Topic Overview
What is leukemia?
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.
Are there different types of leukemia?
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.
- It may be acute or chronic. Acute leukemia gets worse very fast and may make you
feel sick right away. Chronic leukemia gets worse slowly and may not cause
symptoms for years.
- It may be lymphocytic or
myelogenous. Lymphocytic (or lymphoblastic) leukemia
affects white blood cells called lymphocytes. Myelogenous leukemia affects
white blood cells called myelocytes.
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).
What causes leukemia?
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.
What are the symptoms?
Symptoms may depend on what
type of leukemia you have, but common symptoms include:
- Fever and night sweats.
- Headaches.
- Bruising or bleeding easily.
- Bone or joint pain.
- A swollen or painful belly from an enlarged
spleen.
- Swollen lymph nodes in the armpit, neck, or groin.
- Getting a lot of infections.
- Feeling very tired or weak.
- Losing weight and not feeling hungry.
How is leukemia diagnosed?
To find out if you have
leukemia, a doctor will:
- Ask questions about your past health and symptoms.
- Do a physical exam. The doctor will look for swollen lymph
nodes and check to see if your spleen or liver is enlarged.
- Order blood tests. Leukemia causes a high level of white blood
cells and low levels of other types of blood cells.
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.
How is it treated?
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.
- If you have acute leukemia, you will
need quick treatment to stop the rapid growth of leukemia cells.
- Chronic lymphocytic leukemia may not need to
be treated until you have symptoms. But chronic myelogenous leukemia will
probably be treated right away.
Treatments for leukemia include:
- Chemotherapy. This is the main treatment for most types of leukemia.
- Radiation.
- Stem cell transplant. Stem cells can rebuild
your supply of normal blood cells and boost your immune system.
- Biological therapy. This is the use of special
medicines that improve your body's natural defenses against cancer.
Frequently Asked Questions
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Learning about leukemia:
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Being diagnosed:
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Getting treatment:
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Ongoing concerns:
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Living with leukemia:
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End-of-life issues:
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Cause
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
Symptoms of acute
leukemia depend on how much the cancer has grown. They
may include:
- Fevers and night sweats.
- Frequent or unusual infections.
- Weakness and fatigue.
- Headaches.
- Bruising of the skin and bleeding from the gums or rectum.
- Bone pain.
- Joint pain.
- Swelling in the belly or pain on the left side of the belly or in
the left shoulder from a swollen
spleen.
- Swollen
lymph nodes in the armpit, neck, or groin.
- Decreased appetite and weight loss because you feel full and
don't want to eat.
The chronic forms of leukemia often cause no symptoms until
much later in the disease.
What Happens
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.
Survival rates
Survival rates are different for each kind of leukemia. A 5-year
survival rate is the percentage of people who are still alive 5 years or more
after being diagnosed. These
numbers do not necessarily show what will happen in your case. The following are estimated 5-year
survival rates:1
These numbers come from reports that were done at least 5 years ago, before newer treatments were available. So chances of survival today are likely to be higher than these numbers.
Remission
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.
What Increases Your Risk
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. Risk factors include:
When To Call a Doctor
Call your doctor to schedule an
appointment if you have any symptoms, such as:
- A new lump or swollen gland in your neck, under your arm, or in
your groin.
- Frequent nosebleeds, bleeding from the gums or rectum, more
frequent bruising, or very heavy menstrual bleeding.
- Frequent fevers.
- Night sweats.
- Unexplained appetite loss or recent weight loss.
- Feeling tired a lot without a known reason.
- Swelling and pain on the left side of the belly.
Watchful waiting
Watchful waiting 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. For example, it is estimated
that 1 out of 3 people who have CLL never need treatment.3
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:
- Have regular appointments with your doctor.
- Have regular medical tests, including scans and blood
tests.
- Be told which symptoms to report to your doctor
immediately.
Who to see
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.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Tests to diagnose leukemia
If your doctor suspects
leukemia, he or she may:
- Ask about your medical
history.
- Check for enlarged
lymph nodes in your neck, underarm, or groin.
- Check for an enlarged liver or
spleen.
