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Leukemia is cancer of the blood cells. It starts in the bone marrow, the soft tissue inside most bones. Bone marrow is where blood cells are made.
When you have leukemia, the bone marrow starts to make a lot of abnormal white blood cells, called leukemia cells. They don't do the work of normal white blood cells. They grow faster than normal cells, and they don't stop growing when they should.
Over time, leukemia cells can crowd out the normal blood cells. This can lead to serious problems such as anemia, bleeding, and infections. Leukemia cells can also spread to the lymph nodes or other organs and cause swelling or pain.
There are several different types of leukemia. In general, leukemia is grouped by how fast it gets worse and what kind of white blood cell it affects.
The four main types of leukemia are:
There are less common leukemias, such as hairy cell leukemia. There are also subtypes of leukemia, such as acute promyelocytic leukemia (a subtype of AML).
Experts don't know what causes leukemia. Some things may increase your risk, such as being exposed to large amounts of radiation and being exposed to certain chemicals at work, such as benzene.
Symptoms may depend on what type of leukemia you have, but common symptoms include:
To find out if you have leukemia, a doctor will:
If your blood tests aren't normal, the doctor may want to do a bone marrow biopsy. This test lets the doctor look at cells from inside your bone. This can give key information about what type of leukemia it is so you can get the right treatment.
What type of treatment you need will depend on many things, including what kind of leukemia you have, how far along it is, and your age and overall health.
Treatments for leukemia include:
Experts don't know what causes leukemia. But some things can increase the risk of some kinds of leukemia. To learn more, see What Increases Your Risk.
Symptoms of acute leukemia depend on how much the cancer has grown. They may include:
The chronic forms of leukemia often cause no symptoms until much later in the disease. And when symptoms appear, they usually appear gradually.
Your bone marrow is where stem cells grow. These stem cells become white blood cells, red blood cells, and platelets.
In most cases of leukemia, there are too many abnormal white blood cells. These leukemia cells crowd out the normal blood cells in your bone marrow and build up in your lymph nodes, liver, and spleen.
When the leukemia cells crowd out your normal cells, your blood can't do its job. You may bleed or bruise easily, have more infections, and feel very tired.
Leukemia can go away. People sometimes call this a "cure." But your doctor may use the term "remission" instead of "cure" when talking about the effectiveness of your treatment. Many people who have leukemia are successfully treated, but the term remission is used because cancer can return (recur). It is important to discuss the possibility of recurrence with your doctor.
Some things can increase your chances of getting leukemia. These things are called risk factors. But many people who get leukemia don't have any of these risk factors. And some people who have risk factors don't get this cancer.
Call your doctor to schedule an appointment if you have any symptoms, such as:
is a period when your doctor is checking you regularly but not treating you. It may be a treatment choice if you are an older adult, depending on the stage of the leukemia and your overall health.
Doctors may use watchful waiting for patients with chronic lymphocytic leukemia (CLL) at first because treatment may not be needed. People who have CLL often live for a long time without treatment.
Watchful waiting isn't usually recommended for other types of leukemia.
During watchful waiting, you will:
Health professionals who can evaluate symptoms of leukemia include the following:
The diagnosis of leukemia will be done by a medical oncologist, pediatric oncologist, or hematologist. These specialists also treat leukemia.
If your doctor suspects leukemia, he or she may:
If your blood work points to possible leukemia, your doctor will want to find out what kind you might have. Your treatment plan will depend on the specific kind of leukemia that you have.
These tests can help guide treatment. Sometimes they can help your doctor and you know whether your leukemia is likely to go into remission or come back. In some cases, the tests can predict survival rates.
Your doctor may also order other tests, including:
The 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.
Most treatment plans for acute lymphoblastic leukemia (ALL) have 3 steps. These are induction, consolidation, and maintenance.
When there are no signs of leukemia for 5 years, a person is usually considered cured. But if the leukemia doesn't go into remission, or if it comes back within the first few years, treatments may include more chemotherapy, a stem cell transplant, or joining a clinical trial for new treatments.
Treatment for acute myelogenous leukemia (AML) will be based on the genetic makeup of your abnormal myeloid cells. This plan usually has 2 steps that includes induction of remission and post-remission therapy.
Stem cell transplants and chemotherapy are also used when leukemia doesn't respond to treatment or if AML comes back after you haven't had symptoms for a period of time.
To learn more about treatment of acute leukemia, see Medications and Other Treatment.
Chronic lymphocytic leukemia (CLL) isn't always treated right away.
Treatment choices for CLL include:
When CLL doesn't respond to treatment, or if it comes back after you haven't had symptoms for a period of time, you may be treated with more chemotherapy or a stem cell transplant. Or your doctor may recommend that you join a clinical trial for new treatments.
When you have CLL, your body isn't able to fight infections very well. You and your doctor need to watch for any signs of infections, such as pneumonia or yeast infections. Early treatment of these and other infections will help you live longer. You can sometimes prevent certain infections or keep from getting very sick by getting a flu shot or a pneumonia vaccine. Your doctor also may give you antibiotics to prevent infection while you are being treated for leukemia.
Chronic myelogenous leukemia (CML) is treated right away. The most common choices include:
For newly diagnosed people in the beginning stages of CML (chronic phase), a tyrosine kinase inhibitor may work for many years. If they don't have a relapse, they may never need to have a stem cell transplant. But if they have a relapse, they may need to have a stem cell transplant.
