NIHSeniorHealth Leukemia (Print Version)

NIHSeniorHealth: Leukemia (Print Version)
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Leukemia
What Is Leukemia? Leukemia is a cancer of the blood cells. It is the most common type of blood cancer and affects 10 times as many adults as children. Most people diagnosed with leukemia are over 50 years old. Leukemia usually begins in the bone marrow, the soft material in the center of most bones where blood cells are formed. The bone marrow makes three types of blood cells, and each type has a special function.
White blood cells fight infection and disease. Red blood cells carry oxygen throughout the body. Platelets help control bleeding by forming blood clots. In people with leukemia, the bone marrow produces abnormal white blood cells, called leukemia cells. At first, leukemia cells function almost normally. But over time, as more leukemia cells are produced, they may crowd out the healthy white blood cells, red blood cells, and platelets. This makes it difficult for the blood to carry out its normal functions. There are four common types of adult leukemia. Two are chronic, meaning they get worse over a longer period of time. The other two are acute, meaning they get worse quickly. chronic lymphocytic leukemia chronic myeloid leukemia acute myeloid leukemia acute lymphocytic leukemia Chronic lymphocytic leukemia, chronic myeloid leukemia, and acute myeloid leukemia are diagnosed more often in older adults. Of these, chronic lymphocytic leukemia is the most common. Acute lymphocytic leukemia is found more often in children. The symptoms for each type of leukemia differ but may include fevers, frequent infections, fatigue, swollen lymph nodes, weight loss, and bleeding and bruising easily. However, such symptoms are not sure signs of leukemia. An infection or another problem also could cause these symptoms. Only a doctor can diagnose and treat the problem.
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Myeloma and lymphoma are other types of cancer that affect blood cells, but these cancer cells are rarely found in the blood stream. Myeloma is the second most common form of blood cancer, and it affects plasma cells, a type of white blood cell that is found in the bone marrow. Lymphoma accounts for about five percent of all the types of cancer in the United States. It starts in the lymphatic system, which is part of the body's immune system. Both myeloma and lymphoma are more common among older adults and occur more often in men than women. There are many treatments available to treat acute and chronic leukemia. They include chemotherapy, biological therapy, or stem cell transplantation. Some people receive a combination of treatments. Acute leukemia usually needs to be treated right away. But there are many different kinds of acute leukemia. Some respond well to treatment and can be cured in many cases, while others are more difficult to treat. Treatment for chronic leukemia can often control the disease and its symptoms, but it can seldom cure the disease. However, there is a recent treatment for chronic myeloid leukemia that can control the disease for a long time. Quiz 1. Leukemia is the most common form of A. lung cancer. B. blood cancer. C. skin cancer. B is the correct answer. Leukemia is the most common form of blood cancer. It affects 10 times as many adults as children. Most people diagnosed with leukemia are over 50 years old. 2. Leukemia occurs in A. platelets. B. red blood cells. C. white blood cells. C is the correct answer. Leukemia occurs in white blood cells. People with leukemia produce too many abnormal white blood cells, the type of cells that help fight infection and disease. When these cells, called leukemia cells, build up in the blood, they interfere with the function of the healthy white blood cells, red blood cells, and platelets. 3. The most common type of leukemia in adults is A. acute myeloid leukemia. B. chronic lymphocytic leukemia. C. chronic myeloid leukemia. B is the correct answer. Chronic lymphocytic leukemia is the most common type of leukemia in adults.
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4. Lymphoma is a type of cancer that starts in the A. brain. B. lymphatic system of the body. C. plasma cells. B is the correct answer. Lymphoma is another type of cancer that affects blood cells. It starts in the lymphatic system and is more common among older adults.
