Leukemia; Causes, Symptoms, Diagnosis, Treatment

Leukemia is a cancer of the blood or bone marrow.It is a form of cancer that affects the body’s ability to make healthy blood cells. It starts in the bone marrow, the soft center of various bones. This is where new blood cells are made .Bone marrow produces blood cells. It usually affects the leukocytes, or white blood cells. Healthy cells form in the bone marrow and mature into red blood cells (to deliver oxygen and nutrients to the body’s tissues), white blood cells (to fight infections) and platelets (to stop bleeding).

The blood is made up of fluid called plasma and three types of cells. Each type has special functions.

• White blood cells (also called WBCs or leukocytes) – help the body fight infections and other diseases.
• Red blood cells (also called RBCs or erythrocytes) – carry oxygen from the lungs to the body’s tissues and take carbon dioxide from the tissues back to the lungs. The red blood cells give blood its color.
• Platelets (also called thrombocytes) – help form blood clots that control bleeding.

Classification/ Types of Leukemia

1. According to the majority/Depending on the type of cells involved there are four types of leukemia

2.  According to the severity / Depending on how fast it progresses there are two types of leukemia

• Acute leukemia –  is characterized by a rapid increase in the number of immature blood cells. The crowding that results from such cells makes the bone marrow unable to produce healthy blood cells. Immediate treatment is required in acute leukemia because of the rapid progression and accumulation of the malignant cells, which then spill over into the bloodstream and spread to other organs of the body. Acute forms of leukemia are the most common forms of leukemia in children.
• Chronic leukemia –  is characterized by the excessive buildup of relatively mature, but still abnormal, white blood cells. Typically taking months or years to progress, the cells are produced at a much higher rate than normal, resulting in many abnormal white blood cells. Whereas acute leukemia must be treated immediately, chronic forms are sometimes monitored for some time before treatment to ensure maximum effectiveness of therapy. Chronic leukemia mostly occurs in older people, but can occur in any age group.

3. According to the tumor conditions

• In lymphoblastic or lymphocytic leukemias – the cancerous change takes place in a type of marrow cell that normally goes on to form lymphocytes, which are infection-fighting immune system cells. Most lymphocytic leukemias involve a specific subtype of lymphocyte, the B cell.
• In myeloid or myelogenous leukemias – the cancerous change takes place in a type of marrow cell that normally goes on to form red blood cells, some other types of white cells, and platelets.

Combining these two classifications provides a total of four main categories. Within each of these main categories, there are typically several subcategories. Finally, some rarer types are usually considered to be outside of this classification scheme.

