Leukemia

Leukemia is cancer of the white blood cells. These cells normally help your body fight infection. Most blood cells form in the bone marrow. In leukemia, cancerous blood cells form and crowd out the healthy blood cells in the bone marrow, making it hard for blood to do its work.

The type of leukemia depends on the type of blood cell that has become cancerous. Common types of leukemia include:

• acute lymphocytic leukemia
• acute myeloid leukemia
• chronic lymphocytic leukemia
• chronic myeloid leukemia

Lymphocytic leukemias are cancers of the lymphoblasts and myeloid leukemias are cancers of the granulocytes. Lymphoblasts and granulocytes are both types of white blood cells that fight infection as part of your natural immune system.

Leukemia is either acute or chronic. Acute leukemia is a fast-growing cancer that usually gets worse quickly. Chronic leukemia is a slower-growing cancer that gets worse slowly over time.

Leukemia occurs most often in adults older than 55 years, and it is the most common cancer in children younger than 15 years. Adults can get either acute or chronic leukemia; children with leukemia most often have an acute type.

The treatment and prognosis for leukemia depend on the type of blood cell affected and whether the leukemia is acute or chronic. Some leukemias can be cured. Other types are hard to cure, but you can often control them. Chemotherapy is often used to treat leukemia. Radiation therapy and stem cell transplantation may also be used.

Leukemia symptoms vary, depending on the type of leukemia. Common leukemia signs and symptoms include:

• fever or chills
• persistent fatigue, weakness
• frequent or severe infections
• losing weight without trying
• swollen lymph nodes, enlarged liver or spleen
• easy bleeding or bruising
• recurrent nosebleeds
• tiny red spots in your skin
• excessive sweating, especially at night
• bone pain or tenderness

It is not clear what causes leukemia. In general, cancer occurs when your blood cells develop errors (mutations) in their DNA. The errors make cells grow and divide out of control. The accumulating abnormal cells crowd out healthy cells and prevent the blood from working the way it is supposed to work.

Risk factors for developing leukemia include:

• previous cancer treatment. Certain types of chemotherapy and radiation therapy for other cancers can increase your risk of developing certain types of leukemia.
• genetic disorders. Genetic abnormalities may play a role in the development of leukemia. Certain genetic disorders, such as Down syndrome, are also associated with an increased risk of leukemia.
• exposure to certain chemicals. Exposure to certain chemicals, such as benzene — which is found in gasoline and is used by the chemical industry — is also linked to an increased risk of some kinds of leukemia.
• smoking. Smoking cigarettes increases the risk of acute myelogenous leukemia.
• family history of leukemia. If members of your family have been diagnosed with leukemia, your risk for the disease may be increased.

If you have signs or symptoms that suggest leukemia, you may undergo the following diagnostic exams.

• Physical exam. Your doctor will look for physical signs of leukemia, such as pale skin from anemia, swelling of your lymph nodes, and enlargement of your liver and spleen.
• Blood tests. By looking at a sample of your blood, your doctor can determine if you have abnormal levels of white blood cells or platelets, which may suggest leukemia.
• Bone marrow test. Your doctor may recommend a procedure to remove a sample of bone marrow from your hipbone.

If you have or have had leukemia, you can take steps to manage the stress that accompanies the diagnosis.

• Learn about leukemia so you can make informed decisions about your care.
• Have a schedule of follow-up tests and go to each appointment.
• Take care of yourself so that you are ready to fight cancer. This includes eating a healthy that includes plenty of fruits, vegetables and whole grains, exercising for at least 30 minutes most days of the week, and getting enough sleep so that you wake feeling rested.
• Accept help and support from family and friends and talk with a counselor, social worker, or clergy member.

Treatment for your leukemia depends on your age and overall health, the type of leukemia you have, and whether it has spread to other parts of your body.

Common treatments used to fight leukemia include:

Chemotherapy. Chemotherapy is the major form of treatment for leukemia. This drug treatment uses chemicals to kill leukemia cells. Depending on the type of leukemia you have, you may receive a single drug or a combination of drugs. These drugs may come in a pill form, or they may be injected directly into a vein. Chemotherapy agents approved for leukemia include:

• Bendamustine Hydrochloride (Treanda)
• Busulfan (Busulfex, Myleran)
• Chlorambucil (Ambochlorin, Amboclorin, Leukeran, Linfolizin)
• Clofarabine (Clolar, Clofarex)
• Cyclophosphamide (Clafen, Cytoxan, Neosar)
• Cytarabine (Cytosar-U, Tarabine PFS)
• Daunorubicin Hydrochloride (Cerubidine, Rubidomycin)
• Doxorubicin Hydrochloride
• Fludarabine Phosphate (Fludara)
• Idarubicin Hydrochloride (Idamycin)
• Mechlorethamine Hydrochloride (Mustargen)
• Mercaptopurine (Purinethol, Purixan)
• Methotrexate (Abitrexate, Folex, Folex PFS, Mexate, Mexate-AQ)
• Methotrexate LPF (Methorexate)
• Mitoxantrone Hydrochloride
• Nelarabine (Arranon)
• Pegaspargase (Oncaspar)
• Vincristine Sulfate (Vincasar PFS)
• Vincristine Sulfate Liposome (Marqibo)

Biological or targeted therapy. Biological therapy works by using treatments that help your immune system recognize and attack leukemia cells. Targeted therapy uses drugs that attack specific vulnerabilities within your cancer cells. Biologic and targeted therapies approved for leukemia include:

• Alemtuzumab (Campath)
• Blinatumomab (Blincyto)
• Bosutinib (Bosulif)
• Dasatinib (Sprycel)
• Ibrutinib (Imbruvica)
• Idelalisib (Zydelig)
• Imatinib mesylate (Gleevec)
• Nilotinib (Tasigna)
• Obinutuzumab (Gazyva)
• Ofatumumab (Arzerra)
• Ponatinib Hydrochloride (Iclusig)
• Recombinant Interferon Alfa-2b (Intron A)
• Rituximab (Rituxan)
• Tretinoin (Vesanoid)

Radiation therapy. Radiation therapy uses X-rays or other high-energy beams to damage leukemia cells and stop their growth. You may receive radiation in one specific area of your body where there is a collection of leukemia cells, or you may receive radiation over your whole body. Radiation therapy may be used to prepare for a stem cell transplant.

Stem cell transplant. A stem cell transplant is a procedure to replace your diseased bone marrow with healthy bone marrow. Before a stem cell transplant, you receive high doses of chemotherapy or radiation therapy to destroy your diseased bone marrow. Then you receive an infusion of blood-forming stem cells that help to rebuild your bone marrow. You may receive stem cells from a donor, or in some cases you may be able to use your own stem cells. A stem cell transplant is very similar to a bone marrow transplant.