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63-560: Hilary O'Neil is a beautiful, outgoing yet cautious young woman with little luck in work or love. After recently parting ways with her boyfriend when she caught him cheating, Hilary lives with her eccentric mother. One day, Hilary answers an ad in a newspaper for a nurse only to find herself being escorted out before the interview starts. Victor Geddes is a well-educated, rich, and shy 28-year-old battling leukemia . As his health worsens progressively, and despite his father's protests, Victor hires Hilary to be his live-in caretaker while undergoing

126-418: A monoclonal antibody that attacks white blood cells, has been used in treatment with greater success than previous options. Some people who successfully respond to treatment also undergo stem cell transplantation to consolidate the response. Treatment for juvenile myelomonocytic leukemia can include splenectomy , chemotherapy , and bone marrow transplantation . The success of treatment depends on

189-432: A decrease in function of platelets (thrombasthenia), or an increase in the number of platelets (thrombocytosis). There are disorders that reduce the number of platelets, such as heparin-induced thrombocytopenia (HIT) or thrombotic thrombocytopenic purpura (TTP), that typically cause thromboses, or clots, instead of bleeding. Platelets release a multitude of growth factors including platelet-derived growth factor (PDGF),

252-645: A genetic abnormality called the Philadelphia translocation ; 95% of people with CML carry the Philadelphia mutation, although this is not exclusive to CML and can be observed in people with other types of leukemia. Whether or not non-ionizing radiation causes leukemia has been studied for several decades. The International Agency for Research on Cancer expert working group undertook a detailed review of all data on static and extremely low frequency electromagnetic energy, which occurs naturally and in association with

315-454: A greater risk of leukemia. For example, people with Down syndrome have a significantly increased risk of developing forms of acute leukemia (especially acute myeloid leukemia ), and Fanconi anemia is a risk factor for developing acute myeloid leukemia. Mutation in SPRED1 gene has been associated with a predisposition to childhood leukemia. Inherited bone marrow failure syndromes represent

378-403: A kind of premature aging of the bone marrow. In people with these syndromes and in older adults, mutations associated with clonal hematopoiesis may arise as an adaptive response to a progressively deteriorating hematopoietic niche, i.e., a depleting pool of Hematopoietic stem cells . The mutated stem cells then acquire a self-renewal advantage. Chronic myelogenous leukemia is associated with

441-464: A lack of blood platelets , which are important in the blood clotting process. This means people with leukemia may easily become bruised , bleed excessively, or develop pinprick bleeds ( petechiae ). White blood cells , which are involved in fighting pathogens , may be suppressed or dysfunctional. This could cause the person's immune system to be unable to fight off a simple infection or to start attacking other body cells. Because leukemia prevents

504-443: A microscope. Today, this process is generally automated by use of an automated analyzer, with only approximately 10-20% of samples now being examined manually. Abnormally high or low counts may indicate the presence of many forms of disease, and hence blood counts are amongst the most commonly performed blood tests in medicine, as they can provide an overview of a patient's general health status. In 1658 Dutch naturalist Jan Swammerdam

567-505: A more advanced, uncontrolled state, when the person cannot tolerate imatinib, or if the person wishes to attempt a permanent cure, then an allogeneic bone marrow transplantation may be performed. This procedure involves high-dose chemotherapy and radiation followed by infusion of bone marrow from a compatible donor. Approximately 30% of people die from this procedure. Decision to treat People with hairy cell leukemia who are symptom-free typically do not receive immediate treatment. Treatment

630-513: A multi-drug chemotherapy regimen . Some are also treated with radiation therapy . In some cases, a bone marrow transplant is effective. Management of ALL is directed towards control of bone marrow and systemic (whole-body) disease. Additionally, treatment must prevent leukemic cells from spreading to other sites, particularly the central nervous system (CNS); periodic lumbar punctures are used for diagnostic purposes and to administer intrathecal prophylactic methotrexate. In general, ALL treatment