4. According to the  condition of tumor

• Acute lymphoblastic leukemia (ALL) – is the most common type of leukemia in young children. It also affects adults, especially those 65 and older. Standard treatments involve chemotherapy and radiotherapy. The survival rates vary by age: 85% in children and 50% in adults.Subtypes include precursor B acute lymphoblastic leukemia, precursor T acute lymphoblastic leukemia, Burkitt’s leukemia, and acute biphenotypic leukemia.
• Chronic lymphocytic leukemia (CLL) –  most often affects adults over the age of 55. It sometimes occurs in younger adults, but it almost never affects children. Two-thirds of affected people are men. The five-year survival rate is 75%. It is incurable, but there are many effective treatments. One subtype is B-cell prolymphocytic leukemia, a more aggressive disease.
• Acute myelogenous leukemia (AML) –  occurs more commonly in adults than in children, and more commonly in men than women. It is treated with chemotherapy. The five-year survival rate is 40%, except for APL (Acute Promyelocytic Leukemia), which has a survival rate greater than 90%. Subtypes of AML include acute promyelocytic leukemia, acute myeloblastic leukemia, and acute megakaryoblastic leukemia.
• Chronic myelogenous leukemia (CML) – occurs mainly in adults; a very small number of children also develop this disease. It is treated with imatinib (Gleevec in United States, Glivec in Europe) or other drugs. The five-year survival rate is 90%.One subtype is chronic myelomonocytic leukemia.
• Hairy cell leukemia (HCL) –  is sometimes considered a subset of chronic lymphocytic leukemia, but does not fit neatly into this category. About 80% of affected people are adult men. No cases in children have been reported. HCL is incurable but easily treatable. Survival is 96% to 100% at ten years.
• T-cell prolymphocytic leukemia (T-PLL) – is a very rare and aggressive leukemia affecting adults; somewhat more men than women are diagnosed with this disease.Despite its overall rarity, it is the most common type of mature T cell leukemia;nearly all other leukemias involve B cells. It is difficult to treat, and the median survival is measured in months.
• Large granular lymphocytic leukemia – may involve either T-cells or NK cells; like hairy cell leukemia, which involves solely B cells, it is a rare and indolent (not aggressive) leukemia.
• Adult T-cell leukemia is caused by human T-lymphotropic virus (HTLV) – a virus similar to HIV. Like HIV, HTLV infects CD4+ T-cells and replicates within them; however, unlike HIV, it does not destroy them. Instead, HTLV “immortalizes” the infected T-cells, giving them the ability to proliferate abnormally. Human T-cell lymphotropic virus types I and II (HTLV-I/II) are endemic in certain areas of the world.
• Clonal eosinophilias (or clonal hypereosinophilia)s – are a group of hematological disorders characterized by the development and growth of a pre-malignant or malignant population of eosinophils in the bone marrow, blood, and/or other tissues. These disorders may evolve into chronic eosinophilic leukemia or may be associated with various forms of myeloid neoplasms, lymphoid neoplasms, myelofibrosis, or the myelodysplastic syndrome
• Juvenile myelomonocytic leukemia (JMML)  – is a type of myeloid leukemia that usually occurs in children under 6 years of age.
• Large granular lymphocytic leukemia (LGL leukemia) – is a type of chronic leukemia that develops from lymphoid cells. It can be slow- or fast-growing.

Causes of Leukemia

Genetics condition – Certain rare, inherited conditions can increase the risk of acute leukaemia, including:

The following are either known or suspected factors:

• artificial ionizing radiation
• viruses, such as the human T-lymphotropic virus (HTLV-1) and HIV
• benzene and some petrochemicals
• alkylating chemotherapy agents used in previous cancers
• hair dyes
• smoking

Genetic predisposition – Some people appear to have a higher risk of developing leukemia because of a fault in one or several genes.

Down syndrome  – People with Down syndrome appear to have a higher risk, possibly due to certain chromosomal changes.

Very high levels of radiation – People exposed to very high levels of radiation are much more likely than others to develop leukemia. Very high levels of radiation have been caused by atomic bomb explosions (such as those in Japan during World War II) and nuclear power plant accidents (such as the Chernobyl .

Working with certain chemicals  – Exposure to high levels of benzene in the workplace can cause leukemia. Benzene is used widely in the chemical industry. Formaldehyde is also used by the chemical industry. Workers exposed to formaldehyde also may be at greater risk of leukemia.

• Chemotherapy  – Cancer patients treated with certain cancer-fighting drugs sometimes later develop leukemia. For example, drugs known as alkylating agents are associated with the development of leukemia many years later.
• Down syndrome and certain other genetic diseases  – Some diseases caused by abnormal chromosomes may increase the risk of leukemia.
• Human T-cell leukemia virus-I (HTLV-I) – This virus causes a rare type of chronic lymphocytic leukemia known as human T-cell leukemia. However, leukemia does not appear to be contagious.
• Myelodysplastic syndrome — People with this blood disease are at increased risk of developing acute myeloid leukemia.
• As with other cancers – smoking is considered a risk factor for leukemia, but many people who develop leukemia have never smoked, and many people who smoke never develop leukemia.
• Long-term exposure  – to chemicals such as benzene or formaldehyde, typically in the workplace, is considered a risk factor for leukemia, but this accounts for relatively few cases of the disease.
• Prolonged exposure – to radiation is a risk factor, although this accounts for relatively few cases of leukemia. Doses of radiation used for diagnostic imaging such as X-rays and CT scans are nowhere near as prolonged or high as the doses needed to cause leukemia.
• Previous chemotherapy – Certain types of chemotherapy, particularly certain of the alkylating agents and topoisomerase inhibitors, used to treat various types of cancers, are linked to development of leukemia later. It is likely that radiation treatment adds to the risk of leukemia associated with certain chemotherapy drugs.
• Human T-cell leukemia virus 1 (HTLV-1) – Infection with this virus is linked to human T-cell leukemia.
• Myelodysplastic syndromes – This unusual group of blood disorders (formerly referred to as “preleukemia”) is characterized by abnormal blood cell development and a highly increased risk of leukemia.
• Down syndrome and other genetic diseases – Some diseases caused by abnormal chromosomes may increase risk for leukemia.
• Family history – Having a first-degree relative (parent, brother, sister, or child) who has chronic lymphocytic leukemia increases one’s risk of having the disease by as much as four times that of someone who does not have an affected relative.

