What is Leukemia?

Leukemia is cancer of the blood cells which form in the bone marrow. When cancerous blood cells form, they crowd out healthy blood cells. How quickly cancer cells crowd out healthy blood cells varies with each type of leukemia. The type of blood cell that becomes cancerous identifies the type of leukemia. White blood cells are the most common type of blood cell to become cancerous. But red blood cells and platelets may also become cancerous.

Leukemia symptoms, prognosis and treatment depend on the type. Leukemia can be classified as one of the following:

• Acute lymphoblastic leukemia (ALL): This cancer starts from the early version of white blood cells, called lymphocytes, in the bone marrow. It progresses quickly without treatment.
• Acute myeloid leukemia (AML): In this type of cancer, the bone marrow makes abnormal myeloblasts (a type of white blood cell), red blood cells or platelets. It also progresses quickly without treatment.
• Chronic lymphocytic leukemia (CLL): In this type of cancer, the bone marrow makes too many lymphocytes (a type of white blood cell). It progresses slowly without treatment.
• Chronic myeloid leukemia (CML): In this cancer, a genetic change takes place in an early (immature) version of myeloid cells – cells that make red blood cells, platelets and most types of white blood cells (except lymphocytes). This change forms an abnormal gene, which turns the cell into a CML cell. It typically progresses slowly without treatment.
• Hairy cell leukemia (HCL): This is a rare, slow-growing cancer of the blood in which the bone marrow makes too many B-cells (lymphocytes), a type of white blood cell that fights infection. Progression is typically slow without treatment.
• Chronic myelomonocytic leukemia (CMML): In this type, there are increased numbers of monocytes and immature blood cells in the peripheral blood and bone marrow, as well as abnormal looking cells (dysplasia) in at least one type of blood cell. It can progress to other types, like AML.
• Juvenile myelomonocytic leukemia (JMML): This cancer occurs when too many immature white blood cells, called myelocytes and monocytes, are made in the bone marrow. JMML can also progress to other types, like AML.
• Large granular lymphocytic leukemia (LGL): This chronic leukemia affects white blood cells called lymphocytes, which fight off infection. LGL leukemia is characterized by enlarged lymphocytes containing noticeable granules. There are two types of LGL, and each may be slow-growing or aggressive.
• Blastic plasmacytoid dendritic cell neoplasm (BPDCN): This rare, aggressive cancer is a type of AML with features of both leukemia and lymphoma. It involves the skin.

Baptist Health is known for advanced, superior care for patients with cancer and the diagnosis, treatment and management of leukemia. Our specialist hematologist/oncologist and oncology certified nurses provide advanced cancer care in our facilities, which are accredited by the Commission on Cancer. Plus, our infusion centers make outpatient cancer care as convenient as possible.

You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Types of Leukemia 

Doctors classify different types of leukemia based on rate of progression and the impact on specific white blood cells. The progression differentiates acute and chronic leukemia. The condition affects one of two kinds of abnormal white blood cells: lymphoid cells or myeloid cells.

Additional rare types of leukemia also exist. Some of these types include myelodysplastic syndromes, hairy cell leukemia, and myeloproliferative disorders.

Signs and Symptoms

Leukemia symptoms can be divided into two categories: early and later. Doctors might also refer to later symptoms as “progressive” signs.

Early signs of leukemia:

• Reduced appetite
• Trouble breathing
• Pain in your bones
• Feeling tired
• Bleeding
• Fever
• Night sweats
• Bruising
• Weight loss

Late or progressive leukemia symptoms:

• Prolonged infections
• Recurrent infections
• Shortness of breath
• Fatigue
• Dizziness
• Bruises
• Bleeding gums
• Frequent heavy nosebleeds
• Paler skin
• Feeling weaker
• Severe menstrual bleeding

Diagnosis

A physician may detect leukemia in a routine blood test, before symptoms begin. If someone has signs of leukemia, we perform a physical examination and ask questions about symptoms. We then use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. After conducting a complete blood count, your doctor may also perform additional tests to diagnose leukemia. 

Common diagnostic procedures can include:

Bone marrow test: If leukemia is suspected, a sample of bone marrow may be removed from the hip bone. The marrow is removed with a long, thin needle and tested for leukemia cells.

Spinal Tap: This is also sometimes called a lumbar puncture. Your doctor will insert a needle into your lower back to collect spinal fluid. Your spinal fluid helps the doctor determine if the cancer has extended into your central nervous system.