693-422: A nucleus). The condition of having too few red blood cells is known as anemia , while having too many is polycythemia . Erythrocyte sedimentation rate (ESR) is the rate at which RBCs sink to the bottom (when placed in a vertical column after adding an anticoagulant). Normal values of ESR are: • 3 to 5 mm per hour in males. • 4 to 7 mm per hour in females. White blood cells or leukocytes , are cells of

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756-519: A number of less common types. Leukemias and lymphomas both belong to a broader group of tumors that affect the blood, bone marrow, and lymphoid system , known as tumors of the hematopoietic and lymphoid tissues . Treatment may involve some combination of chemotherapy , radiation therapy , targeted therapy , and bone marrow transplant , with supportive and palliative care provided as needed. Certain types of leukemia may be managed with watchful waiting . The success of treatment depends on

819-448: A platelet is normally just 5 to 9 days. Platelets are a natural source of growth factors. They circulate in the blood of mammals and are involved in hemostasis, leading to the formation of blood clots. Platelets release thread-like fibers to form these clots. The normal range (99% of population analyzed) for platelets is 150,000 to 450,000 per cubic millimeter. If the number of platelets is too low, excessive bleeding can occur. However, if

882-531: A positive correlation between exposure to formaldehyde and the development of leukemia, particularly myeloid leukemia . The different leukemias likely have different causes. Leukemia, like other cancers, results from mutations in the DNA . Certain mutations can trigger leukemia by activating oncogenes or deactivating tumor suppressor genes , and thereby disrupting the regulation of cell death, differentiation or division. These mutations may occur spontaneously or as

945-663: A potent chemotactic agent, and TGF beta , which stimulates the deposition of extracellular matrix. Both of these growth factors have been shown to play a significant role in the repair and regeneration of connective tissues. Other healing-associated growth factors produced by platelets include basic fibroblast growth factor (bFGF), insulin-like growth factor 1 (IGF-1), platelet-derived epidermal growth factor, and vascular endothelial growth factor (VEGF). Local application of these factors in increased concentrations through platelet-rich plasma (PRP) has been used as an adjunct to wound healing for several decades. A complete blood count (CBC)

1008-427: A process known as erythropoiesis . In adults, about 2.4 million RBCs are produced each second. The normal RBCs count is 4.5 to 5 millions per cu.mm. RBCs have a lifespan of approximately 100-120 days. After they have completed their lifespan, they are removed from the bloodstream by the spleen . Mature red blood cells are unique among cells in the human body in that they lack a nucleus (although erythroblasts do have

1071-413: A result of brain stem pressure. All symptoms associated with leukemia can be attributed to other diseases. Consequently, leukemia is always diagnosed through medical tests . The word leukemia , which means 'white blood', is derived from the characteristic high white blood cell count that presents in most affected people before treatment. The high number of white blood cells is apparent when a blood sample

1134-465: A result of exposure to radiation or carcinogenic substances. Among adults, the known causes are natural and artificial ionizing radiation and petrochemicals, notably benzene and alkylating chemotherapy agents for previous malignancies. Use of tobacco is associated with a small increase in the risk of developing acute myeloid leukemia in adults. Cohort and case-control studies have linked exposure to some petrochemicals and hair dyes to

1197-632: A scale of A+ to F. Roger Ebert gave the film two out of four stars, and wrote: " Dying Young is a long, slow slog of a movie, up to its knees in drippy self-pity as it marches wearily toward its inevitable ending". Variety wrote: "Julia's hot; Dying Young is lukewarm". The film was nominated for three MTV Movie Awards at the 1992 MTV Movie Awards : Best Female Performance and Most Desirable Female for Julia Roberts , and Best Breakthrough Performance for Campbell Scott . Leukemia Leukemia ( also spelled leukaemia ; pronounced / l uː ˈ k iː m iː ə / loo- KEE -mee-ə )

1260-413: A simple injection under the skin, or six months of pentostatin , given every four weeks by intravenous infusion. In most cases, one round of treatment will produce a prolonged remission. Other treatments include rituximab infusion or self-injection with Interferon-alpha . In limited cases, the person may benefit from splenectomy (removal of the spleen ). These treatments are not typically given as

