Leukemia Overview, Treatment & More

Leukemia

Overview

Leukemia broadly defines a number of different cancers that originate in the bone marrow and blood cell lines, and typically produces an abnormal increase in the number of white blood cells in the body. Leukemias are subdivided into whether they are acute (occur rapidly) or chronic (develop over many years) and then further subdivided into what type of blood cell they start from, lymphocytic (usually from white blood cells that fight infection, like B-cells) or myelogenous (arising from cells in the bone marrow that eventually produce red blood cells). These categories make up the four most common types of leukemia:

Acute Lymphoblastic (ALL): Affects adults over age 65 (50% survival); also the most common form of leukemia in children (85% survival)
Chronic Lymphocytic (CLL): Affects mostly men over age 55 (75% survival)
Acute Myelogenous (AML): Affects mostly adult men (40% survival)
Chronic Myelogenous (CML): Affects mainly adults (90% survival)

Each of these general forms of leukemia is further subdivided into the type of cell that is affected, and treatments differ based on what the root cause is. There are also other types of leukemia that do not generally fit into any of these categories, such as Hairy cell leukemia, Adult T-cell leukemia, and T-cell prolymphocytic leukemia, an extremely rare and aggressive cancer.

Symptoms

Like all blood cells, leukemia cells travel through the body. The symptoms of leukemia depend on the number of leukemia cells and where these cells collect in the body. People with chronic leukemia may not have symptoms. The doctor may find the disease during a routine blood test. People with acute leukemia usually go to their doctor because they feel sick. If the brain is affected, they may have headaches, vomiting, confusion, loss of muscle control, or seizures. Leukemia also can affect other parts of the body such as the digestive tract, kidneys, lungs, heart, or testes.

Common symptoms of chronic or acute leukemia may include:

Swollen lymph nodes that usually don't hurt (especially lymph nodes in the neck or armpit)
Fevers or night sweats
Frequent infections
Feeling weak or tired
Bleeding and bruising easily (bleeding gums, purplish patches in the skin, or tiny red spots under the skin)
Swelling or discomfort in the abdomen (from a swollen spleen or liver)
Weight loss for no known reason
Pain in the bones or joints

Most often, these symptoms are not due to cancer. An infection or other health problems may also cause these symptoms. Only a doctor can tell for sure.

Diagnosis

Doctors sometimes find leukemia after a routine blood test. If you have symptoms that suggest leukemia, your doctor will try to find out what's causing the problems. Your doctor may ask about your personal and family medical history.

You may have one or more of the following tests:

Physical exam: Your doctor checks for swollen lymph nodes, spleen, or liver.
Blood tests: The lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets. Leukemia causes a very high level of white blood cells. It may also cause low levels of platelets and hemoglobin, which is found inside red blood cells.
Biopsy: Your doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether leukemia cells are in your bone marrow. Before the sample is taken, local anesthesia is used to numb the area. This helps reduce the pain.

Your doctor removes some bone marrow from your hipbone or another large bone. A pathologist uses a microscope to check the tissue for leukemia cells. There are two ways your doctor can obtain bone marrow.

Some people will have both procedures during the same visit:

Bone marrow aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow.
Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.

Other Tests

The tests that your doctor orders for you depend on your symptoms and type of leukemia. You may have other tests:

Cytogenetics: The lab looks at the chromosomes of cells from samples of blood, bone marrow, or lymph nodes. If abnormal chromosomes are found, the test can show what type of leukemia you have. For example, people with CML have an abnormal chromosome called the Philadelphia chromosome.
Spinal tap: Your doctor may remove some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). The doctor uses a long, thin needle to remove fluid from the lower spine. The procedure takes about 30 minutes and is performed with local anesthesia. You must lie flat for several hours afterward to keep from getting a headache. The lab checks the fluid for leukemia cells or other signs of problems.
Chest x-ray: An x-ray can show swollen lymph nodes or other signs of disease in your chest.