International Agency for Research on Cancer (IARC) – The IARC is part of the World Health Organization (WHO). Its major goal is to identify causes of cancer. In the past several decades, the IARC has evaluated the cancer-causing potential of more than 900 likely exposures, placing them into one of the following groups:

• Group 1: Carcinogenic to humans
• Group 2A: Probably carcinogenic to humans
• Group 2B: Possibly carcinogenic to humans
• Group 3: Unclassifiable as to carcinogenicity in humans
• Group 4: Probably not carcinogenic to humans

Perhaps not surprisingly, based on how hard it can be to test possible carcinogens, most are listed as being of probable, possible, or unknown risk. Only a little over 100 are classified as “carcinogenic to humans.”

National Toxicology Program (NTP) – The NTP is formed from parts of several US government agencies, including the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Food and Drug Administration (FDA). The NTP updates its Report on Carcinogens (RoC) every few years.

The Report on Carcinogens identifies 2 groups of agents:

• Known to be human carcinogens
• Reasonably anticipated to be human carcinogens

The current version of the RoC lists about 240 substances and exposures. Unlike the IARC’s list, the RoC does not list substances that have been studied and found not to be carcinogens.

Symptoms of Leukemia

Signs and symptoms of leukemia include the following

• Poor blood clotting – Immature white blood cells crowd out platelets, which are crucial for blood clotting. This can cause a person to bruise or bleed easily and heal slowly. They may also develop petechiae, small red to purple spots on the body, indicating a minor hemorrhage.
• Frequent infections – The white blood cells are crucial for fighting off infection. If these are suppressed or not working properly, frequent infections can result. The immune system may attack other good body cells.
• Anemia – A low red blood cell count. Red blood cells carry oxygen around the body. This condition may contribute to weakness, fatigue or shortness of breath.
• Leukopenia – A low white blood cell count. A decrease in the production of functional leukocytes (white blood cells) weakens the body’s immune defense, which can make you more prone to infections.
• Thrombocytopenia – A low blood platelet count. Platelets are the blood cells responsible for blood clotting. A shortage of bloods platelets may lead to easy bruising or bleeding.
• Swollen lymph nodes – In some cases, the signs of leukemia may include noticeable swelling of the neck, armpit or groin. This occurs when leukemia has spread to the lymph nodes.
• Enlarged liver or spleen – The build-up of abnormal blood cells in the liver or spleen may cause a feeling of fullness (loss of appetite) or swelling in the upper left side of the abdomen.
• Fatigue, pale skin – Anemia (a shortage of red blood cells) may cause a child to feel tired, weak, dizzy, or short of breath. It may also cause the skin to appear pale.
• Bone and Joint Pain — Pain in bones and joints is another common symptom of leukemia. This pain is usually a result of the bone marrow being overcrowded and “full.”
• Abdominal Distress — Abdominal pain also may be a symptom. Leukemia cells can collect in the kidney, liver and spleen, enlarging these organs. Pain in the abdomen may cause a loss of appetite and weight.
• Difficulty Breathing or Dyspnea — With T-cell acute lymphocytic leukemia, leukemia cells tend to clump together around the thymus gland. This mass of cells present in the middle of the chest can cause pain and difficulty breathing. Wheezing, coughing or painful breathing requires immediate medical attention.
• Infections and fever – A child with leukemia may develop fever. This is often caused by an infection, which may not improve even with antibiotics. This is because of a lack of normal white blood cells, which would normally help fight the infection.
• Easy bleeding or bruising – A child with leukemia may bruise easily, have frequent nosebleeds and bleeding gums, or bleed excessively from small cuts. There may be pinhead-sized red spots on the skin caused by bleeding from tiny blood vessels. This comes from a lack of blood platelets, which normally stop bleeding by plugging holes in damaged blood vessels.
• Bone or joint pain – Some children with leukemia will have bone pain or joint pain. This is from the buildup of leukemia cells near the surface of the bone or inside the joint.