1323-470: A total of four main categories. Within each of these main categories, there are typically several subcategories. Finally, some rarer types are usually considered to be outside of this classification scheme. The most common symptoms in children are easy bruising , pale skin , fever , and an enlarged spleen or liver . Damage to the bone marrow, by way of displacing the normal bone marrow cells with higher numbers of immature white blood cells, results in

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1386-451: A traumatic chemotherapy course. Hilary becomes insecure about her ability to care for Victor after her first exposure to the side effects of his chemotherapy treatment. She researches leukemia and stocks healthier food in the kitchen. Victor is "finished" with his chemotherapy and suggests a vacation to the coast. They rent a house and Hilary begins to feel that she is no longer needed to care for him. They fall in love and continue living on

1449-401: A worldwide total of $ 82.2 million. Dying Young earned mainly negative reviews from critics. On Rotten Tomatoes , the film has an approval rating of 25% based on 40 reviews with the following consensus: " Dying ' s easy; it's making audiences care about the romance at the heart of this inert drama that proves difficult". Audiences surveyed by CinemaScore gave the film a grade of "B+" on

1512-482: Is viewed under a microscope , with the extra white blood cells frequently being immature or dysfunctional. The excessive number of cells can also interfere with the level of other cells, causing further harmful imbalance in the blood count. Some people diagnosed with leukemia do not have high white blood cell counts visible during a regular blood count. This less-common condition is called aleukemia . The bone marrow still contains cancerous white blood cells that disrupt

1575-402: Is a group of blood cancers that usually begin in the bone marrow and produce high numbers of abnormal blood cells . These blood cells are not fully developed and are called blasts or leukemia cells . Symptoms may include bleeding and bruising , bone pain , fatigue , fever , and an increased risk of infections. These symptoms occur due to a lack of normal blood cells . Diagnosis

1638-461: Is a test panel requested by a doctor or other medical professional that gives information about the cells in a patient's blood. A scientist or lab technician performs the requested testing and provides the requesting medical professional with the results of the CBC. In the past, counting the cells in a patient's blood was performed manually, by viewing a slide prepared with a sample of the patient's blood under

1701-536: Is acute or chronic, the specific abnormal white blood cell type, the presence and severity of anemia or thrombocytopenia , the degree of tissue abnormality, the presence of metastasis and lymph node and bone marrow infiltration, the availability of therapies and the skills of the health care team. Treatment outcomes may be better when people are treated at larger centers with greater experience. In 2010, globally, approximately 281,500 people died of leukemia. In 2000, approximately 256,000 children and adults around

1764-430: Is afraid of hoping. At this confession, Hilary finally tells Victor she loves him and they then decide to go back to the hospital, where he will fight for his life with Hilary. The film's last scene shows Victor and Hilary leaving the house, which has a small picture of Gustav Klimt 's Adam and Eve (the first painting Victor shows Hilary) in the window. The original music score was composed by James Newton Howard , with

1827-435: Is demonstrated by family histories and twin studies . The affected people may have a single gene or multiple genes in common. In some cases, families tend to develop the same kinds of leukemia as other members; in other families, affected people may develop different forms of leukemia or related blood cancers . In addition to these genetic issues, people with chromosomal abnormalities or certain other genetic conditions have

1890-673: Is directed towards suppressing the disease for many years, rather than curing it. The primary chemotherapeutic plan is combination chemotherapy with chlorambucil or cyclophosphamide , plus a corticosteroid such as prednisone or prednisolone . The use of a corticosteroid has the additional benefit of suppressing some related autoimmune diseases, such as immunohemolytic anemia or immune-mediated thrombocytopenia . In resistant cases, single-agent treatments with nucleoside drugs such as fludarabine , pentostatin , or cladribine may be successful. Younger and healthier people may choose allogeneic or autologous bone marrow transplantation in

1953-433: Is divided into several phases: Hematologists base CLL treatment on both the stage and symptoms of the individual person. A large group of people with CLL have low-grade disease, which does not benefit from treatment. Individuals with CLL-related complications or more advanced disease often benefit from treatment. In general, the indications for treatment are: Most CLL cases are incurable by present treatments, so treatment