Who Is at Risk? No one knows why some people develop leukemia and others do not. However, scientists have identified some risk factors for the disease. A risk factor is anything that increases a person's chances of developing a disease. Most people who have known risk factors do not get leukemia, while many who do get the disease have none of these risk factors. Studies have identified the following risk factors for leukemia: older, male, white, working with certain chemicals, smoking, exposure to very high levels of radiation, certain health conditions, and past treatment with chemotherapy or radiation therapy. More than 65 percent of people diagnosed with leukemia are over 55. Leukemia occurs more often in men than women and is more common among white people than other races. Chronic exposure to certain chemicals may lead to the development of leukemia. Benzene is a widely used chemical that has been linked to leukemia. The greatest risk of exposure to high concentrations of benzene is worksites such as chemical plants and gasoline-related industries. However, government agencies have regulated the amount of benzene exposure in the U.S. industry, so cases of leukemia linked to benzene now are rare in this country. Benzene is usually found in low levels in the general environment. However, areas around gasoline stations, high vehicular traffic, and industrial sources may have higher levels. Benzene is also found in tobacco smoke. It is estimated that about half of the benzene exposure in the United States is from cigarette smoke. Smoking is a risk factor for leukemia. Certain disorders and genetic diseases, such as Down syndrome, may increase the risk of leukemia. About 3 out of 10 people with a blood disorder known as myelodysplastic syndrome develop acute myeloid leukemia. In this disorder, as in leukemia, abnormal cells are formed in the bone marrow and too few healthy blood cells enter the bloodstream. People exposed to very high levels of radiation, such as the atomic bomb blast in Hiroshima, Japan or nuclear power plant accidents, also are at risk of developing leukemia. Studies of atomic blasts have estimated that survivors
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have a five and a half times greater risk of developing leukemia than the general public. Although chemotherapy and radiation therapy have been helpful to a lot of people in the treatment of many forms of cancer, and indeed are often lifesaving. They have been linked to the development of second cancers, including leukemia, many years after treatment. Chemotherapy for a first cancer is a stronger risk factor for developing leukemia later than is radiation therapy. The combination of chemotherapy and radiation can significantly increase the risk of leukemia after a first cancer. Powerful cancer-fighting chemotherapy drugs, known as alkylating agents and epipodophyllotoxins, have been associated with leukemia. The dose given and length of treatment as well as other factors may contribute to a person's risk of developing leukemia. Acute myeloid leukemia is the most common type of cancer that has been linked to chemotherapy treatment. Radiation therapy may increase a person's chance of developing leukemia. Several factors influence this risk, such as the dose of radiation administered. A person's age at the time of therapy does not seem to be a risk factor for leukemia. Quiz 1. A risk factor is something that A. increases a person's chances of getting a disease. B. decreases a person's chances of getting a disease. C. does not affect a person's chances of getting a disease. A is the correct answer. A risk factor is something that increases a person's chances of getting a disease. The exact cause of leukemia is not known, but scientists have identified some risk factors. Having a risk factor, or even several risk factors, does not mean that a person will develop leukemia, however. And many people who get the disease do not have any known risk factors. 2. Leukemia is more common in A. infants. B. people over 55. C. young adults. B is the correct answer. More than 65 percent of people diagnosed with leukemia are over 55. However, people at any age can get leukemia. 3. Risk factors for leukemia include A. age. B. past treatment with chemotherapy or radiation therapy. C. working with certain chemicals. D. all of the above
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D is the correct answer. Risk factors include older age, past treatment with chemotherapy or radiation therapy, and working with certain chemicals. Other risk factors for leukemia are sex (male), race (white), smoking, exposure to very high levels of radiation, and certain health conditions. However, most people who have known risk factors do not get leukemia, while many who do get the disease have none of these risk factors. 4. Benzene is a chemical A. found in the environment. B. that has been linked to the development of leukemia. C. found in tobacco smoke. D. all of the above D is the correct answer. Benzene is a widely used chemical that has been linked to leukemia. The greatest risk of exposure to high concentrations of benzene is in the workplace. Although it is usually found in low levels in the general environment, areas around gasoline stations, high vehicular traffic, and industrial sources may have higher levels. It is estimated that about half of the benzene exposure in the United States is from cigarette smoke.