• Swelling of the abdomen – Leukemia cells may collect in the liver and spleen, causing them to enlarge. This may be noticed as a fullness or swelling of the belly. The lower ribs usually cover these organs, but when they are enlarged the doctor can often feel them.
• Loss of appetite, weight loss – If the spleen and/or liver become large enough, they may press against other organs like the stomach. This can limit the amount of food that can be eaten, leading to a loss of appetite and weight loss over time.
• Swollen lymph nodes – Some leukemias may spread to lymph nodes. The child, a parent, or a health care professional may notice swollen nodes as lumps under the skin in certain areas of the body (such as on the sides of the neck, in underarm areas, above the collarbone, or in the groin). Lymph nodes inside the chest or abdomen may also swell, but these can only be detected by imaging tests, such as CT or MRI scans.
• Coughing or trouble breathing – The T-cell type of acute lymphocytic leukemia (ALL) often involves the thymus, which is a small organ in the chest behind the breastbone (sternum) and in front of the windpipe (trachea). Enlargement of the thymus or of lymph nodes inside the chest can press on the trachea. This can lead to coughing or trouble breathing.
• Swelling of the face and arms – The superior vena cava (SVC), a large vein that carries blood from the head and arms back to the heart, passes next to the thymus. Growth of the thymus due to excess leukemia cells may press on the SVC, causing the blood to “back up” in the veins. This is known as SVC syndrome. It can cause swelling in the face, neck, arms, and upper chest (sometimes with a bluish-red skin color).
• Headache, seizures, vomiting – Leukemia can spread outside the bone marrow. It may spread to the central nervous system (brain and spinal cord), the testicles, ovaries, kidneys, lungs, heart, intestines, or other organs. Headache, trouble concentrating, weakness, seizures, vomiting, problems with balance, and blurred vision can be symptoms of central nervous system leukemia.
• Rashes, gum problems – In children with acute myelogenous leukemia (AML), leukemia cells may spread to the gums, causing swelling, pain, and bleeding. Spread to the skin can cause small, darkly colored spots that can resemble common rashes. A collection of AML cells under the skin or in other parts of the body is called a chloroma or granulocytic sarcoma.
• Extreme fatigue,   One rare but very serious consequence of AML is extreme tiredness, weakness, and slurring of speech. This can occur when very high numbers of leukemia cells make the blood too “thick” and slow the circulation through small blood vessels of the brain.

Other symptoms 

There may be nausea, fever, chills, night sweats, flu-like symptoms, weight loss, bone pain, and tiredness. If the liver or spleen becomes enlarged the person may feel full and will eat less, resulting in weight loss.

1.  Acute lymphoblastic leukaemia (ALL)

• symptoms resulting from low blood cell counts, including tiredness, weakness, shortness of breath, fever, infections that don’t go away, bruising and bleeding easily
• weight loss
• night sweats
• loss of appetite
• swelling in the abdomen, as a result of buildup of leukaemia cells in the liver and spleen
• enlarged lymph nodes
• pain in the bones or joints
• symptoms resulting from an enlarged thymus (a specialised organ of the immune system, located in the chest), including coughing and trouble breathing, and a serious syndrome caused by the thymus pressing on the superior vena cava (the major vein that carries blood from the upper body back to the heart)

2.  Acute myeloid leukaemia (AML)

• symptoms resulting from low blood cell counts, including tiredness, weakness, feeling cold, headaches, shortness of breath, fever, infections that don’t go away, bruising and bleeding easily
• symptoms similar to stroke that result from clogging of blood vessels with leukaemia cells
• weight loss
• night sweats
• loss of appetite
• problems with bleeding and clotting
• pain in the bones or joints
• swelling in the abdomen, as a result of buildup of leukaemia cells in the liver and spleen
• skin rash, caused by collection of leukaemia cells under the skin
• bleeding gums
• enlarged lymph nodes

3.  Chronic lymphoblastic leukaemia (CLL: note that people with CLL often do not have any symptoms)

• tiredness
• weakness
• fever
• weight loss
• night sweats
• enlarged lymph nodes
• swelling in the abdomen, as a result of buildup of leukaemia cells in the liver and spleen
• symptoms resulting from low blood cell counts, including tiredness, weakness, shortness of breath, infections that don’t go away, bruising and bleeding easily.

