Congenital Leukemia And Hypoplastic Preleukemia - Causes, Symptoms, and Treatment

What Is Congenital Leukemia?

Congenital leukemia is a rare hematological disease that develops inside the mother's womb or in utero and becomes more evident soon after birth. This condition is generally diagnosed very soon after birth or within one month after birth. It is also known as neonatal leukemia. The mortality rate is higher in congenital leukemia than in other types of leukemia.

As these are very rare, there is no standard staging system given.

What Is Hypoplastic Preleukemia?

Hypoplastic preleukemia is acute hematological leukemia that precedes aplastic anemia, which more likely tends to develop into acute lymphoblastic leukemia, whereas myelodysplastic preleukemic is specific for acute myelocytic leukemia. It is a very rare condition. More than 40 cases have been reported today. As these are very rare hematological cancers, there is no standard staging system given.

What Is leukemia?

Leukemia is a cancer cell formed in the blood system, especially in the blood and the bone marrow, and makes the body incapable of fighting against the disease. The blood contains white blood cells, or WBC, which are capable of fighting against various infections. When cancer cells form in the blood system, WBC function is altered, and they will not be able to fight against the diseases. Certain leukemias are common in children, and few are commonly seen in adults.

What Causes Congenital Leukemia?

The exact cause of congenital leukemia is unknown. Still, it may occur due to the following factors:

• Most cancers are inherited or run in families, and can be other reasons also.

• Occurs due to inherited DNA mutations from parents.

• Inherited genes from the parent are less likely to be effective in removing harmful chemicals from the body, so exposure to the harmful chemical during pregnancy may also result in congenital leukemia.

• Excessive exposure to radiation during pregnancy results in cancer-causing cells and results in congenital leukemia.

• Several chromosomal abnormalities or rearrangements are also seen in children with congenital leukemia.

What Are the Causes Of Hypoplastic Preleukemia?

There is no exact cause for congenital hypoplastic preleukemia, but it is developed after aplastic anemia. There is no evidence, but it is also suspected that hypoplastic preleukemia occurs after the treatments for cancer like radiotherapy and chemotherapy.

Which Types of Leukemias Are Congenital?

Several leukemias are congenital:

• Acute myeloid leukemia.

• Acute lymphoblastic leukemia.

• Mixed phenotype acute leukemia.

What Are the Symptoms of Congenital Leukemia?

The following are the symptoms of congenital leukemia in children:

• Difficulty in feeding.

• Fever.

• Tender lymph nodes.

• Pallor.

• Hepatosplenomegaly (enlargement of the liver) is also seen in a few cases.

• Breathing difficulties are also observed in children with congenital leukemia.

• Seizures.

• Vomiting.

• Swelling on the face and also underarms.

• Lack of appetite and weight loss.

• Swollen abdomen.

• Recurrent infections and nose bleeding.

Some of the above symptoms are benign, but if any of these symptoms are recurring, immediately visit a doctor.

What Are the Symptoms of Hypoplastic Preleukemia?

The following are the symptoms of hypoplastic preleukemia.

• Severe weakness is seen due to decreased hemoglobin.

• Tiredness is seen in patients with hypoplastic preleukemia.

• Occasional breathlessness is also seen in children with hypoplastic preleukemia. This is because of the low or decreased number of red blood cells that occurred due to aplastic anemia.

• Other symptoms of anemia like headache, chest pain, irregular heartbeats, cold hands and feet, and dizziness are also seen.

• Severe bleeding is also seen due to a lack of platelets.

• Recurrent infections and fever are also observed.

• Bone pain is also seen in a few cases.

What Are Syndromes Associated With Congenital Leukemia?

The syndromes associated with congenital leukemia are:

• Turner's syndrome.

• Mosaic trisomy nine.

• Mosaic monosomy seven.

What Are the Risk Factors for Congenital Leukemia and Hypoplastic Leukemia?

The following are the risk factors for congenital leukemia and hypoplastic preleukemia:

• Any treatment procedure previously like chemotherapy and radiotherapy.

• Any constant exposure to radiation may also be another factor for leukemias.

• Long-term exposure to harmful or toxic chemicals may also lead to congenital and hypoplastic leukemias.

• Defective bone marrow stem cells. Bone marrow is the material present inside the bones that helps in the production of blood cells. Lack of or defective bone marrow leads to decreased production of blood cells which leads to aplastic anemia, which precedes hypoplastic preleukemia.

How Are Leukemias Diagnosed?

Generally, they may exhibit few symptoms, and it is not able to diagnose with only the clinical symptoms; only a routine complete blood picture will be able to diagnose it properly. If there are any abnormal or irregular counts in the blood picture, the doctor will advise to take two more tests: bone marrow aspiration and bone marrow biopsy. This is a simple procedure where using fine and thin needles; the marrow cells are aspirated. A microscopic analysis of the chromosomes, known as a cytogenetic study, will reveal the presence of any abnormal bone marrow cells. A peripheral blood smear test is also performed to diagnose leukemias. Flow cytometry is also performed as a diagnostic test.

What Is the Treatment and Management of Congenital and Hypoplastic Leukemia?

• Antibiotic therapy for preventing recurrent infections.

• Transfusion therapy is done to increase the number of red blood cells and platelets. In addition, chelation therapy is done to remove excess iron from the blood.

• Chemotherapy is done to control the number of fast-growing cells. It is done by giving medication to kill the cancer cells, which affects the whole body. While destroying the cancer cells, there are high chances of killing healthy cells, which leads to various side effects.

• Genetic therapy is also done to stimulate tumor-suppressing genes.

• Growth factor therapy helps increase the number of red and white blood cells.

Conclusion:

Congenital leukemias are generally developed in the mother's womb or in utero. The leukemic process becomes more evident during the delivery or within one month of delivery. There is no particular cause for this, but defective genes or chromosomal rearrangements may lead to these hematological conditions. There are many risk factors, like radiation exposure, and cancer treatments like radiotherapy and chemotherapy also increase the risk of the condition. Although there are many treatment options like gene therapy, transfusion therapy, chelation therapy, and gene therapy, the mortality rates are very high.