Symptoms and Diagnosis During the early stages of leukemia, there may be no symptoms. Many of the symptoms of leukemia don't become apparent until a large number of normal blood cells are crowded out by leukemia cells. In chronic leukemia, symptoms develop gradually and are generally not as severe as in acute leukemia. Chronic leukemia is usually found during a routine doctor's exam before symptoms are present. When symptoms appear, they generally are mild at first and gradually get worse, but sometimes they don't worsen until many years after an initial diagnosis. Recently, researchers discovered that abnormal white blood cells can be present in the blood of chronic lymphocytic leukemia patients more than six years before a diagnosis. This finding may lead to a better understanding of the cellular changes that occur in the earliest stages of the disease and how the disease progresses. In acute leukemia, symptoms usually appear and get worse quickly. People with this disease usually go to their doctor because they feel sick. People with leukemia may have very high levels of white blood cells, but because the cells are abnormal, they are unable to fight infection. Therefore, patients may develop frequent fevers or infections. A shortage of red blood cells, called anemia, can cause a person to feel tired. Not having enough blood platelets may cause a person to bleed and bruise easily. Some symptoms depend on where leukemia cells collect in the body. Leukemia cells can collect in many different tissues and organs, such as the
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digestive tract, kidneys, lungs, lymph nodes, or other parts of the body, including the eyes, brain, and testicles. Other common symptoms of leukemia include headache, weight loss, pain in the bones or joints, swelling or discomfort in the abdomen (from an enlarged spleen), and swollen lymph nodes, especially in the neck or armpit. Symptoms of acute leukemia may include vomiting, confusion, loss of muscle control, and seizures. Some of the symptoms of leukemia are similar to those caused by the flu or other common diseases, so these symptoms are not sure signs of leukemia. It is important to check with your doctor if you have these symptoms. Only a doctor can diagnose and treat leukemia. To find the cause of leukemia symptoms, the doctor will ask about medical history and conduct a physical exam. During the exam, the doctor will check for signs of disease such as lumps, swelling in the lymph nodes, spleen, and liver, or anything else that seems unusual. The doctor will need to do blood tests that check the levels and types of blood cells and look for changes in the shape of blood cells. The doctor also may look at certain factors in the blood to see if leukemia has affected other organs such as the liver or kidneys. Even if blood tests suggest leukemia, the doctor may look for signs of leukemia in the bone marrow by doing a biopsy before making a diagnosis. A biopsy is a procedure where a small amount of bone marrow is removed from a bone. A pathologist examines the sample under a microscope to look for abnormal cells. There are two ways the doctor can obtain bone marrow. In a bone marrow aspiration, marrow is collected by inserting a needle into the hipbone or another large bone and removing a small amount of bone marrow. A bone marrow biopsy is performed with a larger needle and removes bone marrow and a small piece of bone. If leukemia cells are found in the bone marrow sample, the doctor may perform more tests to determine if the disease has spread to other parts of the body. The doctor may collect a sample of the fluid around the brain and spinal cord by performing a spinal tap and checking for leukemia cells or other signs of problems. Chest x-rays, computed tomography (CT) scans, and ultrasounds are tests used to determine if leukemia has spread from the bone marrow. These tests produce pictures of the inside of the body. With these tests, the doctor looks for abnormalities such as enlarged organs or signs of infection. Quiz 1. Symptoms of leukemia include A. frequent infections. B. weakness.
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C. weight loss. D. all of the above D is the correct answer. Common symptoms of leukemia include fevers or night sweats, frequent infections, feeling weak or tired, and headache. Symptoms also include bleeding and bruising easily, pain in the bones or joints, weight loss, swelling or discomfort in the abdomen, and swollen lymph nodes, especially in the neck or armpit. 2. Chronic leukemia is usually found A. at a routine doctor's visit before symptoms are present. B. after symptoms develop. C. after the patient has become very sick. A is the correct answer. Chronic leukemia is usually found at a routine doctor's visit before symptoms are present. In the early stages of chronic leukemia, cells function almost normally. When symptoms do appear, they are generally mild at first and get worse gradually. 3. A doctor performs blood tests to A. check the number of red blood cells, white blood cells, and platelets. B. look for changes in the shape of blood cells. C. see if leukemia has affected other organs such as the liver or kidneys. D. all of the above D is the correct answer. Blood tests are used to determine the levels of red blood cells, white blood cells, and platelets, and to look for leukemia cells. The doctor also may look for other factors in the blood to determine if leukemia has affected other organs in the body. 4. Chest x-rays, computed tomography (CT) scans, and ultrasound are tests used to determine if leukemia A. cells are present in the blood. B. has spread from the bone marrow. C. has affected other types of blood cells. B is the correct answer. Chest x-rays, computed tomography (CT) scans, and ultrasound are tests used to determine if leukemia has spread from the bone marrow. These tests are imaging tests that produce pictures of the inside of the body. With these tests, the doctor looks for abnormalities such as enlarged organs or signs of infection. A spinal tap also can be used to determine if leukemia has spread.
