this deep dive, it's clear
that leukemia is complex.
Speaker 3 (17:21):
It's diverse, definitely Multiple types,
different pathways.
Speaker 2 (17:24):
But the big takeaway seems to be that, thanks to
these incredible advances inunderstanding the biology and
diagnostics and personalizedtreatments, it's becoming
increasingly manageable andoften curable.
Speaker 3 (17:35):
Yes, the progress has been remarkable journey from
the very first suspicion with aCBC or smear, through the
sophisticated genetic analysisfor diagnosis and treatment
planning, all the way to thatultra sensitive MRD testing for
long-term monitoring.
It's indispensable.
Speaker 2 (17:55):
It really highlights how understanding those early
symptoms, even though they'reoften vague, knowing the risk
factors is such a vital firststep for everyone.
But what really stands out forme, anyway, is the sheer power
of routine lab work, that simpleCBC acting almost like a silent
guard, sometimes picking up thevery first clue that
something's not quite right.
It's honestly a testament tohow far medical science has come
(18:17):
, giving us insights we justdidn't have years ago.
Speaker 3 (18:19):
And this, I think, leads to a really important
question for you, the listener.
Think about it Many of thoseearly leukemia symptoms fatigue,
infections, bruising they caneasily be brushed off, as you
know just having the flu orbeing stressed out, run down and
some chronic forms.
They creep along slowly foryears without obvious signs.
So the question is how might adeeper awareness of your own
(18:43):
body, knowing what's normal foryou, combined with the
availability of these routine,accessible health screenings,
how might that truly change theoutcome if something like
leukemia were to develop For youor maybe for someone you care
about?
How can you use this knowledgewe've discussed today to be a
more informed, more proactiveadvocate for your own health,
maybe even for the health ofpeople around you?
(19:03):
Something to really think aboutadvocate for your own health,
maybe even for the health ofpeople around you Something to
really think about.
Speaker 1 (19:09):
Thanks for tuning into the Health Pulse.
If you found this episodehelpful, don't forget to
subscribe and share it withsomeone who might benefit.
For more health insights anddiagnostics.
Visit us online atwwwquicklabmobilecom.
Stay informed, stay healthy andwe'll catch you in the next
episode.
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