4.  Chronic myeloid leukaemia (CML)

• tiredness
• weakness
• fever
• weight loss
• night sweats
• bone pain
• swelling in the abdomen, as a result of buildup of leukaemia cells in the liver and spleen
• symptoms resulting from low blood cell counts, including tiredness, weakness, shortness of breath, infections that don’t go away, bruising and bleeding easily.

Additional symptoms of Leukemia

The following symptoms of leukemia are common to all acute and some chronic types

• Unexplained fevers
• Frequent infections
• Night sweats
• Fatigue (feeling tired or washed out)
• Weight loss
• Easy bleeding or bruising
• Headache
• Confusion
• Balance problems
• Blurred vision
• Painful swellings in the neck, under the arms, or in the groin
• Shortness of breath
• Nausea or vomiting
• Abdominal pain and/or swelling
• Testicular pain and/or swelling
• Pain in the bones or joints
• Weakness or loss of muscle control
• Seizures

Diagnosis of Leukemia

Once you notice symptoms, or as part of a routine examination, your doctor may use the following tests to look for leukemia:

• Physical exam
• Blood tests
  • Complete blood count – This test checks for the number of red blood cells, white blood cells and platelets in your blood sample.
  • Peripheral blood smear – Also known as a blood film, this test smears a thin layer of blood on a glass slide for examination under a microscope.
• Chest X-ray.
• Bone marrow aspiration.
• Cultures — If your child has a fever or other signs of infection, one or more samples of blood, urine or stool, throat secretion or pus may be taken to check for infection. To confirm an infection, any organisms contained in these samples are allowed to grow in a culture for several days. To get a head start at fighting the infection, however, antibiotics may be prescribed before your child’s doctor has the final results of the culture.
• Bone Marrow Biopsy — Cells are removed from the spongy network of tissues inside the bones, called bone marrow, to check for signs of cancer. Depending on the diagnosis, this procedure may be done periodically throughout your child’s treatment to determine if cancerous cells have spread to the bone marrow. Leukemia is the most common type of cancer found in the bone marrow. A bone marrow aspiration and biopsy usually takes 15 to 20 minutes to complete.
• Spinal Tap — A clear fluid called cerebrospinal fluid (CSF) surround the brain and spinal cord. Sometimes a sample of this fluid is removed and examined for cancer cells or signs of infection. Another name for a spinal tap is lumbar (lower spine) puncture or LP. This procedure takes about 15 minutes..
• Bone marrow aspiration and biopsy – A hollow needle is inserted into your hipbone or breastbone to extract a sample of bone marrow, blood and bone tissue. A pathologist then examines the tissue for signs of cancer.
• Imaging tests – Although medical imaging procedures – such as X-ray and magnetic resonance imaging scans – are not typically used to diagnose leukemia, they may be ordered if your doctor suspects that leukemia cells are growing in an organ, such as the spleen or liver.
• Cytogenetic analysis – A test that looks for genetic or chromosomal abnormalities in a blood or bone marrow sample
• Bone Scan, Gallium Scan and MIBG Scan — Evaluation and treatment of a child with cancer may involve specialized nuclear medicine scans of organs, tissues or bones to check for disease or infection. The three most common types of scans are bone scans, gallium scans and MIBG scans. MIBG stands for meta-iodobenzylguanidine. Both gallium and MIBG are radioactive substances that enable doctors to detect cancerous cells in the scans.
  A nuclear medicine scan requires the injection of a small amount of a radioactive substance into the blood about two to three hours before a bone scan, 48 to 72 hours before the gallium scan and 24 hours before the MIBG scan. Registration and the injection of the radioactive substance should take no more than 15 minutes.
• Magnetic Resonance Imaging (MRI) – MRI uses magnets, rather than X-rays, to produce detailed images of the body. An MRI machine sends radio waves into the body and then measures the response with a computer. The computer makes an image or picture of the body’s internal organs. MRIs are used for certain types tumors in certain locations of the body because they can produce a better image than X-rays.