Treatment and Research There are many treatment options for people with leukemia. The choice of treatment depends on your age and general health, the type of leukemia you
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have, whether or not it has spread outside the bone marrow, and other factors. Treatment and Research - Planning Treatment If tests show that you have leukemia, you should talk with your doctor and make treatment decisions as soon as possible, although many patients with chronic lymphocytic leukemia do not require treatment for many years. A team of specialists often treats people with leukemia. The team will keep the primary doctor informed about the patient's progress. The team may include a hematologist who is a specialist in blood and blood-forming tissues, a medical oncologist who is a specialist in cancer treatment, and a radiation oncologist who is a specialist in radiation therapy. Before starting treatment, you may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion. Others may pay for a second opinion if you or your doctor requests it. Some leukemia patients take part in studies of new treatments. These studies, called clinical trials, are designed to find out whether a new treatment is safe and effective and better than current treatments. Talk to your doctor if you are interested in taking part in a clinical trial. The U.S. National Institutes of Health, through its National Library of Medicine and other Institutes, maintains a database of clinical trials at ClinicalTrials.gov. Click here to search for current clinical trials on leukemia. A separate window will open. Click the "x" in the upper right hand corner of the "Clinical Trials" window to return here. Quiz 1. A person with leukemia is usually treated by A. their primary doctor only. B. a team of specialists. C. a dermatologist. B is the correct answer. Leukemia is a complex type of cancer, so a team of specialists often treats a person with this disease. The team may include a hematologist who is a specialist in blood and blood-forming tissues, a medical oncologist who is a specialist in cancer treatment, and a radiation oncologist who is a specialist in radiation therapy. 2. If you are diagnosed with leukemia, your doctor may request that you A. get a second opinion. B. go to work. C. start exercising. A is the correct answer. If you are diagnosed with leukemia, your doctor may request that you get a second opinion. Before starting treatment, you may
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want another doctor to review the diagnosis and treatment plan. 3. Clinical trials often compare A. two diseases. B. older versus newer treatments. C. clinics and hospitals. B is the correct answer. Clinical trials are research studies in which new treatments -- drugs, diagnostics, procedures, vaccines, and other therapies -- are tested in people to see if they are safe, effective, and better than the current standard of care. 4. If you are interested in participating in a clinical trial, you should A. talk with your accountant. B. talk with your lawyer. C. talk with your doctor. C is the correct answer. If you are interested in participating in a clinical trial, you should talk to your doctor. You and your doctor can discuss the risks and benefits of participating in a clinical trial.
Treatment and Research - Standard Treatments Unlike other types of cancer, leukemia isn't a tumor that your doctor can surgically remove. Leukemia cells are produced in the bone marrow and travel throughout the body. Treatment depends on a number of factors, including the type of leukemia, the patient's age and general health, whether leukemia cells are present in the fluid around the brain or spinal cord, and whether the leukemia has been treated before. It also may depend on certain features of the leukemia cells and the patient's symptoms. If a person has acute leukemia, they will need treatment right away. The purpose of treatment is to stop the rapid growth of leukemia cells and to bring about remission, meaning the cancer is under control. In many cases, a person will continue treatment after signs and symptoms disappear to prevent the disease from coming back. Some people with acute leukemia can be cured. Chronic leukemia may not need to be treated until symptoms appear. Treatment can often control the disease and its symptoms. However, chronic leukemia can seldom be cured. The goal of treatment for leukemia is to destroy the leukemia cells and allow normal cells to form in the bone marrow. Depending on the type and extent of the disease, patients may have chemotherapy, biological therapy, radiation therapy, or stem cell transplantation. Some patients receive a combination of treatments.
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Chemotherapy uses drugs to kill cancer cells. This is the most common treatment for most types of leukemia. Chemotherapy may be taken by mouth in pill form, by injection directly into a vein, or through a catheter. If leukemia cells are found in the fluid around the brain or spinal cord, the doctor may inject drugs directly into the fluid to ensure that the drugs reach the leukemia cells in the brain. Chemotherapy uses drugs to kill cancer cells. This is the most common treatment for most types of leukemia. Chemotherapy may be taken by mouth in pill form, by injection directly into a vein, or through a catheter. If leukemia cells are found in the fluid around the brain or spinal cord, the doctor may inject drugs directly into the fluid to ensure that the drugs reach the leukemia cells in the brain.
