Leukemia

Leukemia is a cancer of the blood cells and the tissues that create blood cells, such as bone marrow (the central part of the bones).

In a healthy person, blood cells form in the bone marrow as stem cells and later mature into different types of blood cells (red blood cells, white blood cells, or platelets) and move into the bloodstream. In a person with leukemia, the bone marrow makes abnormal blood cells instead of normal blood cells. These abnormal blood cells grow out of control, get into the blood, and travel around the body. Sometimes, these cells collect in certain parts of the body.

When the bone marrow makes abnormal blood cells, it does not make the normal blood cells a person's body needs, causing different symptoms.

There are different types of leukemia. Some types grow very slowly ("chronic leukemias"), while others grow much faster ("acute leukemias"). Sometimes, people have a type of chronic leukemia that is slow-growing at first and later becomes a fast-growing.

Types of leukemia

Acute Leukemia: Develops and worsens rapidly. It can be life-threatening. The bone marrow starts to produce high numbers of immature white blood cells called blasts, which enter the bloodstream. These immature blood cells quickly crowd out the normal blood cells in the bloodstream and do not function properly enough to fight infection and bleeding or prevent anemia in the body, making the body extremely vulnerable.

The two most common types of acute leukemia are:

Acute lymphoblastic leukemia (ALL)
Acute myelogenous leukemia (AML)

Chronic Leukemia: Slow-developing and worsens gradually. Symptoms may take a while to appear. Sometimes chronic leukemia is diagnosed during a routine check-up before symptoms even appear. This is because the leukemia cells are usually developed enough to function like normal white blood cells at first, before they start to gradually worsen.

Types of chronic leukemia:

Chronic Myelogenous Leukemia (CML)
Chronic Lymphocytic Leukemia (CLL)

Another type of leukemia is hairy cell leukemia (HCL). Hairy cell leukemia is a rare form of blood cancer that gets its name from its appearance under the microscope. Occurring mostly in older adults, this disease affects more men than women. The most common symptoms are weakness and fatigue due to anemia.

Factors that may increase the risk of developing leukemia

Exposure to high levels of radiation
Smoking
Exposure to benzene (used in the chemical industry and cigarette smoke)
Certain chemotherapy drugs, including etoposide and drugs known as alkylating agents
People with myelodysplastic syndrome and certain other blood disorders

Symptoms of leukemia

Feeling weak and lethargic
Unexplained weight loss
Loss of appetite or feeling very full after only eating a little
Bleeding or bruising easily
Frequent infections
Unexplained fever or night sweats
Swollen lymph glands in the neck or armpit area
Bloating or discomfort in the abdomen
Inflammation and bleeding in the gums

Diagnosis of leukemia

Blood tests such as a complete blood count (CBC), kidney function test, liver function test and uric acid level determination. Also, microscopic examination of a blood smear is necessary to check for malignant cells.
Bone marrow biopsy is commonly used to determine the type of leukemia.
Spinal tap to check for malignant cells in the cerebrospinal fluid (CSF), the fluid that fills the spaces in and around the brain and spinal cord.
Cytogenetic analysis to examine chromosomes of the blood, bone marrow, or lymph node cells to detect significant genetic problems, as people with CML have an abnormal chromosome called the Philadelphia chromosome.
Molecular diagnostics (PCR and FISH tests). PCR tests are able to detect minute traces of cancer cells in the body while FISH tests detect any chromosomal defects in a cell’s DNA.

Treatment of leukemia at KHCC

Doctors can treat leukemia in different ways. Sometimes, it is treated right away. Other times, if the leukemia is slow-growing and not causing symptoms, doctors might watch it closely until treatment is needed.

The right treatment for each person will depend on the type of leukemia they have, their age, and the prevalence of other health problems.

Treatment for leukemia can include one or more of the following:

Chemotherapy – Chemotherapy is the medical term for medicines that kill cancer cells or stop them from growing.
Bone marrow transplant (also called "stem cell transplant") – This treatment replaces cells in the bone marrow that are killed by chemotherapy or radiation by donor cells.

For ALL, treatment typically includes three main phases: induction therapy, consolidation therapy and maintenance therapy. These therapies include the use of chemotherapy, radiation, stem and bone marrow transplantation.

For AML, chemotherapy is often used. Bone marrow or stem cell transplant can be used for others to increase the chance of cure or for relapse or progression. Commonly, patients need support with blood transfusions or platelets and antibiotics in case of infection.

For CML, the goal of treatment is to eliminate blood cells containing the abnormal gene. Since it is a "chronic" disease, treatment will not cure the patient, but they may live a relatively normal life. Patients learn to cope with the side effects of long-term treatment. Treatment may also include bone marrow transplantation, biological therapy and chemotherapy. Transplant is an important modality for young individuals.

For CLL, different types of treatments are used, most commonly chemotherapy, radiation therapy and targeted therapies which attack specific cancer cells without affecting normal cells. In some cases, surgery may be needed to remove an enlarged spleen.

For HCL, because this cancer is slow growing, some patients may not need treatment, though most will. Fortunately, though there is no cure, treatment can put this disease in long term remission. Treatment includes chemotherapy, biological therapy, and in rare cases surgery to remove the spleen.

What happens after treatment?

The patient will be checked every so often to see if the leukemia comes back. Regular follow up tests include talking with your doctor, exams, and blood tests. Sometimes, will also need a bone marrow biopsy

It is important to follow all of your doctor's instructions about visits and tests. It's also important to talk to your doctor about any side effects or problems you have during treatment.

What happens if the leukemia comes back?

If the leukemia comes back, you might have more chemotherapy, radiation, or bone marrow transplantation.