Imaging Tests: Possible imaging tests might include ultrasounds, X-rays, or computed tomography (CT) scans. These tests reveal any damage to other organs.

Liver Function Test: These tests help determine the health and function of your liver. Liver function tests analyze enzymes, proteins, and bilirubin in your blood. From these tests, doctors may discover liver damage.

Flow Cytometry: This test explores the DNA of cancer cells. Doctors use this test to identify how fast your cancer cells grow, also known as the growth rate.

Additional tests may be needed to confirm the type of leukemia and the extent to which it has spread throughout the body.

Causes

Researchers don’t know the exact causes of leukemia, but believe a combination of genetic and environmental factors can lead to its development. Certain causes include:

• Exposure to high-dose radiation
• Smoking tobacco

Risk Factors

Risk factors that can contribute to leukemia include:

Exposure to certain chemicals: Exposure to substances such as benzene has been linked to some forms of leukemia.

Family history: Disease risk may be greater if family members have been diagnosed.

Genetic disorders: Some genetic disorders, like Down syndrome, are associated with an increased risk of leukemia.

Previous cancer treatment: Leukemia sometimes develops in people who have been treated with chemotherapy and radiation for other types of cancer.

Prevention 

There is no known way to prevent most types of leukemia. Some types can be prevented by avoiding:

• Exposure to benzene: Benzene is a chemical found in many household products, such as cleaning supplies. It is also found in pesticides, glues, plastics, and car exhaust. The best prevention is reading product labels and limiting exposure.

• High doses of radiation: Radon is an odorless gas linked to cancer. Radon is found in some homes. Since it is also colorless, the best way to detect radon is to get your house tested. You can hire an expert or purchase a test at a local hardware store.

• Healthy lifestyle: You can reduce your risk for leukemia by practicing a healthy lifestyle. You can exercise, avoid smoking, eat a healthy diet, read product labels, limit medical radiation, and use protective gloves and face masks when using certain products.

When to see a doctor

For many people, early leukemia symptoms go unrecognized. These early signs can appear similar to common conditions such as the flu.

If you or a loved one experience prolonged or recurring signs of leukemia, we recommend that you schedule an appointment with your doctor. Leukemia is occasionally identified during blood tests for other potential conditions.

Prognosis

Leukemia prognosis does not vary by type of leukemia. However, factors such as age, lifestyle, disease progression, and your body’s reaction to treatment often impact prognosis.

Treatment

Leukemia treatment depends on a person’s age and overall health, the type of leukemia and whether it has spread to other parts of the body. Common treatments include:

Biological Therapy. These treatments help the immune system recognize and attack cancer cells.

Chemotherapy uses special drugs designed to kill cancer cells can be given as a pill or injected into the bloodstream.

Radiation Therapy targets cancer cells with high-energy radiation. Similar to getting an X-ray, the radiation is directed specifically to collections of cancer cells. Sometimes, it’s spread out over the whole body. Most often, radiation treatments are given five days a week for several weeks.

Stem Cell Transplant is a procedure that replaces diseased bone marrow with healthy bone marrow. Before the transplant, a patient receives high doses of chemotherapy or radiation to destroy diseased bone marrow. Then, the patient receives an infusion of blood-forming stem cells to help rebuild the bone marrow – either from a donor or one’s own stem cells.

Targeted Therapy uses drugs to attack specific targets within the cancer cells.

Surgery. The type of leukemia determines the type of surgery. Sometimes surgery means removal of your spleen.

Interferon Therapy. This treatment involves use of a drug that mimics naturally occurring proteins in your immune system. The drug slows or stops the progression of leukemia but sometimes produces serious side effects.

Watchful Waiting. Your doctor may monitor your symptoms for slowly progressing leukemia. This is a non-active treatment option.

Complications

Complications of leukemia stem from the depletion of normal blood cells, as well as side effects of treatment, and may include:

Anemia: This is a condition that develops when the blood lacks enough healthy red blood cells or hemoglobin.

Bleeding: This occurs due to low levels of platelets, which are responsible for clotting.

Frequent infections: These can be caused by low levels of lymphocytes — one type of white blood cell that helps the body fight infection.

Graft-versus-host disease: Occurring after a stem cell or bone marrow transplant, this is when newly transplanted donor cells attack the transplant recipient’s body.

Relapse or progression: Leukemia may return even after remission, spread elsewhere in the body or progress to a different type.

Weight loss: This can occur as a result of the disease itself or because of nausea and loss of appetite caused by chemotherapy or other treatments.