Biological therapy uses special substances that improve the body's natural defenses against cancer. Some patients with chronic lymphocytic leukemia receive monoclonal antibodies, which are man-made proteins that can identify leukemia cells. Monoclonal antibodies bind to the cells and assist the body in killing them. Although monoclonal antibodies are being used to treat leukemia, researchers are studying more innovative ways to use them in treatment. Some antibodies are used alone to try to prompt the immune system to attack leukemia cells. Other antibodies are attached to substances that can poison cancer cells. These modified antibodies, called immunotoxins, deliver the toxins directly to the cancer cells. A natural substance called interferon is used to treat some patients with chronic myeloid leukemia. This substance can slow the growth of leukemia cells. The newest therapies target an enzyme responsible for the growth of the myeloid cells, and are very effective. Radiation therapy uses high-energy x-rays to destroy cancer cells. A machine outside the body directs high-energy beams at the spleen, the brain, or other parts of the body where leukemia cells have collected. Radiation therapy is used primarily to control disease in bones that are at risk of fracture or at sites that are causing pain. Stem cell transplantation uses high doses of chemotherapy and total body irradiation to kill the leukemia cells. After these treatments, the patient's immune system is usually very weak, because normal cells in the bone marrow are killed along with the leukemia cells. Healthy stem cells must be given to the patient to restore the immune system so it can fight infection and disease. There are several types of stem cell transplantation. Bone marrow transplantation replaces a patient's bone marrow with leukemia-free stem cells from bone marrow. Peripheral stem cell transplantation uses stem cells that are collected from the bloodstream.
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Umbilical cord blood transplantation uses stem cells from a newborn baby. Stem cells used for transplants come from the patient or a donor whose cells match the patient's cells. Use of the patient's own cells is called autologous stem cell transplantation. The cells are collected, treated to remove leukemia cells, and stored. After the patient receives high-dose chemotherapy or radiation treatment, their stored cells are returned to them. Use of stem cells from a donor is called an allogeneic transplant. Allogeneic transplantation can be done using cells from a sibling or from another individual who has a similar immune system. Quiz 1. The type of leukemia treatment that a doctor recommends depends on A. the type of leukemia. B. the patient's age and general health. C. whether a person has been treated for leukemia before. D. all of the above D is the correct answer. Treatment depends on a number of factors, including the type of leukemia, the patient's age and general health, whether leukemia cells are present in the fluid around the brain or spinal cord, and whether the leukemia has been treated before. It also may depend on certain features of the leukemia cells and the patient's symptoms. 2. Chronic lymphocytic leukemia patients who do not have symptoms A. may not require immediate treatment. B. need to be treated immediately. C. may require surgery. A is the correct answer. Chronic lymphocytic leukemia patients who do not have symptoms may not require immediate treatment. The health care team may suggest watchful waiting for some patients with chronic leukemia. They will carefully monitor the patient's health so that treatment can begin once symptoms occur. 3. Chemotherapy is a treatment that kills cancer cells with A. radiation. B. the body's natural defenses. C. drugs. C is the correct answer. Chemotherapy is a treatment that kills cancer cells with drugs. It is the most common treatment for most types of leukemia. These anti-cancer drugs may be taken by mouth in pill form, by injection directly into a vein, or through a catheter. They also may be injected into the cerebrospinal fluid if leukemia cells are found in the fluid around the brain or spinal cord.
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4. Monoclonal antibodies are A. used in stem cell transplants. B. man-made proteins that assist the body in killing the cancer cells. C. natural proteins that destroy cancer cells. B is the correct answer. Monoclonal antibodies are man-made proteins that assist the body in killing the cancer cells. The use of monoclonal antibodies is a form of biological therapy. The antibodies are produced in the lab and they help improve the body's natural defenses against cancer. When an antibody binds to a cancer cell, it prompts immune cells to attack and kill the cancer cell.
