Subleukemic leukemia, also known as leukemia subleukemic and aleukemic leukemia cutis, is a rare, cancerous blood disease characterized by the presence of abnormal or atypical white blood cells in the peripheral blood while the total white blood cell count is within the normal range. It can also be characterized by leukemic cells in the skin and subcutaneous tissue which can manifest as visible lesions that are known as cutaneous lesions. Subleukemic leukemia has the same treatment plans as leukemia, including chemotherapy and radiation treatments.

Signs and symptoms

Subleukemic leukemia does not have any widely known specific symptoms at this time. The most common symptoms presented by patients with the disease are fevers and fatigue. Other common symptoms include weight loss, bone pain, bruising, and bleeding. Additionally, subleukemic leukemia can cause visible skin lesions called cutaneous lesions or

leukemia cutis Leukemia cutis is the infiltration of neoplastic leukocytes or their precursors into the skin resulting in clinically identifiable cutaneous lesions. This condition may be contrasted with leukemids, which are skin lesions that occur with leukemia, ...

. These lesions can be in the form of bull’s eye rashes, papules, or nodules and may progress into alternative forms.

Causes

While subleukemic leukemia has no widely known causes at this time, there are risk factors that are known to increase an individual’s chance of developing the disease. These risk factors do not directly cause an individual to develop this disease, rather studies have shown that individuals with these risk factors are more likely to develop this disease than those without any risk factors. These risk factors include exposure to ionizing radiation, as well as a number of medications and genetic disorders. The medications and drugs include

Chlorambucil Chlorambucil, sold under the brand name Leukeran among others, is a chemotherapy medication used to treat chronic lymphocytic leukemia (CLL), Hodgkin lymphoma, and non-Hodgkin lymphoma. For CLL it is a preferred treatment. It is given by mouth ...

chloramphenicol Chloramphenicol is an antibiotic useful for the treatment of a number of bacterial infections. This includes use as an eye ointment to treat conjunctivitis. By mouth or by intravenous, injection into a vein, it is used to treat meningitis, pl ...

cyclophosphamide Cyclophosphamide (CP), also known as cytophosphane among other names, is a medication used as chemotherapy and to suppress the immune system. As chemotherapy it is used to treat lymphoma, multiple myeloma, leukemia, ovarian cancer, breast cancer ...

melphalan Melphalan, sold under the brand name Alkeran among others, is a chemotherapy medication used to treat multiple myeloma; malignant lymphoma; lymphoblastic and myeloblastic leukemia; childhood neuroblastoma; ovarian cancer; mammary adenocar ...

nitrogen mustard Nitrogen mustards (NMs) are cytotoxic organic compounds with the bis(2-chloroethyl)amino ((ClC2H4)2NR) functional group. Although originally produced as chemical warfare agents, they were the first chemotherapeutic agents for treatment of canc ...

phenylbutazone Phenylbutazone, often referred to as "bute", is a nonsteroidal anti-inflammatory drug (NSAID) for the short-term treatment of pain and fever in animals. In the United States and United Kingdom, it is no longer approved for human use (except in t ...

, and procarbazine. Genetic disorders that have been linked with an increased chance of developing subleukemic leukemia include

ataxia telangiectasia Ataxia (from Greek α- negative prefix+ -τάξις rder= "lack of order") is a neurological sign consisting of lack of voluntary coordination of muscle movements that can include gait abnormality, speech changes, and abnormalities in e ...

Bloom syndrome Bloom syndrome (often abbreviated as BS in literature) is a rare autosomal recessive genetic disorder characterized by short stature, predisposition to the development of cancer, and genomic instability. BS is caused by mutations in the '' BLM'' g ...

, Down syndrome,

Fanconi anemia Fanconi anemia (FA) is a rare, autosomal recessive genetic disease characterized by aplastic anemia, congenital defects, endocrinological abnormalities, and an increased incidence of developing cancer. The study of Fanconi anemia has improve ...

, and

Li–Fraumeni syndrome Li–Fraumeni syndrome (LFS) is a rare, autosomal dominant, hereditary disorder that predisposes carriers to cancer development. It was named after two American physicians, Frederick Pei Li and Joseph F. Fraumeni Jr., who first recognized the ...

. Some genes have been inferred to be connected to the disease, but this research is not widespread, accepted knowledge.

Diagnosis

Subleukemic leukemia is diagnosed with a blood test to determine the number of normal and abnormal white blood cells present in the peripheral bloodstream. The peripheral bloodstream references all blood flow within the body not within organs. Individuals with subleukemic leukemia will likely have normal or low white blood cell counts but high abnormal blood cell counts.

White blood cells White blood cells (scientific name leukocytes), also called immune cells or immunocytes, are cells of the immune system that are involved in protecting the body against both infectious disease and foreign entities. White blood cells are genera ...

, or leukocytes, are colorless blood cells that flow through the bloodstream and primarily counteract foreign bodies and diseases. High or low white blood cell counts affect the body’s ability to combat disease and can affect an individual’s health. Subleukemic leukemia can also be diagnosed by the skin lesions that may present on some individuals.

Treatments

The widely available medicinal treatments for subleukemic leukemia are the same as widespread recommendations for leukemia such as

chemotherapy Chemotherapy (often abbreviated chemo, sometimes CTX and CTx) is the type of cancer treatment that uses one or more anti-cancer drugs (list of chemotherapeutic agents, chemotherapeutic agents or alkylating agents) in a standard chemotherapy re ...

radiation therapy Radiation therapy or radiotherapy (RT, RTx, or XRT) is a therapy, treatment using ionizing radiation, generally provided as part of treatment of cancer, cancer therapy to either kill or control the growth of malignancy, malignant cell (biology), ...

stem cell therapy Stem-cell therapy uses stem cells to treat or prevent a disease or condition. , the only FDA-approved therapy using stem cells is hematopoietic stem cell transplantation. This usually takes the form of a bone marrow or peripheral blood stem cel ...

, and medication. Leukemia treatments typically have three objectives: immediate patient support and relief, future infection prevention, and elimination of the cancerous cells. Treatments can target cancerous cells, while also promoting the growth of healthy cells to help the patient’s immune response normalize.

Prevalence

The prevalence of subleukemic leukemia in healthy individuals is not widely known at this time research studies primarily present the prevalence of cases where individuals have both Subleukemic Leukemia and another disease, such as pancytopenia.

Pancytopenia Pancytopenia is a medical condition in which there is significant reduction in the number of almost all blood cells (red blood cells, white blood cells, platelets, monocytes, lymphocytes, etc.). If only two parameters from the complete blood cou ...

is a disease where an individual has lower than average numbers of red and white blood cells, as well as platelets. This condition can lead to leukemia or other blood diseases. The prevalence of subleukemic leukemia in individuals with pancytopenia is currently known to be between 3-12%. The wide range in prevalence is the result of limited studies and information on the subject.

Prognosis

The prognosis for this disease is not well understood. As it is currently widely accepted, the prognosis is primarily affected by the specific type of leukemia each patient has.

Research

Subleukemic leukemia is a rare disease with little information widely available or known. This disease is currently widely understood to be a manifestation or precursor to leukemia. Because the abnormal white blood cells are in the peripheral blood and visible symptoms primarily present on the skin, many scientists think that it is a precursor to the bone marrow and full bloodstream involvement characteristic of leukemia. Research is currently being conducted to investigate causes and preventative measures for this disease.

References

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