Leukemia

Leukemia is a cancer of the blood, characterized by the rapid growth of abnormal blood cells. This uncontrolled growth takes place in your bone marrow, where most of your body’s blood is made. Leukemia cells are usually immature white blood cells.

Types of leukemia #

There are four main types of leukemia:

Acute lymphocytic leukemia (ALL) #

It is the most common type of leukemia in children, teens and young adults up to age 39. ALL can affect adults of any age.

Acute myelogenous leukemia (AML) #

It is the most common type of acute leukemia in adults. It’s more common in older adults (those over 65). AML also occurs in children.

Chronic lymphocytic leukemia (CLL) #

It is the most common chronic leukemia in adults (most common in people over 65). Symptoms may not appear for several years with CLL.

Chronic myelogenous leukemia (CML) #

It is more common in older adults (most common in people over 65) but can affect adults of any age. It rarely occurs in children. Symptoms may not appear for several years with CML.

Causes of Leukemia #

• Leukemia starts when the DNA of a single cell in your bone marrow changes (mutates).

• DNA is the instruction code that tells a cell when to grow, how to develop and when to die. Because of the mutation, or coding error, leukemia cells keep multiplying. All cells arising from the original mutated cell also have the mutated DNA.

• Scientists don’t know what causes these developing cells to mutate. They’ve been able to identify some common mutations that people diagnosed with different types of leukemia share.

Symptoms of Leukemia #

• Fatigue, tiring easily.

• Fever or night sweats.

• Frequent infections.

• Shortness of breath.

• Pale skin.

• Unexplained weight loss.

• Bone/joint pain or tenderness.

• Pain or full feeling under your ribs on the left side.

• Swollen lymph nodes in your neck, underarm, groin or stomach, an enlarged spleen or liver.

• Bruising and bleeding easily, including nosebleeds, bleeding gums, a rash that looks like tiny red spots in skin (petechiae) or purplish/darkened skin patches.

Diagnosis of Leukemia #

• Physical exam: Your healthcare provider will ask about your symptoms and feel for swollen lymph nodes and an enlarged spleen or liver. They may also inspect your gums for bleeding and swelling. They may look for a skin rash associated with leukemia that may appear red, purple or brown.

• Complete blood count (CBC): This blood test lets your healthcare provider know if you have abnormal levels of red blood cells, white blood cells and platelets. If you have leukemia, you’ll likely have higher than normal counts of white blood cells.

• Blood cell examination: Your healthcare provider may take additional blood samples to check for markers that indicate the presence of leukemia cells or a specific type of leukemia. Flow cytometry and peripheral blood smear are additional tests your healthcare provider may order.

• Bone marrow biopsy (bone marrow aspiration): Your healthcare provider may perform a biopsy if you have an abnormal white blood cell count. A long needle inserted into your bone marrow (usually in your pelvic bone) draws out fluid during the procedure. The fluid sample gets tested in a lab for leukemia cells. A bone marrow biopsy helps determine the percentage of abnormal cells in your bone marrow, confirming a leukemia diagnosis.

• Imaging and other tests: Your doctor may order a chest X-ray, CT scan, or magnetic resonance imaging (MRI) scan if symptoms indicate leukemia has affected your bones, organs or tissue. The leukemia cells don’t show up on imaging.

• Lumbar puncture (spinal tap): Your healthcare provider may test a sample of spinal fluid to see if leukemia has spread to the spinal fluid surrounding your brain and spinal cord.

Treatment of Leukemia #

• Chemotherapy: Chemotherapy is the most common form of leukemia treatment. It involves using chemicals to kill leukemia cells or keep them from multiplying. During treatment, you may receive the chemicals (medication) as a pill, an injection into a vein or a shot under your skin. Usually, you’ll receive a combination of chemotherapy drugs.

• Immunotherapy (biologic therapy): This treatment uses certain drugs to boost your body’s defense system your immune system to fight leukemia. Immunotherapy helps your immune system identify cancer cells and produce more immune cells to fight them.

• Targeted therapy: This treatment uses drugs designed to attack specific parts of a leukemia cell (like a protein or gene) that are causing them to overtake normal blood cells. Targeted therapies may prevent leukemia cells from multiplying, cut off the cells’ blood supply or kill them directly. Targeted therapy is less likely to harm normal cells. Examples of targeted therapy drugs include monoclonal antibodies and tyrosine kinase inhibitors.

• Radiation therapy: This treatment uses strong energy beams or X-rays to kill leukemia cells or stop them from growing. During treatment, a machine directs radiation to the exact spots in your body where the cancer cells are or distributes radiation over your whole body. Distributing radiation throughout your body may happen before a hematopoietic cell transplant.

• Hematopoietic cell transplant (stem cell or bone marrow transplant): This treatment replaces the cancerous blood-forming cells killed by chemotherapy and/or radiation therapy with new, healthy hematopoietic cells. Your healthcare provider may remove these healthy cells from your blood or bone marrow before chemo and radiation, or they may come from a donor. The healthy new cells multiply, forming new bone marrow and blood cells that become the red blood cells, white blood cells and platelets your body needs.

• Chimeric antigen receptor (CAR) T-cell therapy: This is a novel type of therapy that takes your body’s infection-fighting T-cells (T-cell or T-lymphocyte is a type of immune cell), engineers them to fight leukemia cells and infuse them back into your body.