leukemia .futurelab

LEUKEMIA

LEUKEMIA Cancer of blood

ContentsI. IntroductionII. CausesIII. SymptomsIV. TypesV. DiagnosisVI. Treatment

VII. References

What is Leukemia?Leukemia is a type of cancer of the blood or bone marrow characterized by an abnormal increase of immature white blood cells called "blasts". Leukemia is a broad term covering a spectrum of diseases. In turn, it is part of the even broader group of diseases affecting the blood, bone marrow, and lymphoid system, which are all known as hematological neoplasms.

A Wright's stained bone marrow aspirate smear from a patient

with precursor B-cell acute lymphoblastic leukemia.

What is Leukemia?Leukemia is a treatable disease. Most treatments involve chemotherapy, medical radiation therapy, or hormone treatments. The rate of cure depends on the type of leukemia as well as the age of the patient. Children are more likely to be permanently cured than adults. Even when a complete cure is unlikely, most people with a chronic leukemia and many people with an acute leukemia can be successfully treated for years.

Dr. Stephen A. Grupp examining Emma, recipient of CTL019 therapy.

Experts do not know what causes leukemia. They do not know why some people get it and others do not. It is likely that the different types of leukemia have different causes.

Leukemia: Causes

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Causes of LeukemiaNo one knows the exact causes of leukemia. Doctors can seldom explain why one person gets leukemia and another does not. Studies have found the following risk factors for leukemia:

Benzene as a cause of leukemia had documented since 1928. In 1948, the American Petroleum Institute officially

reported a link between this solvent used in many of their industries used and

cases of leukemia in their workers. Their findings concluded that the only safe

level of benzene exposure is no exposure at all.

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.


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 [also called Chornobyl]

accident in 1986).

Very high levels of radiation — People exposed to very high levels of radiation are much more likely than others to develop leukemia. Medical treatment that uses radiation can be another source of high-level exposure. Radiation used for diagnosis, however, exposes people to much lower levels of radiation and is not linked to leukemia.


For patients treated for Hodgkin lymphoma (HL), cumulative doses of

alkylating agent (AA) is associated with the risk of therapy-related acute myeloid leukemia/myelodysplastic syndrome (t-

AML/MDS), according to a study published online Jan. 7 in the Journal of Clinical

Oncology.

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.


SMOKING cigarettes may increase a person's risk of contracting leukemia by 30 percent and cause up to 3,600 cases of adult leukemia a year in the United States. (Published February 3, 1993)

Smoking— Tobacco products are the single, major avoidable cause of cancer. Smoking is also causally associated with cancers of the pancreas, kidney, bladder, stomach, and cervix and with myeloid leukemia.


Down syndrome was linked to leukemia for the first time in a case report published in 1930.

Since then, Down syndrome has been recognized as one of the most important

leukemia-predisposing syndromes and patients with Down syndrome and leukemia have unique

clinical features and significant differences in treatment response and toxicity profiles

compared to patients without Down syndrome.

Down syndrome and certain other genetic diseases — Some diseases caused by abnormal chromosomes may increase the risk of leukemia.

Over 1 million Americans are living with, or are in remission from, leukemia, lymphoma or myeloma.

Leukemia: Symptoms

SymptomsLike all blood cells, leukemia cells travel through the body. Depending on the number of abnormal cells and where these cells collect, patients with leukemia may have a number of leukemia symptoms. Acute leukemia symptoms appear and get worse quickly. Chronic leukemia symptoms may not appear for a long time; when leukemia symptoms do appear, they generally are mild at first and get worse gradually.

Fever, chills, and other flu-like symptoms

Weakness and fatigue Frequent infections Loss of appetite and/or weight Swollen or tender lymph nodes, liver,

or spleen; Easy bleeding or bruising Tiny red spots (called petechiae)

under the skin Swollen or bleeding gums; Sweating, especially at night; and/or Bone or joint pain.

Symptoms In acute leukemia, the abnormal

cells may collect in the brain or spinal cord (also called the central nervous system or CNS). The result may be headaches, vomiting, confusion, loss of muscle control, and seizures. Leukemia cells also can collect in the testicles and cause swelling. Also, some patients develop sores in the eyes or on the skin. Leukemia also can affect the digestive tract, kidneys, lungs, or other parts of the body.

In chronic leukemia, the abnormal blood cells may gradually collect in various parts of the body. Chronic leukemia may affect the skin, central nervous system, digestive tract, kidneys, and testicles.