For people who are diagnosed with CML in the later stages (accelerated or blast crisis phase), treatment may involve having chemotherapy or a tyrosine kinase inhibitor before having a stem cell transplant. This can increase the chances of a successful transplant.
Additional information about leukemia is provided by the National Cancer Institute.
Clinical trials play a very important part in the treatment of leukemia. Clinical trials test the latest drugs and other new treatments. They have made it possible for many people who have leukemia to live longer. People who are in clinical trials get all the recommended treatments for their cancer and are closely watched.
Talk to your doctor about whether there is a clinical trial that might be good for you. For more information, see www.cancer.gov/clinical_trials/ or http://clinicaltrials.gov.
Treatments for children who have leukemia aren't the same as treatments for adults who have leukemia. After the leukemia has been treated, children may need to be monitored for treatment side effects that may appear months or years later.
For childhood ALL
Acute lymphoblastic leukemia (ALL)
is the most common leukemia in children. Treatments for ALL in children aren't the same as treatments for adults, and are different for infants, children, and adolescents. Treatments include chemotherapy, radiation therapy, chemotherapy with stem cell transplant, and targeted therapy.
For childhood AML and other myeloid diseases
Acute myelogenous leukemia (AML)
in children is grouped with other myeloid diseases that affect the blood and bone marrow, including chronic myelogenous leukemia. Treatment for each type is different, but include chemotherapy, radiation therapy, stem cell transplant, and targeted therapy.
Additional information about childhood leukemia is provided by the National Cancer Institute.
Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit. You can have this care along with treatment to cure your illness.
Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.
If you're interested in palliative care, talk to your doctor.
For more information, see the topic Palliative Care.
For some people who have advanced cancer, a time comes when treatment to cure the cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But you can still get treatment to make you as comfortable as possible during the time you have left. You and your doctor can decide when you may be ready for hospice care.
For more information, see the topics:
There is no known way to prevent most types of leukemia.
Some types of leukemia may be prevented by avoiding high doses of radiation, exposure to the chemical benzene, smoking and other tobacco use, or certain types of chemotherapy used to treat other types of cancer.
You can do things at home to help manage your side effects. If your doctor has given you instructions or medicines to treat these symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms.
Other problems that can be treated at home include:
Having cancer can be very stressful. It may feel overwhelming to face the challenges in front of you. Finding new ways of coping with the symptoms of stress may improve your overall quality of life.
These ideas may help:
Having cancer can change your life in many ways. For support in managing these changes, see the topic Getting Support When You Have Cancer.
Chemotherapy is the standard treatment for many types of leukemia. Even when a cure isn't possible, chemotherapy may help you live longer and feel better.
Chemotherapy for leukemia is usually a combination of drugs. This is because different drugs attack leukemia cells in different ways. The combination also helps keep the leukemia cells from becoming resistant to any one drug.
Along with the chemotherapy drugs, other medicines may be given to help the chemotherapy drugs work better and prevent infection or bleeding. These drugs include epoetin and hematopoietic stimulants.
Some types of acute leukemia spread to the brain and spinal cord. Regular chemotherapy can't 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.
For acute leukemia
Your treatment plan will include the kind of medicine that works best for the specific type or subtype of leukemia that you have.
For chronic leukemia
Medicines used for treatments for chronic lymphocytic leukemia (CLL) are taken orally (by mouth) or given intravenously for limited periods of time. If there is relapse, medicines are given again.
For chronic myelogenous leukemia (CML), medicine is usually taken by mouth for as long as needed.
Nausea and vomiting are common side effects of chemotherapy. They usually go away when treatment stops. Your doctor will prescribe medicines to help relieve nausea.
In rare cases of chronic lymphocytic leukemia (CLL), the spleen needs to be removed. This happens when the spleen is destroying red blood cells and platelets. The operation is called a splenectomy.
Often a swollen lymph node will be removed to confirm the diagnosis of leukemia. This operation is called a lymphadenectomy.
Surgery is sometimes needed to place a central venous catheter into a large vein in the chest. The catheter is a small tube that is used to give you chemotherapy and other drugs. The tube can also be used to take samples of blood or for giving blood transfusions when needed. It prevents the need for many needle sticks during treatment.
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:
Mind-body treatments like the ones listed above may help you feel better. They can make it easier to cope with cancer treatments. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, it is very important to talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. Complementary therapies aren't meant to take the place of standard medical treatment. But they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.
Other Works Consulted
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National Comprehensive Cancer Network (2012). Non-Hodgkin's lymphomas. NCCN Clinical Practice Guidelines in Oncology, version 3.2012. Available online: http://www.nccn.org/professionals/physician_gls/PDF/nhl.pdf.
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Current as of:
April 29, 2020
Author: Healthwise StaffMedical Review: E. Gregory Thompson MD - Internal MedicineKathleen Romito MD - Family MedicineBrian Leber MDCM, FRCPC - Hematology
Current as of: April 29, 2020
E. Gregory Thompson MD - Internal Medicine & Kathleen Romito MD - Family Medicine & Brian Leber MDCM, FRCPC - Hematology
To learn more about Healthwise, visit Healthwise.org.
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