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2016-444: Is generally considered necessary when the person shows signs and symptoms such as low blood cell counts (e.g., infection-fighting neutrophil count below 1.0 K/μL), frequent infections, unexplained bruises, anemia, or fatigue that is significant enough to disrupt the person's everyday life. Typical treatment approach People who need treatment usually receive either one week of cladribine , given daily by intravenous infusion or

2079-441: Is still questionable whether phototherapy is genuinely the cause of cancer or simply a result of the same underlying factors that gave rise to cancer. Large doses of Sr-90 (called a bone seeking radioisotope) from nuclear reactor accidents, increases the risk of bone cancer and leukemia in animals and is presumed to do so in people. Some people have a genetic predisposition towards developing leukemia. This predisposition

2142-596: Is typically made by blood tests or bone marrow biopsy . The exact cause of leukemia is unknown. A combination of genetic factors and environmental (non-inherited) factors are believed to play a role. Risk factors include smoking , ionizing radiation , petrochemicals (such as benzene ), prior chemotherapy, and Down syndrome . People with a family history of leukemia are also at higher risk. There are four main types of leukemia— acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL) and chronic myeloid leukemia (CML)—and

2205-522: Is uncommon. Despite the use of these methods to diagnose whether or not a person has leukemia, many people have not been diagnosed because many of the symptoms are vague, non-specific , and can refer to other diseases. For this reason, the American Cancer Society estimates that at least one-fifth of the people with leukemia have not yet been diagnosed. Most forms of leukemia are treated with pharmaceutical medication , typically combined into

2268-438: The cancer is unlikely to return . In 2015, leukemia was present in 2.3 million people worldwide and caused 353,500 deaths. In 2012, it had newly developed in 352,000 people. It is the most common type of cancer in children, with three-quarters of leukemia cases in children being the acute lymphoblastic type. However, over 90% of all leukemias are diagnosed in adults, CLL and AML being most common. It occurs more commonly in

2331-407: The developed world . Blood cell A blood cell (also called a hematopoietic cell , hemocyte , or hematocyte ) is a cell produced through hematopoiesis and found mainly in the blood . Major types of blood cells include red blood cells (erythrocytes), white blood cells (leukocytes), and platelets (thrombocytes). Together, these three kinds of blood cells add up to a total 45% of

2394-439: The developed world . Clinically and pathologically, leukemia is subdivided into a variety of large groups. The first division is between its acute and chronic forms: Additionally, the diseases are subdivided according to which kind of blood cell is affected. This divides leukemias into lymphoblastic or lymphocytic leukemias and myeloid or myelogenous leukemias : Combining these two classifications provides

2457-444: The immune system involved in defending the body against both infectious disease and foreign materials. They are produced and derived from multipotent cells in the bone marrow known as hematopoietic stem cells . Leukocytes are found throughout the body, including the blood and lymphatic system . There are a variety of types of white blood cells that serve specific roles in the human immune system. WBCs constitute approximately 1% of

2520-429: The blood tissue by volume, with the remaining 55% of the volume composed of plasma , the liquid component of blood. Red blood cells or erythrocytes pors carry oxygen and collect carbon dioxide through the use of hemoglobin . Hemoglobin is an iron -containing protein that gives red blood cells their color and facilitates transportation of oxygen from the lungs to tissues and carbon dioxide from tissues to

2583-440: The blood volume. White blood cells are divided into granulocytes and agranulocytes , distinguished by the presence or absence of granules in the cytoplasm. Granulocytes include basophils , eosinophils , neutrophils , and mast cells . Agranulocytes include lymphocytes and monocytes . The condition of having too few white blood cells is leukopenia , while having too many is leukocytosis . There are individual terms for

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2646-568: The coast. Victor hides his use of morphine to kill the pain. During dinner with one of the friends they made at the coast, Victor starts acting aggressively and irrationally. He collapses and is helped to bed. Hilary searches the garbage and discovers his used syringes. She confronts him and he admits he was not finished with his chemotherapy. Victor explains that he wants quality in his life and Hilary says he has lied to her. She calls his father, who comes to take him home, but Victor wants to stay for one last Christmas party. Hilary and Victor reconnect at