Treatments

People with leukemia have many treatment options. The options are watchful waiting, chemotherapy, targeted therapy, biological therapy, radiation therapy, and stem cell transplant. If your spleen is enlarged, your doctor may suggest surgery to remove it. Sometimes a combination of these treatments is used.

People with acute leukemia need to be treated right away. The goal of treatment is to destroy signs of leukemia in the body and make symptoms go away. This is called a remission. After people go into remission, more therapy may be given to prevent a relapse. This type of therapy is called consolidation therapy or maintenance therapy. Many people with acute leukemia can be cured.

If you have chronic leukemia without symptoms, you may not need cancer treatment right away. Your doctor will watch your health closely so that treatment can start when you begin to have symptoms. Not getting cancer treatment right away is called watchful waiting.

Watchful Waiting

People with chronic lymphocytic leukemia who do not have symptoms may be able to put off having cancer treatment. By delaying treatment, they can avoid the side effects of treatment until they have symptoms.
If you and your doctor agree that watchful waiting is a good idea, you'll have regular checkups (such as every 3 months). You can start treatment if symptoms occur.
Although watchful waiting avoids or delays the side effects of cancer treatment, this choice has risks. It may reduce the chance to control leukemia before it gets worse.
You may decide against watchful waiting if you don't want to live with an untreated leukemia. Some people choose to treat the cancer right away.

Chemotherapy

Many people with leukemia are treated with chemotherapy. Chemotherapy uses drugs to destroy leukemia cells.

Depending on the type of leukemia, you may receive a single drug or a combination of two or more drugs.

You may receive chemotherapy in several different ways:

By mouth: Some drugs are pills that you can swallow.
Into a vein (IV): The drug is given through a needle or tube inserted into a vein.
Through a catheter (a thin, flexible tube): The tube is placed in a large vein, often in the upper chest. A tube that stays in place is useful for patients who need many IV treatments. The health care professional injects drugs into the catheter, rather than directly into a vein. This method avoids the need for many injections, which can cause discomfort and injure the veins and skin.
Into the cerebrospinal fluid: If the pathologist finds leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord, the doctor may order intrathecal chemotherapy.

Targeted Therapy

People with chronic myeloid leukemia and some with acute lymphoblastic leukemia may receive drugs called targeted therapy. Imatinib (Gleevec) tablets were the first targeted therapy approved for chronic myeloid leukemia. Other targeted therapy drugs are now used too.

Targeted therapies use drugs that block the growth of leukemia cells. For example, a targeted therapy may block the action of an abnormal protein that stimulates the growth of leukemia cells.

Biological Therapy

Some people with leukemia receive drugs called biological therapy. Biological therapy for leukemia is treatment that improves the body's natural defenses against the disease.

One type of biological therapy is a substance called a monoclonal antibody. It's given by IV infusion. This substance binds to the leukemia cells. One kind of monoclonal antibody carries a toxin that kills the leukemia cells. Another kind helps the immune system destroy leukemia cells.

For some people with chronic myeloid leukemia, the biological therapy is a drug called interferon. It is injected under the skin or into a muscle. It can slow the growth of leukemia cells.

Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill leukemia cells. People receive radiation therapy at a hospital or clinic.

Some people receive radiation from a large machine that is aimed at the spleen, the brain, or other parts of the body where leukemia cells have collected. This type of therapy takes place 5 days a week for several weeks. Others may receive radiation that is directed to the whole body. The radiation treatments are given once or twice a day for a few days, usually before a stem cell transplant.

Stem Cell Transplant

Some people with leukemia receive a stem cell transplant. A stem cell transplant allows you to be treated with high doses of drugs, radiation, or both. The high doses destroy both leukemia cells and normal blood cells in the bone marrow. After you receive highdose chemotherapy, radiation therapy, or both, you receive healthy stem cells through a large vein. (It's like getting a blood transfusion.) New blood cells develop from the transplanted stem cells. The new blood cells replace the ones that were destroyed by treatment.

