Chronic granulocytic leukemia etiology

Written by He Li Fang
Hematology
Updated on September 16, 2024
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Chronic granulocytic leukemia is a myeloproliferative tumor originating from multipotent stem cells. It is characterized by the translocation of chromosomes 9 and 22 forming the BCR/ABL fusion gene. The Philadelphia chromosome is a characteristic change in chronic granulocytic leukemia, first discovered and named in Philadelphia in 1960. Initially, it was observed as a deletion of the long arm of the primary chromosome in dividing blood cells of patients with this leukemia. Currently, studies have shown that abnormalities in the interaction between hematopoietic progenitor cells and the stroma might be central to treating the disease. Abnormal adhesion and anchoring characteristics of progenitor cells lead to disrupted cell maturation and proliferation. Chronic granulocytic cells do not adhere to stromal cells as normal cells do, particularly lacking integrin-mediated adhesion. Additionally, the expression of the adhesion molecule lymphocyte function-associated antigen 3 is also reduced in these cells. Therefore, the progression of the disease results from clonal changes. During the transformation of chronic granulocytic leukemia to acute myeloid leukemia, there is an increased rate of genetic mutations. Changes in gene expression during the progression involve various aspects, including nucleosome sugar metabolism, bone marrow myeloid differentiation, genomic instability of cell apoptosis genes, and processes related to DNA damage repair.

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What is acute leukemia?

Acute leukemia is a malignant clonal disease originating from hematopoietic stem progenitor cells. Normally, hematopoietic stem progenitor cells differentiate into white blood cells, which gradually mature into normal white blood cells. However, leukemia cells are primitive cells and immature cells, which means that the hematopoietic stem cells lose the ability to differentiate and mature. Additionally, they proliferate massively in the bone marrow while suppressing normal hematopoietic functions, and can widely infiltrate various organs such as the liver, spleen, and lymph nodes. Due to the suppression of bone marrow hematopoiesis, patients may exhibit clinical manifestations such as anemia, bleeding, and infections. Patients with acute leukemia often seek medical attention because of fever, fatigue, or bleeding from the skin and mucous membranes.

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What are the symptoms of leukemia?

The symptoms of leukemia mainly fall into four categories: infections, anemia, bleeding, and tumor infiltration. Infections occur because the proliferation of leukemia cells leads to a reduction in the patient's own granulocytes, lowering their resistance and possibly leading to various secondary infections such as respiratory, urinary system, and skin mucous membrane infections. Anemia is due to the proliferation of leukemia cells, which restricts normal erythropoiesis in the bone marrow, leading to symptoms in patients such as dizziness, headaches, fatigue, and decreased stamina. Bleeding occurs due to a decrease in platelets, posing a risk of spontaneous bleeding, which can include bleeding of the skin mucous membranes, organs, and even cerebral hemorrhage. Tumor infiltration by leukemia cells may manifest as tumor masses on the skin surface.

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Written by Yan Xin Liang
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Early symptoms of childhood leukemia

Generally speaking, leukemia can manifest symptoms related to a decrease in all three blood cell lines. Changes in these three lines typically include an increase or decrease in white blood cells, a decrease in red blood cells leading to symptoms of anemia, and a reduction in platelets, resulting in symptoms of bleeding. Children with leukemia often experience recurrent fevers and are prone to infections, as well as bleeding gums. There may also be enlargement of the liver, spleen, and lymph nodes, along with pallor of the face and lips, which appear pale and bloodless.

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Symptoms of Acute Leukemia

The common symptoms of acute leukemia include four main categories: infection, anemia, bleeding, and tumor infiltration. Symptoms of infection manifest as fever, cough, expectoration, chest pain, abdominal pain, diarrhea, frequent urination, urgent urination, painful urination, skin infections, and perianal infections. Anemia is characterized by dizziness, fatigue, poor appetite, and decreased endurance. Symptoms of reduced platelets mainly involve bleeding, which can manifest as bleeding of the skin and mucous membranes, organ bleeding, and even cerebral hemorrhage. Tumor infiltration can manifest as gingival hyperplasia and skin rashes among other swellings.

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The difference between chronic granulocytic leukemia and leukemia

Chronic granulocytic leukemia is a type of leukemia, which itself is a group of malignant clonal disorders of hematopoietic stem cells. In leukemia, the leukemic cells exhibit enhanced self-renewal, uncontrolled proliferation, and obstructed apoptosis, causing a halt at various stages of cell development. Leukemia is divided into acute leukemia and chronic leukemia. Acute leukemia includes acute lymphoblastic leukemia and acute myeloid leukemia, while chronic leukemia includes chronic lymphocytic leukemia and chronic granulocytic leukemia. The primary difference between acute and chronic leukemia is that the leukemic cells in acute leukemia mainly stall at the primitive and immature stages, whereas in chronic leukemia, the cells primarily remain at the mid-immature and late-immature stages.