CONDITIONS

Leukemia

What Is Leukemia

Leukemia is a cancer that affects the lymphatic system, which produces your white blood cells, and bone marrow, which makes red and white blood cells, and platelets. Because of this, people sometimes refer to leukemia as blood cancer or bone cancer.

Some types of leukemia tend to affect children. Others are more common in adults. Leukemia accounts for about a third of all childhood cancers. 

Leukemia can be classified as:

  • Acute leukemia, which starts in immature blood cells. Acute leukemia worsens quickly and needs aggressive treatment right away.
  • Chronic leukemia, which starts in mature blood cells, and usually develops more slowly.

Most leukemia in children is acute.

The type of leukemia also depends on the cells it affects–the lymphocytes, which govern your immune system, or the myeloid cells, which form red and white blood cells and the cells that make platelets so your blood can clot if you are injured.

  • Acute lymphocytic leukemia (ALL) is the most common leukemia in children, affecting nearly 4 out of 5 kids with leukemia. However, it can also affect adults.
  • Acute myelogenous leukemia (AML) is the most common leukemia in adults. AML also affects 1 in 5 kids with leukemia.
  • Chronic lymphocytic leukemia (CLL) is the most common chronic leukemia and can go unnoticed for years. CLL mainly affects adults and is rare in children.
  • Chronic myeloid leukemia (CML) can also last for years unnoticed before the cancer starts to grow more quickly. CML mainly affects adults and is rare in children.

Rarer types of leukemia include: 

  • Myelodysplastic syndromes, which cause poorly formed blood cells
  • Myeloproliferative disorders, which cause the marrow to make too many blood cells of one type
  • Hairy cell leukemia, which makes your body produce too many lymphocytes

What Causes Leukemia

Doctors believe that leukemia starts when some blood cells develop mutations in their DNA, or other changes that aren’t well understood. These changes cause the cells to divide more rapidly and crowd out healthy blood cells.

No one knows what causes these changes to happen, but it’s believed that they may be influenced by genetic factors and by causes in your environment, such as exposure to radiation or a chemical called benzene.

Risk Factors For Leukemia

Things that may raise your risk of leukemia include:

  • Exposure to radiation, such as in radiation therapy for cancer
  • Exposure to certain drugs and chemicals, such as benzene, chemotherapy drugs, and cigarettes
  • Genetic disorders or family history of leukemia
  • Certain blood disorders

Diagnosing Leukemia

Your doctor may start by asking you questions about your symptoms. Or it may be that your leukemia was spotted in a routine blood test, without symptoms in either case, the next steps will involve: 

  • A physical exam. Your doctor will check you for paleness and for swelling in your liver, lymph nodes, or spleen.
  • Blood tests to check for high white blood cell count.
  • A bone marrow test. If your doctor recommends this test, you will have a marrow sample taken from your hip with a long needle to be examined in a laboratory.

Other tests may also be needed to confirm the diagnosis, pinpoint the type of leukemia, and find out how advanced it is.

Symptoms of Leukemia

Chronic leukemia can go without symptoms for a very long time, while other types may show symptoms much sooner. Common symptoms of leukemia include:

  • Paleness
  • Fever or chills
  • Extreme tiredness or weakness that doesn’t go away
  • Frequent or severe infections
  • Unexplained weight loss
  • Swelling in the liver, lymph nodes, or spleen
  • Easy bleeding or bruising, such as frequent nosebleeds
  • Petechiae, which are tiny red spots on your skin
  • Profuse sweating
  • A feeling of pain or tenderness in your bones or joints
  • Loss of appetite and subsequent weight loss

Prognosis

The outlook depends on the type of leukemia you have.

The outlook for patients with acute lymphocytic leukemia, or ALL, is better in younger patients, and best in children. 98% to 99% of kids with ALL go into remission in the first six months of treatment, and 9 out of 10 are cured.  In adults, ALL goes into remission for 80% to 90%, but the disease is more likely to return than in children. This leads to an overall cure rate of 40%.

Acute myeloid leukemia is much more difficult to treat successfully. The 5-year survival rate is only about 25%. But for those who do survive 5 years, the disease doesn’t usually return.

Chronic lymphocytic leukemia has fast-growing and slow-growing varieties. CLL has a survival rate of 50% to 80% at 5 years, and 35% at 10 years. People with the slower type tend to live longer than those with the fast-growing variety. 

Survival rates with chronic myeloid leukemia are hard to estimate because of new treatments developed around the turn of the century. But results so far look hopeful. One study found that 9 out of 10 patients taking the new drug Gleevec (imatinib) were still alive 5 years later, and most had normal white blood cell levels.

Living With Leukemia

A diagnosis of leukemia can be frightening. Having a child with leukemia can be even harder. Some things you can do to help yourself cope include:

  • Learn about the condition so you can make informed decisions, advocate for yourself or your child, and know what to expect.
  • Speak openly with friends and family, and ask for the help you need. You may also seek out help from a counselor or a survivors’ support group.  
  • Eat well to support your overall health. This may be harder if treatment makes you nauseous or changes the taste of food. But your doctor or dietitian may have ideas to help you.