• Echocardiogram — Because certain types of chemotherapy can affect heart muscle, tests may be done periodically to detect changes in your child’s heart to help identify problems before they become serious. An echocardiogram is used to record the echoes of sounds sent through the heart. This test shows the size of the four heart chambers, as well as how the heart muscle functions. Your child may need to remove clothing above the waist for this test.
• Ultrasound  – An ultrasound exam or sonogram uses high frequency sound waves to create images of organs in the body. No radiation is used. Sound waves bounce off tissue using the same principles as sonar. The echoes that return to a transducter are used to draw the images on the screen.
• Computerized Tomography (CT or CAT) Scan – CT scans use computers and X-rays to create pictures with more detail than conventional X-rays. X-rays are sent through the body in thin cross sections to create images. These scans often supplement other diagnostic X-rays.
• Immunophenotyping – This test looks for specific markers on the surface of the leukemia cells, and is used to help identify the disease subtype.
• Reverse transcription-polymerase chain reaction (RT-PCR) test – This test uses chemicals to look at structure or function of genes, and can help identify leukemia subtypes.
• Lymph node biopsy – If you have enlarged lymph nodes, your doctor may recommend a biopsy to see if this is related to leukaemia.Tissue will be removed from the affected lymph node and examined under a microscope. You may have a local or general anaesthetic, depending on where the affected node is. You may have the procedure while you’re an outpatient or during a brief stay as an inpatient.
• Lumbar puncture  – Your doctor may recommend a lumbar puncture. This is to check for leukaemic cells in the fluid around the brain and spinal cord.If your doctor suspects that leukemia cells have spread to your brain and spinal cord, a small sample of your cerebrospinal fluid – or CSF – may be extracted from your spine for further evaluation.A fine needle will be put into a space between bones in your lower back. Some fluid will be removed from around your spine. This will be looked at under a microscope.
• Chromosome testing – the genetic changes that occur in leukaemia often involve chromosome changes, which can be seen under a microscope or using laboratory tests
• Investigating “leukemia stem cells” – that allow the disease to relapse and grow following cancer treatment. By better understanding the biology and weaknesses of these cancer stem cells, scientists and clinicians can develop better treatments that produce lasting cures.
• Enhance bone marrow/stem cell transplants – While stem cell transplants can be a lifesaving procedure for leukemia patients, they also carry a risk of graft-versus-host disease (GvHD), in which the newly transplanted stem cells do not recognize the recipient’s body as their own and start producing an immune response against it, leading to chronic and potentially serious complications. To reduce the likelihood of GvHD and to improve transplant outcomes, City of Hope is researching new ways to classify and match stem cell donors and recipients.
• Improving survivorship – City of Hope runs an ongoing long-term, follow-up program for bone marrow transplant recipients, which monitors them for chronic side effects and educates them on improving their quality of life based on their disease and the treatments they have received.

Treatment of Leukemia

The treatment you get depends on the type of leukemia you have, how far it has spread, and how healthy you are. But the main options are

Acute leukemias

Unlike other cancers, the treatment of acute leukemia does not depend on how far the disease has advanced but on the person’s condition.

With ALL, treatment generally occurs in phases. However, not all patients experience all of these phases:

• Phase 1 (induction therapy) uses chemotherapy in the hospital to try to control the disease.
• Phase 2 (consolidation) continues chemotherapy, but on an outpatient basis, to keep the disease in remission. This means that person returns to the hospital for treatment, but does not stay overnight.
• Phase 3 (prophylaxis) uses different chemotherapy drugs to prevent the leukemia from entering the brain and central nervous system. Chemotherapy may be combined with radiation therapy.
• Phase 4 (maintenance) involves regular physical exams and laboratory tests after the leukemia has been treated to be sure that it has not returned.
• Recurrent ALL uses different doses of various chemotherapy drugs to combat the disease if it returns. People may need several years of chemotherapy to keep the leukemia in remission. Some people may receive a bone marrow transplant.