2709-412: The degree of liver and kidney damage or the effects of chemotherapy on the person. When concerns arise about other damages due to leukemia, doctors may use an X-ray , MRI , or ultrasound . These can potentially show leukemia's effects on such body parts as bones (X-ray), the brain (MRI), or the kidneys, spleen, and liver (ultrasound). CT scans can be used to check lymph nodes in the chest, though this

2772-406: The development of some forms of leukemia. Diet has very limited or no effect, although eating more vegetables may confer a small protective benefit. Viruses have also been linked to some forms of leukemia. For example, human T-lymphotropic virus (HTLV-1) causes adult T-cell leukemia . A few cases of maternal-fetal transmission (a baby acquires leukemia because its mother had leukemia during

2835-855: The first treatment because their success rates are lower than cladribine or pentostatin. Most people with T-cell prolymphocytic leukemia, a rare and aggressive leukemia with a median survival of less than one year, require immediate treatment. T-cell prolymphocytic leukemia is difficult to treat, and it does not respond to most available chemotherapeutic drugs. Many different treatments have been attempted, with limited success in certain people: purine analogues (pentostatin, fludarabine, cladribine), chlorambucil , and various forms of combination chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisone CHOP , cyclophosphamide, vincristine, prednisone [COP], vincristine, doxorubicin, prednisone, etoposide, cyclophosphamide, bleomycin VAPEC-B ). Alemtuzumab (Campath),

2898-635: The generation, transmission, and use of electrical power. They concluded that there is limited evidence that high levels of ELF magnetic (but not electric) fields might cause some cases of childhood leukemia . No evidence for a relationship to leukemia or another form of malignancy in adults has been demonstrated. Since exposure to such levels of ELFs is relatively uncommon, the World Health Organization concludes that ELF exposure, if later proven to be causative, would account for just 100 to 2400 cases worldwide each year, representing 0.2 to 4.9% of

2961-445: The hope of a permanent cure. Many different anti-cancer drugs are effective for the treatment of AML. Treatments vary somewhat according to the age of the person and according to the specific subtype of AML. Overall, the strategy is to control bone marrow and systemic (whole-body) disease, while offering specific treatment for the central nervous system (CNS), if involved. In general, most oncologists rely on combinations of drugs for

3024-410: The immune system from working normally, some people experience frequent infection , ranging from infected tonsils , sores in the mouth , or diarrhea to life-threatening pneumonia or opportunistic infections . Finally, the red blood cell deficiency leads to anemia , which may cause dyspnea and pallor . Some people experience other symptoms, such as fevers, chills, night sweats, weakness in

3087-425: The induction phase. There are many possible treatments for CML, but the standard of care for newly diagnosed people is imatinib (Gleevec) therapy. Compared to most anti-cancer drugs, it has relatively few side effects and can be taken orally at home. With this drug, more than 90% of people will be able to keep the disease in check for at least five years, so that CML becomes a chronic, manageable condition. In

3150-495: The initial, induction phase of chemotherapy. Such combination chemotherapy usually offers the benefits of early remission and a lower risk of disease resistance. Consolidation and maintenance treatments are intended to prevent disease recurrence. Consolidation treatment often entails a repetition of induction chemotherapy or the intensification of chemotherapy with additional drugs. By contrast, maintenance treatment involves drug doses that are lower than those administered during

3213-454: The lack or overabundance of specific types of white blood cells. The number of white blood cells in circulation is commonly increased in the incidence of infection . Many hematological cancers are based on the inappropriate production of white blood cells. Platelets , or thrombocytes , are very small, irregularly shaped clear cell fragments, 2–3 μm in diameter, which derive from fragmentation of megakaryocytes . The average lifespan of

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3276-560: The limbs, feeling fatigued and other common flu-like symptoms . Some people experience nausea or a feeling of fullness due to an enlarged liver and spleen ; this can result in unintentional weight loss . Blasts affected by the disease may come together and become swollen in the liver or in the lymph nodes causing pain and leading to nausea. If the leukemic cells invade the central nervous system , then neurological symptoms (notably headaches ) can occur. Uncommon neurological symptoms like migraines , seizures , or coma can occur as

