Leukemia

What Is Leukemia?

Leukemia is a group of blood cancers that begin in blood-forming tissues such as the bone marrow. Abnormal blood-forming cells multiply or survive in an uncontrolled way and can interfere with the production of normal red blood cells, white blood cells, and platelets.

The white blood cell count may be high, normal, or low depending on the type and stage of leukemia. Diagnosis requires appropriate blood tests and, when indicated, bone marrow and genetic or molecular testing.

Leukemia Symptoms

Different types of leukemia can cause different problems. You might not notice any signs in the early stages of some forms. When you do have symptoms, they may include:

• Weakness or fatigue
• Bruising or bleeding easily
• Fever or chills
• Infections that are severe or keep coming back
• Pain in your bones or joints
• Headaches
• Vomiting
• Seizures
• Weight loss
• Night sweats
• Shortness of breath
• Swollen lymph nodes or organs like your spleen

Leukemia Causes and Risk Factors

No one knows exactly what causes leukemia. People who have it have certain unusual chromosomes, but the chromosomes don’t cause leukemia.

You can’t prevent leukemia, but certain things may trigger it. You might have a higher risk if you:

• Smoke
• Are exposed to a lot of radiation or certain chemicals
• Had radiation therapy or chemotherapy to treat cancer
• Have a family history of leukemia
• Have a genetic disorder like Down syndrome

How does leukemia happen?

Blood has three types of cells: white blood cells that fight infection, red blood cells that carry oxygen, and platelets that help blood clot.

Leukemia can interfere with the normal production and function of blood cells. Depending on the type and stage, the white blood cell count may be high, normal, or low, and abnormal cells may crowd the bone marrow or accumulate in the blood and tissues. Over time, you may not have enough red blood cells to supply oxygen, enough platelets to clot your blood, or enough normal white blood cells to fight infection.

Leukemia classifications

Leukemia is grouped by how fast it develops and gets worse, and by which type of blood cell is involved.

The first group, how fast it develops, is divided into acute and chronic leukemia.

Leukemia is classified by how quickly it progresses and by the blood-forming cell line involved. Acute leukemias generally progress rapidly, while chronic leukemias often progress more slowly, but each type requires its own diagnostic and treatment approach.

The second group, what type of cell is involved, is divided into lymphocytic and myelogenous leukemia.

• Lymphocytic (or lymphoblastic) leukemia involves bone marrow cells that become lymphocytes, a kind of white blood cell.
• Myelogenous (or myeloid) leukemia involves the marrow cells that create red blood cells, platelets, and other kinds of white blood cells.

Types of leukemia

The four main types of leukemia are:

• Acute lymphocytic leukemia (ALL): This is the most common form of childhood leukemia. It can spread to your lymph nodes and central nervous system.
• Acute myelogenous leukemia (AML): This is the second most common form of childhood leukemia and one of the most common forms for adults.
• Chronic lymphocytic leukemia (CLL): This is the other most common form of adult leukemia. Some kinds of CLL will be stable for years and won’t need treatment. But with others, your body isn’t able to create normal blood cells, and you’ll need treatment.
• Chronic myelogenous leukemia (CML): With this form, you might not have noticeable symptoms. You might not be diagnosed with it until you have a routine blood test. People 65 and older have a higher risk of this type.

Leukemia Diagnosis

Your doctor will need to check for signs of leukemia in your blood or bone marrow. They might do tests including:

• Blood tests: A complete blood count (CBC) looks at the number and maturity of different types of blood cells. A blood smear looks for unusual or immature cells.
• Bone marrow biopsy: This test involves marrow taken from your pelvic bone with a long needle. It can tell your doctor what kind of leukemia you have and how severe it is.
• Spinal tap: This involves fluid from your spinal cord. It can tell your doctor whether the leukemia has spread.
• Imaging tests: Things like CT, MRI, and PET scans can spot signs of leukemia.

Leukemia Treatments

The treatment you get depends on the type of leukemia you have, how far it’s spread, and how healthy you are. The main options are:

• Chemotherapy
• Radiation
• Biologic therapy
• Targeted therapy
• Stem cell transplant
• Surgery

Chemotherapy uses drugs to kill cancer cells in your blood and bone marrow. You can get the medicine:

• Through a shot into a vein or muscle
• As a pill
• Into the fluid around your spinal cord

Radiation uses high-energy X-rays to kill leukemia cells or keep them from growing. You can get it all over or in only one part of your body where there are a lot of cancer cells.

Biologic therapy , also called immunotherapy, helps your immune system find and attack cancer cells. Drugs like interleukins and interferon can help boost your body's natural defenses against leukemia.

Targeted therapy uses drugs to block specific genes or proteins that cancer cells need to grow. This treatment can stop the signals that leukemia cells use to grow and divide, cut off their blood supply, or kill them directly.

A stem cell transplant replaces the leukemia cells in your bone marrow with new ones that make blood. Your doctor can get the new stem cells from your own body or from a donor. First, you'll have high doses of chemotherapy to destroy the cancer cells in your bone marrow. Then, you'll get the new stem cells through an infusion into one of your veins. They will grow into new, healthy blood cells.

Surgery: Your doctor can remove your spleen if it’s filled with cancer cells and is pressing on nearby organs. This procedure is called a splenectomy.

Frequently Asked Questions