With AML, treatment generally depends on the patient’s age and overall health. It also depends on the patient’s blood cell counts. As with ALL, treatment usually begins with induction therapy in an effort to send the leukemia into remission. When leukemia cells can no longer be seen, consolidation therapy begins. Bone marrow transplantation may also be considered in the treatment plan.

Chronic leukemias

To treat CLL, your doctor must first determine the extent of the cancer. This is called staging. There are five stages of CLL:

• Stage 0. There are too many lymphocytes in the blood. Generally, there are no other symptoms of leukemia.
• Stage I. The lymph nodes are swollen because there are too many lymphocytes in the blood.
• Stage II. The lymph nodes, spleen, and liver are swollen because there are too many lymphocytes.
• Stage III. Anemia has developed because there are too few red blood cells in the blood.
• Stage IV. There are too few platelets in the blood. The lymph nodes, spleen, and liver may be swollen. Anemia may be present.

Treatment of CLL depends on the stage of the disease, as well as on the person’s age and overall health. In stage 0, treatment may not be needed, but the person’s health will be monitored closely. In stage I or II, observation (with close monitoring) or chemotherapy is the usual treatment. In Stage III or IV, intensive chemotherapy with one or more drugs is the standard treatment. Some people may need a bone marrow transplant.

Drug therapy 

Drug therapy may be given to patients to fight leukemia cells throughout the body by killing them or stopping their growth and spread. These drugs include

• Chemotherapy, which targets rapidly dividing cells, including leukemia cells
• Targeted therapy, which selectively identifies and attacks leukemia based on specific markers expressed by the cancerous cells
• Immunotherapy, which stimulates the patient’s own immune system to attack leukemia cells
• Radiation
• Biologic therapy
• Targeted therapy
• Stem cell transplant

Chemotherapy – uses drugs to kill cancer cells in your blood and bone marrow. You can get the medicine:

• Through an injection into a vein or muscle
• As a pill
• Into the fluid around your spinal cord

Radiation Therapy – uses high-energy X-rays to kill leukemia cells or keep them from growing. You can get it in only one part of your body where there are a lot of cancer cells, or all over.Radiation therapy uses focused, high-energy X-rays or other forms of radiation to kill cancer cells.

For leukemia, radiation is typically used in the following manner:

• To treat leukemia cells that have accumulated in specific areas of the body, such as the brain or the spleen
• Before a stem cell transplant to help kill leukemia cells throughout the bone marrow and body
• To treat symptoms caused by leukemia, such as bone pain

Chemotherapy – These are cell-killing drugs which kill and/or stop them from dividing. Chemotherapy is often given in blocks or ‘cycles’ of treatment. One cycle of treatment will consist of a series of doses of chemotherapy followed by a break for the healthy cells to recover.

Targeted therapy – uses drugs that target specific vulnerabilities within leukaemia cells to inhibit their growth. For example, the drug imatinib blocks the action of a specific enzyme that is required for the growth of leukaemia cells in people with chronic myeloid leukaemia.

Stem cell transplantation – a procedure in which diseased bone marrow is replaced with healthy bone marrow. Prior to a stem cell transplantation, high doses of chemotherapy or radiation therapy are given to destroy diseased bone marrow. An infusion of blood-forming stem cells that help to rebuild bone marrow is then given. Transplants may be the patient’s own stem cells (autologous transplant) or stem cells from another person (allogeneic transplant).

Biologic therapy – also called immunotherapy, helps your immune system find and attack cancer cells. Drugs like interleukins and interferon can help boost your body’s natural defenses against leukemia.

Targeted therapy  – uses drugs to block specific genes or proteins that cancer cells need to grow. This treatment can stop the signals leukemia cells use to grow and divide, cut off their blood supply, or kill them directly.

Stem cell transplant – replaces the leukemia cells in your bone marrow with new ones that make blood. Your doctor can get the new stem cells from your own body or from a donor. First you’ll have high doses of chemotherapy to destroy the cancer cells in your bone marrow. Then you’ll get the new stem cells through an infusion into one of your veins. They will grow into new, healthy blood cells.