Treatment and Research - Latest Research Researchers are conducting clinical trials in many parts of the country. Clinical trials already have led to advances, and researchers continue to search for more effective ways to treat and diagnose leukemia. They are studying various drugs, immunotherapy, stem cell transplantation, and other types of treatments. They are also studying the effectiveness of using combinations of treatments. The drug imatinib (Gleevec) is important in the treatment of chronic myeloid leukemia. Imatinib targets an abnormal protein that is present in most leukemia cells. By blocking the abnormal protein, imatinib kills the leukemia cells, but it does not kill normal cells. However, imatinib stops working in some people with leukemia because the cells become resistant. Fortunately, two drugs, dasatinib (Sprycel) and nilotinib (Tasigna), have been effective in clinical trials for the treatment of people who stop responding to imatinib. These drugs work against the same abnormal protein targeted by imatinib, but in different ways. Immunotherapy is a treatment that uses immune cells or antibodies to fight leukemia or stop it from getting worse. The idea is to zero in on leukemia cells so the treatment is less toxic to normal cells. Leukemia vaccines are not vaccines in the way that most people think of them. Unlike most vaccines, which help prevent diseases, leukemia vaccines are used to treat someone who already has cancer. A vaccine introduces a molecule called an antigen into the body. The immune system recognizes the antigen as a foreign invader and attacks it. Researchers are studying a vaccine in which the antigen is the same abnormal protein that imatinib targets. The vaccine causes immune cells to destroy leukemia cells that contain this protein. Gene therapy -- replacing, manipulating, or supplementing nonfunctional genes with healthy genes -- is being explored for treatment of leukemia. It is being studied as a way to stimulate a patient's immune system to kill leukemia cells and also to interfere with the production of proteins that cause cells to
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become cancerous. Researchers also are investigating ways to improve current stem cell transplant techniques, such as more precise matching of donors to patients and better ways to prepare the patient's immune system to accept the transplanted cells. A modified form of stem cell transplant, called a mini-transplant, has been developed. Compared with standard stem cell transplants, this technique requires less intensive radiation and chemotherapy before a patient is given donor cells. This approach has made stem cell transplants a treatment option for older adults and others who may not be able to tolerate high doses of radiation or chemotherapy. Because leukemia is a complicated disease, using more than one type of treatment may be beneficial. Combining therapies can complement and enhance the effects of each. For example, patients receiving a stem cell transplant also undergo chemotherapy or radiation to prepare their body for the new stem cells. A clinical trial at the National Cancer Institute is taking this combination treatment one step further. The researchers are looking at giving drugs to patients before and after the transplant so that the patient's immune system will stop attacking the transplanted cells. Quiz 1. Recent research in leukemia includes studies on A. drug development. B. immunotherapy. C. stem cell transplantation. D. all of the above D is the correct answer. Scientists are searching for more effective ways to treat and diagnose leukemia. They are studying various drugs, immunotherapy, stem cell transplantation, and other types of treatments. They are also looking at treating leukemia by combining treatment options. 2. The drug imatinib (Gleevec) A. targets an abnormal protein that is present in most leukemia cells. B. kills the leukemia cells, but it does not kill normal cells. C. stops working in some people with leukemia because the cells become resistant. D. all of the above D is the correct answer. The drug imatinib (Gleevec) is important in the treatment of chronic myeloid leukemia. Imatinib targets an abnormal protein that is present in most leukemia cells. By blocking the abnormal protein, imatinib kills the leukemia cells, but it does not kill normal cells. However, imatinib stops working in some people with leukemia because the cells become resistant. Fortunately, two drugs, dasatinib (Sprycel) and nilotinib
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(Tasigna), have been effective in clinical trials for the treatment of people who stop responding to imatinib. 3. Leukemia vaccines A. are used to prevent leukemia. B. are given only to young people. C. are used to treat someone who already has the disease. C is the correct answer. Leukemia vaccines are used to treat someone who already has the disease. Leukemia vaccines are not vaccines in the way that most people think of them. Unlike most vaccines, which help prevent diseases, leukemia vaccines help immune cells target and kill leukemia cells in someone who already has cancer. 4. A mini-stem cell transplant uses A. fewer stem cells than a standard transplant. B. smaller cells than a standard transplant. C. less intense radiation and chemotherapy than a standard transplant. C is the correct answer. A mini-stem cell transplant uses less intense radiation and chemotherapy than a standard transplant. A mini-transplant may be an option for older adults who are not candidates for a standard transplant because they are unable to tolerate high doses of radiation or chemotherapy.