Leukemia is the 10th most frequently occurring type of cancer in all races or ethnicities.

Leukemia: Types

TypesThere are several types of leukemia. The different types of leukemia are grouped in two ways. One way is by how quickly the disease develops and gets worse. The other way is by the type of blood cell that is affected.

by how quickly the disease develops Chronic Acute

by the type of blood cell that is affected Lymphoid cells Myeloid cells

Types In chronic leukemia, the

leukemia cells come from mature, abnormal cells. The cells thrive for too long and accumulate. The cells grow slowly. It is not unusual in chronic cases for symptoms to take a long time to even appear.

Acute leukemia develop from early cells, called "blasts". Blasts are young cells, that divide frequently. They target immature cells, causing symptoms to appear quickly. In acute leukemia cells, they don't stop dividing like their normal counterparts do.

Types Lymphocytic

leukemia begins from white blood cells called lymphocytes or immature types of lymphocytes. It commonly affects lymph nodes in the body but can invade all body tissues.

Myelogenous leukemia involves the other 3 common types of white blood cells known as granulocytes. They are the neutrophils, eosinophils, or basophils.

About 20 percent of adult acute myeloid leukemia cases are linked to smoking.

Leukemia: Diagnosis

DiagnosisThe diagnosis of leukemia frequently occurs following a routine blood test that results in an abnormal blood cell count. If you have symptoms that suggest leukemia, your doctor will try to find out what's causing the problems. Your doctor may ask about your personal and family medical history.You may have one or more of the following tests:

Blood tests: The lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets. Leukemia causes a very high level of white blood cells. It may also cause low levels of platelets and hemoglobin, which is found inside red blood cells.


Biopsy: Your doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know Your doctor removes some bone marrow from your hipbone or another large bone. A pathologist uses a microscope to check the tissue for leukemia cells. There are two ways your doctor can obtain bone marrow. Some people will have both procedures during the same visit:


Biopsy Bone marrow

aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow.

Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.

Diagnosis The tests that your doctor

orders for you depend on your symptoms and type of leukemia. You may have other tests:

Cytogenetics: The lab looks at the chromosomes of cells from samples of blood, bone marrow, or lymph nodes. If abnormal chromosomes are found, the test can show what type of leukemia you have. For example, people with CML have an abnormal chromosome called the Philadelphia chromosome.

Chest x-ray: An x-ray can show swollen lymph nodes or other signs of disease in your chest.

Diagnosis The tests that your doctor

orders for you depend on your symptoms and type of leukemia. You may have other tests:

Spinal tap: Your doctor may remove some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). The doctor uses a long, thin needle to remove fluid from the lower spine. The procedure takes about 30 minutes and is performed with local anesthesia. You must lie flat for several hours afterward to keep from getting a headache. The lab checks the fluid for leukemia cells or other signs of problems.

Hispanic children of all races under the age of 20 years have the highest rate of leukemia.

Leukemia: Treatment

TreatmentThe goal of treatment for leukemia is to destroy the leukemia cells and allow normal cells to form in your bone marrow. Treatment decisions are based on the kind of leukemia you have, its stage, and your age and general health. Many times, leukemia is treated with one or more types of treatment. Treatment for Acute

Leukemia

Chemotherapy - Chemotherapy is the use of drugs that either kill cancer cells or preventing the cells from dividing. Chemotherapy can be given in a variety of ways, with IV infusion and pill being more common. The type of chemotherapy given depends on the stage and type of lung cancer.


Leukemia

Some types of acute leukemia spread to the brain and spinal cord. Regular chemotherapy cannot reach those areas, because your body puts up a special barrier to protect them. A different way of giving chemotherapy, called intrathecal chemotherapy, treats these areas by injecting the drugs directly into your spinal canal to attack any leukemia cells there.


Leukemia

Radiation Therapy - Radiation therapy uses high doses of radiation, such as X-rays, to destroy cancer cells. Radiation is usually given from a machine outside the body that directs radiation to the cancer (external radiation). Radiation is also used to treat acute leukemia that has spread to the brain and spinal cord.


Leukemia

Stem cell transplant may be part of the treatment plan for people who have high-risk acute leukemia. Most stem cell transplants for leukemia are allogeneic, meaning the stem cells are donated by someone else. The goal of a transplant is to destroy all the cells in your bone marrow, including the leukemia cells, and replace them with new, normal cells.