CAR-T cell therapy – Immune system cells called T cells guard against disease; they can detect invaders such as bacteria and viruses and destroy them. City of Hope scientists are currently investigating to see how these cells can be reprogrammed to recognize and attack leukemia, as well.

Enhanced subtype profiling – While leukemia is typically classified as one of four major groups, it is actually a collection of over a hundred abnormalities that lead to uncontrolled cell growth. Our researchers are actively studying these subtypes and whether they have specific genetic or molecular targets to focus therapy on.

New therapies for relapsed/refractory disease – for patients who have undergone and failed standard treatments. These clinical trials may include novel agents developed at City of Hope, or new combinations or regimens of already-approved therapies that may be more effective.

Developing more tolerable regimens – for patients who cannot withstand standard treatments, such as older patients and those with comorbid conditions.

Bone Marrow Transplant – The first step of bone marrow transplant (BMT) involves high doses of chemotherapy, sometimes with radiation, to destroy all of your child’s bone marrow. Healthy marrow from a donor, whose tissue is the same as or almost the same as your child’s, is transplanted into your child. The donor may be a twin, who is the best match; a brother or sister; or other person not related. The healthy marrow from a donor is given to your child intravenously through a needle in a vein to replace the marrow that was destroyed. This process, involving marrow from a donor, is called an allogeneic bone marrow transplant.

Biological Therapy – Biological therapy attempts to stimulate or restore the ability of your child’s immune system to fight cancer. It uses substances produced by your child’s body, or made in a laboratory, to boost, direct or restore the natural defenses against disease. Biological therapy is sometimes called biological response modifier therapy or immunotherapy.

Exercise – A groundbreaking study shows that exercising can be very beneficial to patients suffering from leukemia. However, please consult your doctor for his approval before deciding on an exercise regimen. Weight training, swimming, jogging and walking are excellent forms of exercises for leukemia patients. While training with weights, it is imperative that you use very light weights, to prevent fatigue and injury.

Specialists and other health professionals who care for people with leukaemia include:

• haematologists and medical oncologists, who diagnose and treat people with blood diseases and usually give medication for leukaemia
• surgeons, who specialise in biopsies and other surgical procedures
• dietitians, who will recommend the best diets to follow while you’re in treatment and recovery
• nurses and general practitioners, who will help you through all stages of your cancer
• social workers, psychologists, counsellors, physiotherapists and occupational therapists, who will advise you on support services and help you to get back to normal activities
• a palliative care team to help with symptom management and emotional support for you and your family if your cancer can’t be cured.
• Acupuncture to relieve pain.
• Meditation or yoga to relieve stress.
• Massage and biofeedback to reduce pain and ease tension.
• Breathing exercises for relaxation.

Prevention of Leukemia

We can help with all of the following concerns, and more

• Managing symptoms and side effects, such as pain, nausea and fatigue
• Recovering after stem cell transplantation
• Handling emotional, social and spiritual issues in group or one-on-one settings
• Coping with the stress of diagnosis, treatment and recovery
• Addressing fertility and family planning issues
• Navigating the health care system, including related legal and financial issues
• Maintaining a healthy lifestyle with expert nutrition and physical activity guidance
• Building caregiver skills
• Improving communication with family, partners and loved ones
• Restoring normalcy in your family, job or school routine
• Restoring your body and mind through healing arts workshops
• Connecting with and learning from other patients and survivors
• Returning to wellness after active treatment

References

People Also Reading

Chronic Lymphocytic Leukemia – Symptoms, Treatment Acute Lymphocytic Leukemia – Symptoms, Treatment B-cell Prolymphocytic Leukemia – Causes, Test, Treatment Acute Granulocytic Leukemia – Causes, Symptoms, Treatment Hairy Cell Leukemia – Causes, Symptoms, Treatment Acute Basophilic Leukemia – Causes, Symptoms, Treatment Acute Non-Lymphocytic Leukemia – Symptoms, Treatment Acute Myelogenous Leukemia – Causes, Symptoms, Treatment Acute Myelocytic Leukemia – Causes, Symptoms, Treatment Acute Myeloid Leukemia – Causes, Symptoms, Treatment Acute Promyelocytic Leukemia – Symptoms, Treatment Acute Monoblastic Leukemia – Causes, Symptoms, Treatment