Frequently Asked Questions 1. What is cancer? Cancer begins in cells, which make up the blood and other tissues. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy and functioning properly. Sometimes, however, the process of creating a new cell goes wrong -- cells become abnormal and form more cells in an uncontrolled way. 2. What is leukemia? Leukemia is a cancer of the blood cells. It usually begins in the bone marrow where blood cells are formed. In leukemia, the bone marrow produces abnormal white blood cells. Over time, as the number of abnormal white blood cells builds up in the blood, they crowd out healthy blood cells. This makes it difficult for the blood to carry out its normal functions. 3. What is the difference between acute leukemia and chronic leukemia? Acute leukemia gets worse quickly. In chronic leukemia, symptoms develop gradually and are generally not as severe as in acute leukemia.
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4. What are the most common types of leukemia? There are four common types of leukemia. They are chronic lymphocytic leukemia, chronic myeloid leukemia, acute myeloid leukemia, and acute lymphocytic leukemia. Chronic lymphocytic leukemia, chronic myeloid leukemia, and acute myeloid leukemia are diagnosed more often in older adults. Acute lymphocytic leukemia is found more often in children. 5. What are other cancers that affect blood cells? Myeloma and lymphoma are other types of blood cancers. Both are common among older adults and occur more often in men than women. Myeloma affects plasma cells, a type of white blood cells typically found in the bone marrow. Lymphoma starts in the lymphatic system, which is part of the body's immune system.
6. Am I at risk of developing leukemia? No one knows why some people develop leukemia and others do not. Most people who have known risk factors do not get leukemia, while many who get the disease do not have any risk factors. The following risk factors increase a person's chance of developing leukemia: older, male, white, past treatment with chemotherapy or radiation therapy, working with certain chemicals, smoking, exposure to very high levels of radiation, and certain health conditions. 7. Why does smoking increase a person's chance of developing leukemia? Cigarette smoke contains the chemical benzene as well as many other toxic substances. Chronic exposure to high levels of benzene has been associated with leukemia. Although benzene is found in low levels in most environments, cigarette smoke is estimated to account for about half of the benzene exposure in the United States. 8. What are the symptoms of leukemia? Common symptoms of leukemia may include fevers; frequent infections; feeling weak or tired; headache; bleeding and bruising easily; pain in the bones or joints; swelling or discomfort in the abdomen (from an enlarged spleen); swollen lymph nodes, especially in the neck or armpit; and weight loss. Symptoms of acute leukemia may include vomiting, confusion, loss of muscle control, and seizures. 9. What are some tests for leukemia? There are no standard or over-the-counter tests for leukemia. Your doctor can request lab analyses for leukemia that include blood tests that check the levels and types of blood cells and look for changes in the shape of blood cells. The doctor may also look for signs of leukemia in the bone marrow or the fluid around the brain or the spinal cord 10. How does a doctor collect bone marrow?
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There are two ways that a doctor can obtain bone marrow: through a bone marrow aspiration or a bone marrow biopsy. A bone marrow aspiration is performed by inserting a needle into the hipbone or another large bone to remove a small amount of bone marrow. In a bone marrow biopsy, marrow is collected with a larger needle. During this procedure, a small piece of bone may also be removed. 11. Can my primary doctor treat leukemia? A team of specialists often treats people with leukemia. The team may include a hematologist who is a specialist in blood and blood-forming tissues, a medical oncologist who is a specialist in cancer treatment, and a radiation oncologist who is a specialist in radiation therapy. The team keeps the primary doctor informed of the patient's progress. 12. How does my doctor decide which leukemia treatment is best for me? Treatment depends on a number of factors, including the type of leukemia, the patient's age and general health, where leukemia cells have collected in the body, and whether the leukemia has been treated before. Certain features of the leukemia cells and the patient's symptoms also may determine treatment options. 13. What are the standard treatments for leukemia? Standard treatments for leukemia include chemotherapy, biological therapy, radiation therapy, and stem cell transplantation. Some patients receive a combination of treatments. 14. What is chemotherapy? Chemotherapy is a cancer treatment that uses drugs to kill cancer cells. This is the most common treatment for most types of leukemia. Chemotherapy may be taken by mouth in pill form, by injection directly into a vein, or through a catheter. If leukemia cells are found in the fluid around the brain or spinal cord, the doctor may inject drugs directly into the fluid to ensure that the drugs reach the leukemia cells in the brain. 15. What is biological therapy? Biological therapy is a treatment that uses a person's own immune system to fight leukemia. This therapy uses special substances to stimulate the immune system's ability to fight cancer. Some patients with chronic lymphocytic leukemia receive monoclonal antibodies, which are man-made proteins that can identify leukemia cells and help the body kill them. Interferon is used to treat some people with chronic myeloid leukemia. It is a natural substance that can slow the growth of leukemia cells. The newest therapies target an enzyme responsible for the growth of the myeloid cells, and are very effective in many patients.