3339-412: The lungs to be exhaled. Red blood cells are the most abundant cell in the blood, accounting for about 40-45% of its volume. Red blood cells are circular, biconcave, disk-shaped and deformable to allow them to squeeze through narrow capillaries. They do not have a nucleus. Red blood cells are much smaller than most other human cells. RBCs are formed in the red bone marrow from hematopoietic stem cells in

3402-416: The main song "Theme from Dying Young" performed by American saxophonist Kenny G , it was nominated for a Best Pop Instrumental Performance . The soundtrack was released on July 2, 1991, by Arista Records . Prior to its original 1991 release, Premiere predicted the film to be the highest-grossing movie that summer. Dying Young grossed $ 33.6 million domestically and $ 48.6 million internationally, with

3465-403: The normal production of blood cells, but they remain in the marrow instead of entering the bloodstream, where they would be visible in a blood test. For a person with aleukemia, the white blood cell counts in the bloodstream can be normal or low. Aleukemia can occur in any of the four major types of leukemia, and is particularly common in hairy cell leukemia . Studies in 2009 and 2010 have shown

3528-433: The number of platelets is too high, blood clots can form thrombosis, which may obstruct blood vessels and result in such events as a stroke , myocardial infarction , pulmonary embolism , or blockage of blood vessels to other parts of the body, such as the extremities of the arms or legs. An abnormality or disease of the platelets is called a thrombocytopathy, which can be either a low number of platelets ( thrombocytopenia ),

3591-406: The party and he tells her that he is leaving with his father to go back to the hospital in the morning. After speaking with Victor's father, who says Victor wants to spend one night alone before leaving, Hilary returns to the house they rented only to find Victor packing clothes, ready to run away and not go with his father to the hospital. Hilary confronts him about running away and Victor admits he

3654-464: The pregnancy) have been reported. Children born to mothers who use fertility drugs to induce ovulation are more than twice as likely to develop leukemia during their childhoods than other children. In a recent systematic review and meta-analysis of any type of leukemia in neonates using phototherapy , typically to treat neonatal jaundice , a statistically significant association was detected between using phototherapy and myeloid leukemia. However, it

3717-536: The total incidence of childhood leukemia for that year (about 0.03 to 0.9% of all leukemias). Diagnosis is usually based on repeated complete blood counts and a bone marrow examination following observations of the symptoms. Sometimes, blood tests may not show that a person has leukemia, especially in the early stages of the disease or during remission. A lymph node biopsy can be performed to diagnose certain types of leukemia in certain situations. Following diagnosis, blood chemistry tests can be used to determine

3780-464: The type of leukemia and the age of the person. Outcomes have improved in the developed world. Five-year survival rate was 67% in the United States in the period from 2014 to 2020. In children under 15 in first-world countries, the five-year survival rate is greater than 60% or even 90%, depending on the type of leukemia. In children who are cancer-free five years after diagnosis of acute leukemia,

3843-410: The type of leukemia and the age of the person. Outcomes have improved in the developed world. The average five-year survival rate is 65% in the United States. In children under 15, the five-year survival rate is greater (60 to 85%), depending on the type of leukemia. In children with acute leukemia who are cancer-free after five years, the cancer is unlikely to return. Outcomes depend on whether it

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3906-401: The world developed a form of leukemia, and 209,000 died from it. This represents about 3% of the almost seven million deaths due to cancer that year, and about 0.35% of all deaths from any cause. Of the sixteen separate sites the body compared, leukemia was the 12th most common class of neoplastic disease and the 11th most common cause of cancer-related death. Leukemia occurs more commonly in

3969-448: Was the first person to observe red blood cells under a microscope, and in 1695, microscopist Antoni van Leeuwenhoek , also Dutch, was the first to draw an illustration of "red corpuscles", as they were called. No further blood cells were discovered until 1842 when French physician Alfred Donné discovered platelets. The following year leukocytes were first observed by Gabriel Andral , a French professor of medicine, and William Addison ,

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