Leukemia

Preventing Chronic Disease | Living With Chronic Disease

Courtesy The Leukemia and Lymphoma Society

What is it?

“Leukemia” is the general term for four different types of blood cancer called:

Acute lymphocytic (lymphoblastic) leukemia (ALL)
Acute myelogenous (myeloid) leukemia (AML)
Chronic lymphocytic leukemia (CLL)
Chronic myelogenous leukemia (CML)

These four types of leukemia do have one thing in common- they begin in a cell in the bone marrow. The cell undergoes a change and becomes a type of leukemia cell.

The marrow is really two organs in one. The first is the blood cell-forming organ. This is the site where myelogenous leukemia begins. The second is the lymphocyte-forming organ and is a part of the immune system. It is the site where lymphocytic leukemia begins.

The leukemia is called “lymphocytic” or “lymphoblastic” if the cancerous change takes place in a type or marrow cell that forms “lymphocytes”. The leukemia is called “myelogenous” or “myeloid” if the cell change takes place in a type of marrow cell that normally goes on to form red cells, some kinds of white cells, and platelets.

The ways in which patients are affected and how they are treated are different for each type of leukemia. “Acute lymphocytic leukemia” and “acute myelogenous leukemia” are each composed of young cells, known as “lymphoblasts” or “myeloblasts”. These cells are sometimes called “blasts”. Acute leukemias progress rapidly without treatment. “Chronic” leukemias have few or no blast cells. “Chronic lymphocytic leukemia” and “chronic myelogenous leukemia” usually progress slowly compared to acute leukemias.

What causes it?

Doctors do no know the causes of most cases of leukemia. They do know that once the marrow cell undergoes a “leukemic” change, it multiplies into many cells. These leukemia cells grow and survive better than normal cells and, over time, they crowd out normal cells.

Normal stem cells in the marrow form three main cell-types. Red cell carry oxygen to all the tissues of the body, such as the heart, lung and brain; platelets prevent bleeding and form “plugs” that help stop bleeding after an injury; and white cells fight infection in the body. The rate at which leukemia progresses and how the cells replace the normal blood and marrow cells are different with each type of leukemia.

In acute myelogenous leukemia (AML) and acute lymphocytic leukemia (ALL), the original acute leukemia cell goes on to form about a trillion more leukemia cells. These cells are described as “nonfunctional” because they do not work like normal cells. They also crowd out the normal cells in the marrow; in turn, this causes a decrease in the number of new normal cells made in the marrow. This further results in low cell counts (anemia).

In chronic myelogenous leukemia (CML), the leukemia cell that starts the disease makes blood cells (red cells, white cells, and platelets) that function almost like normal cells. The number of red cells is usually less than normal, resulting in anemia. But many white cells and sometimes many platelets are still made. Even though the white cells are nearly normal in how they work, their counts are high and continue to rise. This can cause serious problems if the patient does not get treatment. If untreated, the white cell count can rise so high that blood flow slows down and anemia becomes severe.

In chronic lymphocytic leukemia (CLL), the leukemia cell that starts the disease makes too many lymphocytes that do not function. These cells replace normal cells in the marrow and lymph nodes. They interfere with the work of normal lymphocytes, which weakens the patient’s immune response. The high number of leukemia cells in the marrow may crowd out normal blood-forming cells and lead to a low red cell count (anemia). A very high number of leukemia cells building up in the marrow also can lead to low white cell (neutrophil) and platelet counts.

Unlike the other three types of leukemia, some patients with CLL may have the disease that does not progress for a long time. Some people with CLL have such slight changes that they remain in good health and do not need treatment for long periods of time. Most patients require treatment at the time of diagnosis or soon after.

How does it affect my job?

A patient with one of the four types of leukemia may have to stop working all together or may have to take days off of work to go to medical appointments or to recover from treatments.

Hearing the words, “you have leukemia”, may make a person feel as if life has changed completely in an instant. It may help to know that after diagnosis, many people with leukemia do survive and live many good, quality years. Most people with leukemia are able to cope with what at first may seem too hard to accept. This usually takes time. Knowing more about the disease and its treatment may make it easier to cope. Patients may first want to focus on learning about their type of leukemia and its treatment. They can look ahead to remission and recovery.

Patients should ask their healthcare team for help and guidance, not only for medical concerns, but also for emotional issues related to the disease and its treatment. This includes special needs of children or a family member or friend with leukemia.

Making treatment choices and finding the time and money for medical care are stressful. Contact the Society or ask the healthcare team for guidance and referrals to other sources for help.

Can it be prevented or treated?

People can get leukemia at any age. It is most common in people over age 60. The most common types in adults are AML and CLL. Each year, about 3,500 children develop leukemia. ALL is the most common form of leukemia in children.

The term “risk factor” is used to describe something that may increase the chance that a person will develop leukemia. For most types of leukemia, the risk factors and possible causes are not known. For AML, specific risk factors have been found, but most people with AML do not have these risk factors.

It is important to get medical care at a center where doctors are experienced in treating patients with leukemia. The aim of leukemia treatment is to bring about a “complete remission”. This means that after treatment, there is no sign of the disease and the patient returns to good health. Today, more and more leukemia patients are in complete remission at least five years after treatment.

Patients with an acute leukemia need to start treatment right away. Usually, they begin treatment with chemotherapy in the hospital. The first part of treatment is called “induction therapy”. More inpatient treatment is usually needed even after a patient is in complete remission. This is called “consolidation” or “post induction” therapy. This part of treatment may include chemotherapy with or without stem cell transplantation (sometimes called “bone marrow transplantation”).

Patients with CML need to begin treatment once they are diagnosed. They usually begin treatment with imatinib mesylate (Gleevec). This drug is taken by mouth. Gleevec does not cure CML, but it keeps CML under control for many patients as long as they take it. Other drugs such as dasatinib (Sprycel) are used for certain patients instead of Gleevec.

Allergenic stem cell transplantation is the only treatment that can cure CML at this time. This treatment is most successful in younger patients, but patients up to 60 years of age who have a matched donor may be considered for this treatment. Allogenic transplantation can be a high-risk procedure. Studies are under way to see whether CML patients have better long term outcomes with drug therapy or with transplantation.

Some CLL patients do not need treatment for long periods of time after diagnosis. Patients who need treatment may receive chemotherapy or monoclonal antibody therapy alone or in combination. Allogenic stem cell transplantation is a treatment option for certain patients.

AML, ALL, CML, and CLL patients who are in remission need to see their doctors regularly for exams and blood tests. Bone marrow tests may be needed from time to time. The doctor may recommend longer periods of time between follow-up visits if a patient continues to be disease free.

Patients and caregivers should talk with their healthcare providers about long term and late effects of cancer treatment. Cancer-related fatigue is one common long term effect.

New cancer treatments are under study in clinical trials to help a growing number of patients achieve remission or be cured of their disease. Cancer clinical trials are studies to test new and better ways to: diagnose and treat leukemia and other cancers, prevent or relieve treatment side effects, help prevent a return of disease, and improve comfort and quality of life.

How can I live successfully?

This Information is for educational purposes only; it should not be construed as medical advice. You should not use it for diagnosing or treating a health problem or disease. Consult your physician for detailed information about medical conditions as well as information contained here.