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16. What is radiation therapy? Radiation therapy is a cancer treatment that uses high-energy x-rays to destroy cancer cells. Some patients received radiation treatment that is directed at the whole body. Total-body irradiation usually is given before a bone marrow transplant. 17. What is stem cell transplantation? In stem cell transplantation, high doses of chemotherapy and total body irradiation are used to kill leukemia cells. Since normal cells in the bone marrow are also killed, the patient's immune system is very weak. After what is called depletion therapy, healthy stem cells are given to the patient to restore the immune system. 18. What are the different types of stem cell transplantation? There are three different types of stem cell transplantation. Each uses stem cells from different sources. Bone marrow transplantation replaces a patient's bone marrow with leukemia-free stem cells from bone marrow. Peripheral stem cell transplantation uses stem cells that are collected from the bloodstream. Umbilical cord blood transplantation uses stem cells from a newborn baby. 19. What is a clinical trial? Clinical trials are research studies in which new treatments -drugs, diagnostics, procedures, vaccines, and other therapies -are tested in people to see if they are safe, effective, and better than the current standard of care. Clinical trials often compare a new treatment with a standard treatment to determine which one gives better results. People with leukemia who are interested in taking part in a clinical trial should contact their doctor or go to www.clinicaltrials.gov. 20. What new treatments for leukemia are being developed? Researchers are studying various drugs, immunotherapies, stem cell transplantation techniques, and other types of treatments. Because leukemia is a complicated disease, researchers are also studying the effectiveness of using combinations of treatments. Following are a few examples of some areas of current research. Because leukemia is a complex disease, using more than one type of treatment may be beneficial. Combining therapies can complement and enhance the effects of each. For example, patients receiving a stem cell transplant also undergo chemotherapy or radiation to prepare their body for the new stem cells. Also, researchers at the National Cancer Institute are looking at giving drugs to patients before and after the transplant that will stop the patient's immune system from attacking the transplanted cells. The drug imatinib (Gleevec) is important in the treatment of chronic myeloid leukemia. However, imatinib stops working in some people with leukemia
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because the cells become resistant. Fortunately, two drugs, dasatinib (Sprycel) and nilotinib (Tasigna), have been shown to be effective in clinical trials for the treatment of people who stop responding to imatinib. Both are approved by the FDA for use in patients. These drugs work against the same abnormal protein targeted by imatinib, but in different ways. Gene therapy -- replacing, manipulating, or supplementing nonfunctional genes with healthy genes -- is being explored for treatment of leukemia. It is being studied as a way to stimulate a patient's immune system to kill leukemia cells and also to interfere with the production of proteins that cause cells to become cancerous. A modified form of stem cell transplant, called a mini-transplant, has been developed. Compared with standard stem cell transplants, this technique requires less intensive radiation and chemotherapy before a patient is given donor cells. This approach has made stem cell transplants a treatment option for older adults and others who may not be able to tolerate high doses of radiation or chemotherapy. 21. Where can I find more information about research on leukemia? The National Cancer Institute has developed a comprehensive online cancer database called the Physician Data Query, or PDQ, to present evidence from the most recent research on leukemia. Click here to see the PDQ. A window will open. Click the "x" in the upper right hand corner of the "PDQ" window to return here. Topic last reviewed: 06 January 2011 Topic first published: 23 October 2008
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