Screening

There is no standard screening test for leukemia, but sometimes a routine blood test may discover the disease.

Prevention

For most people, there is no way to reduce the risk of leukemia. If you smoke, quitting can improve your odds. It’s also a good idea to avoid working with radiation or with chemicals such as benzene. If exposure is unavoidable, follow proper handling procedures to maximize safety.

Common Treatment

Several treatments are available for leukemia. The best treatment for you depends on factors such as your age, your overall health, the type of leukemia you have, and how far it has spread. The available treatments include: 

  • Chemotherapy, which treats cancer by preferentially targeting rapidly growing cells, which is characteristic of cancer cells. Chemotherapy is the most common treatment for leukemia as other treatments for cancers, such as surgery and radiation, are not practical for a systemic “blood cancer” that is not localized to one area of the body.
  • Biological therapy, which helps your immune system recognize and attack cancer cells. Common biologics include the use of specific antibodies, cytokines, and even vaccines in specific cases.
  • Targeted therapy, which identifies specific weaknesses in the cancer cells and exploits them.  This allows the treatment to only destroy cancer cells and to not affect normal cells. Tyrosine kinase inhibitors, such as Imatinib, are considered targeted therapy as they block the enzyme tyrosine kinase, which functions in cell division and is over-expressed in cancer cells compared to normal cells.
  • Radiation therapy, which uses x-rays or other radiation to stop cancer from growing. Ionizing radiation specifically targets the DNA of cancer cells. By disrupting these crucial DNA segments necessary to growth and cell division, the cancer cells are destroyed. Nearby tissue may also be affected by radiation, so discreet, localized targets typically work best for radiation treatment.
  • Stem cell transplant, in which stem cells from a donor, or your own stem cells, are used to replace diseased marrow that has been destroyed with radiation treatment. As a result of the transplant, the “new” bone marrow will now produce only normal blood components and in normal numbers.

Sometimes a treatment may fall into more than one type. For instance, the new medicine Gleevec, which is showing promise in CML, is both a targeted therapy and a biologic agent.

Complementary and Alternative Treatment

There is no viable alternative to modern medicine for treating leukemia, but there are complementary treatments that can help manage symptoms, reduce treatment side effects, and improve your overall quality of life. For instance: 

  • Massage is shown to reduce pain nausea, and fatigue, and to help patients relax and improve sleep. However, there is debate regarding potential cancer spread secondary to massage. Discuss the possible risks and benefits of massage with your doctor.
  • Acupuncture is helpful for many cancer symptoms and treatment side effects. In particular, acupuncture can help to reduce nausea, and to improve sensitivity when cancer treatments have damaged a person’s nerves.
  • Music therapy can help with anxiety and reduce the risk of depression.
  • Mind-body techniques may also improve symptoms and lessen side effects, such as:
    • meditation
    • self-hypnosis
  • Healthy diet and exercise are also critically important and can improve your odds of survival and prevent complications later in life. Foods rich in vitamins and anti-oxidants, such as fruits and vegetables, may help prevents damages to the DNA of cells, which play a role in the development of many types of cancers, not only leukemia.

Only take vitamins and herbal supplements after consultation with your doctor, as these pills may affect how well your medical treatments work.

Care Guide

After completing treatment, you’ll need regular follow-up care to monitor your overall health and watch to make sure your cancer doesn’t return. This can range from monthly checkups for the first year after acute leukemia treatment to semiannual checkups if you had chronic leukemia. Follow-up care also helps watch for other cancers and for long-term effects that may develop after treatment. 

It’s also very important to take care of your overall health by eating properly and staying active. Regular exercise and eating plenty of fruits and vegetables can help reduce your risk of cancer and prevent some long-term complications that may arise after leukemia treatment, such as obesity and heart disease. 

In addition, it’s good to seek out emotional support from friends, family, and sometimes a counselor or other cancer survivors. The emotional strain of cancer can be more than you realize, and a good network can help you cope.

When To Contact A Doctor

Leukemia symptoms may often seem like the flu or other common diseases. Talk to your doctor if you have symptoms that worry you and don’t go away.

Questions For Your Doctor

Treating leukemia may take more than one type of specialist. The doctors on your health care team may include: 

  • A medical oncologist, who specializes in cancer treatment
  • A radiation oncologist, who specializes in radiation therapy for cancer
  • A hematologist, who specializes in blood diseases
  • Other health care workers, such as an oncology nurse, a dietitian, and a social worker

Your doctor can direct you to the specialists you need. Alternately, the National Cancer Institute can help you find a treatment center near you or You can also call 1-800-4-CANCER.

Questions For A Doctor

When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:

  • What type of leukemia do I have?
  • Do I need more tests?
  • What treatment do you recommend?
  • What are the side effects?
  • What are my other treatment options?
  • What is the outlook for me?
  • Is there anything else I should know about leukemia?

Resources

Other useful resources to help you learn about leukemia can be found at:

National Cancer Institute

American Cancer Society

Leukemia & Lymphoma Society