TreatmentSometimes leukemia gets worse in spite of treatments. Sometimes it gets better, or "goes into remission." Sometimes it comes back, or "relapses." Even when that happens, there are several treatments that may help to cure the leukemia or help you live longer: Treatment if Acute

Leukemia gets Worse

Stem cell transplant . Donated cells from a "matched" donor can rebuild your supply of normal blood cells and your immune system.

Chemotherapy. Sometimes medicines or doses that are different from those used during your initial chemotherapy can help.

TreatmentChronic lymphocytic leukemia is not always treated right away. It usually gets worse more slowly than acute leukemia. Treatment of Chronic

Leukemia Chronic Lymphocytic

Leukemia

Watchful waiting - CLL usually gets worse very slowly, and you may have no symptoms for some time. You and your doctor may decide to hold off on treatment for a while. During this time your doctor will watch you carefully.

Radiation therapy - Radiation may be used to destroy cancer cells. It also may be used to shrink swollen lymph nodes or a swollen spleen. Sometimes radiation is used on the whole body to prepare for a bone marrow transplant.


Leukemia Chronic Lymphocytic

Leukemia

Chemotherapy - Chemotherapy is the use of medicines that attack cancer cells. Many medicines are available to fight leukemia and help you live longer.

Surgery - If the spleen starts destroying red blood cells and platelets, it may need to be removed. This operation is called a splenectomy.

Targeted therapy with a monoclonal antibody. These antibodies can kill cancer cells, stop their growth, or keep them from spreading.


Leukemia Chronic Myelogenous

Leukemia

Targeted therapy with a tyrosine kinase inhibitor, such as imatinib or dasatinib, is the first treatment used for CML.

Chemotherapy - Chemotherapy is the use of medicines that attack cancer cells. Many medicines are available to fight leukemia and help you live longer.

Biological therapy - This is the use of special medicines that improve your body's natural defenses against cancer.


Leukemia Chronic Myelogenous

Leukemia

High-dose chemotherapy with stem cell transplant - After chemotherapy is completed, stem cells that were previously donated and frozen are thawed and infused.

Donor lymphocyte infusion (DLI) - This is a treatment that may be used after a stem cell transplant. With DLI, a person is given more of their donor's white blood cells (lymphocytes).

Surgery - If the spleen starts destroying red blood cells and platelets, it may need to be removed. This operation is called a splenectomy.

Overview: http://www.cancer.ca/Canada-wide/About cancer/Types of cancer/Treatment for leukemia.aspx

http://www.cancer.ca/Canada-wide/About%20cancer/Types%20of%20cancer/Treatment%20for%20leukemia.aspx




The incidence of leukemia is highest among whites, and lowest among American Indians, and the Asian and Pacific Islander population.

Leukemia: References

References “New leukemia therapy destroys cancer by turning blood cells into assassins“, Ryan Jaslow,

CBS News http://www.cbsnews.com/8301-504763_162-20091135-10391704.html “Mechanism behind acute leukemia identified by VUMC researchers”, Mary Beth Gardner,

Vanderbilt University Medical Center http://www.mc.vanderbilt.edu/reporter/index.html?ID=2190

“Understanding Leukemia - Diagnosis and Treatment, WebMD http://www.webmd.com/cancer/understanding-leukemia-treatment

“Leukemia: Causes and Risk Factors”, CancerCompass http://www.cancercompass.com/leukemia-information/causes-and-risk-factors.htm

Ontario Task Force on the Primary Prevention of Cancer.: Recommendations for the Primary Prevention of Cancer. Toronto, Canada: Queen's Printer for Ontario, 1995.

“Cigarette Smoking: Health Risks and How to Quit”, National Cancer Institute http://www.cancer.gov/cancertopics/pdq/prevention/control-of-tobacco-use/HealthProfessional/page2

Leukemia - Treatment Overview, WebMD http://www.webmd.com/cancer/tc/leukemia-treatment-overview

http://www.cbsnews.com/8301-504763_162-20091135-10391704.html

http://www.mc.vanderbilt.edu/reporter/index.html?ID=2190

http://www.webmd.com/cancer/understanding-leukemia-treatment

http://www.webmd.com/cancer/understanding-leukemia-treatment

http://www.cancercompass.com/leukemia-information/causes-and-risk-factors.htm



http://www.cancer.gov/cancertopics/pdq/prevention/control-of-tobacco-use/HealthProfessional/page2



http://www.webmd.com/cancer/tc/leukemia-treatment-overview

http://www.webmd.com/cancer/tc/leukemia-treatment-overview

Healthcare

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