Stem cell transplants take place in the hospital. Stem cells may come from you or from someone who donates their stem cells to you.

Causes

When you're told that you have cancer, it's natural to wonder what may have caused the disease. No one knows the exact causes of leukemia. Doctors seldom know why one person gets leukemia and another doesn't. However, research shows that certain risk factors increase the chance that a person will get this disease.

The risk factors may be different for the different types of leukemia:

Radiation: People exposed to very high levels of radiation are much more likely than others to get acute myeloid leukemia, chronic myeloid leukemia, or acute lymphocytic leukemia.
Atomic bomb explosions: Very high levels of radiation have been caused by atomic bomb explosions (such as those in Japan during World War II). People, especially children, who survive atomic bomb explosions are at increased risk of leukemia.
Radiation therapy: Another source of exposure to high levels of radiation is medical treatment for cancer and other conditions. Radiation therapy can increase the risk of leukemia.
Diagnostic x-rays: Dental x-rays and other diagnostic x-rays (such as CT scans) expose people to much lower levels of radiation. It's not known yet whether this low level of radiation to children or adults is linked to leukemia. Researchers are studying whether having many x-rays may increase the risk of leukemia. They are also studying whether CT scans during childhood are linked with increased risk of developing leukemia.
Smoking: Smoking cigarettes increases the risk of acute myeloid leukemia.
Benzene: Exposure to benzene in the workplace can cause acute myeloid leukemia. It may also cause chronic myeloid leukemia or acute lymphocytic leukemia. Benzene is used widely in the chemical industry. It's also found in cigarette smoke and gasoline.
Chemotherapy: Cancer patients treated with certain types of cancer-fighting drugs sometimes later get acute myeloid leukemia or acute lymphocytic leukemia. For example, being treated with drugs known asalkylating agents or topoisomerase inhibitors is linked with a small chance of later developing acute leukemia.
Down syndrome and certain other inherited diseases: Down syndrome and certain other inherited diseases increase the risk of developing acute leukemia.
Myelodysplastic syndrome and certain other blood disorders: People with certain blood disorders are at increased risk of acute myeloid leukemia.
Human T-cell leukemia virus type I (HTLV-I): People with HTLV-I infection are at increased risk of a rare type of leukemia known as adult T-cell leukemia. Although the HTLV-I virus may cause this rare disease, adult T-cell leukemia and other types of leukemia are not contagious.
Family history of leukemia: It's rare for more than one person in a family to have leukemia. When it does happen, it's most likely to involve chronic lymphocytic leukemia. However, only a few people with chronic lymphocytic leukemia have a father, mother, brother, sister, or child who also has the disease.

Having one or more risk factors does not mean that a person will get leukemia. Most people who have risk factors never develop the disease.

Getting Help

Before starting treatment, you might want a second opinion about your diagnosis and treatment plan. Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it.

If you get a second opinion, the doctor may agree with your first doctor's diagnosis and treatment plan. Or the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at your options.

It may take some time and effort to gather your medical records and see another doctor. In most cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually won't make treatment less effective. To make sure, you should discuss this delay with your doctor. Some people with leukemia need treatment right away.

There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, a nearby hospital, or a medical school for names of specialists.

Related Information

According to the Leukemia and Lymphoma Society, there are over 245,000 people in the United States living with some form of leukemia, and over 44,000 new cases will be diagnosed each year. Among children with cancer, one out of every three will have some form of leukemia. However, over 90% of all cases of leukemia occur in adults.

Living With

Learning you have leukemia can change your life and the lives of those close to you. These changes can be hard to handle. It's normal for you, your family, and your friends to have new and confusing feelings to work through.

Concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, keeping your job, or continuing daily activities.

Here's where you can go for support:

Doctors, nurses, and other members of your health care team can answer many of your questions about treatment, working, or other activities.
Social workers, counselors, or members of the clergy can be helpful if you want to talk about your feelings or concerns. Often, social workers can suggest resources for financial aid, transportation, home care, or emotional support.

Support groups can also help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.