- Do a complete blood count (CBC) and a blood profile. These tests let your doctor look into symptoms such as
fatigue, weakness, fever, bruising, or weight loss.
- Do a bone marrow aspiration and biopsy. This is the key to
diagnosing most leukemias and helps determine the type.
Finding the type of leukemia
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.
- A blood test is usually enough to find signs of
chronic lymphocytic leukemia (CLL).
- Tests that look closely at unusual cells,
chromosomes, or proteins on cells can show what type
or subtype of leukemia you have. These tests include:
- A test that looks for certain changes in the cell chromosomes from a sample of blood or bone marrow (cytogenetic analysis).
- A test that compares cancer cells to normal blood cells to find the specific kind of leukemia (immunophenotyping).
- A test to look for genes that are "turned on" in several types of leukemia, such as acute promyelocytic leukemia. This test is called a reverse transcription-polymerase chain reaction test, or RT-PCR.
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:
- Chest X-rays, to find out if leukemia or an infection
is the cause of lung problems such as persistent coughing, coughing up blood,
chest pain, or trouble breathing.
- CT scan of the head, chest, and belly, to find out
if leukemia has spread there.
- Lumbar puncture, to find out if leukemia cells
are in your
cerebrospinal fluid (CSF).
- MRI of the brain, to look into symptoms such as
confusion, paralysis, numbness, vision problems, vertigo, or headaches. Those
symptoms could mean that leukemia has spread to the brain.
- A
biopsy of a lymph node or other tissues, to
look for leukemia cells.
Treatment Overview
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.
Treatment for acute leukemia
- Chemotherapy is the usual treatment for acute
leukemia. For most people, that means receiving drugs
in stages:
- Induction kills leukemia cells in the blood and bone marrow to induce remission.
- Consolidation kills any leukemia cells that may be present even though they don't show up in tests. If these cells regrow, they could cause a relapse.
- Maintenance also prevents any remaining leukemia cells from growing. This may be done using lower doses of chemotherapy than those used during induction or consolidation. This is only used in people with ALL and a few rare forms of AML.
- Radiation therapy is usually given from a machine outside the body that directs radiation to the cancer (external radiation).
- 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.
Stem cell transplants and chemotherapy are also used when leukemia 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.
For more information about acute leukemias in adults, see the following topics:
Treatment of chronic leukemia
For CLL
Chronic
lymphocytic leukemia (CLL) isn't always treated right away.
Treatment choices for CLL include:
- 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.
- Chemotherapy.
- Surgery. Your spleen may need to be removed.
- Targeted therapy with a monoclonal antibody. These antibodies can kill cancer cells, stop their growth, or keep them from spreading.
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.
For CML
Chronic
myelogenous leukemia (CML) is treated right away. Treatment choices include:
- Targeted therapy with a tyrosine kinase inhibitor. This is the first treatment used for CML.
- Chemotherapy.
- Biological therapy. This is the use of special medicines that improve your body's natural defenses against cancer.
- High-dose chemotherapy followed by a stem cell transplant.
- Donor lymphocyte infusion (DLI). This is a treatment that may be used after a stem cell transplant. With DLI, you are given more of your donor's white
blood cells (lymphocytes).
- Surgery. Your spleen may need to be removed.
To learn more about treatment for chronic leukemia, see Medications, Surgery, and Other Treatment.
For more information about chronic leukemias in adults, see the following topics:
For information about hairy cell leukemia, see the following topics:
Clinical trials
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 with 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.
Leukemia in children
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.
Supportive care
Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. Palliative care can improve your quality of life by helping you manage your symptoms. It also can help you with other concerns that you may have when you are living with a serious illness.
For some people who have advanced cancer, a time comes when treatment to cure 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 this isn't the end of treatment. You and your doctor can decide when you may be ready for hospice care.
It can be hard to decide when to stop treatment to prolong your life and shift the focus to end-of-life care. For more information, see:
Prevention
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.
Home Treatment
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.
- Home treatment for nausea or vomiting
includes watching for and treating early signs of dehydration, such as a dry
mouth or feeling lightheaded when you stand up. Eating smaller meals may help. A little bit of ginger candy or ginger tea can help too.
- Home treatment for diarrhea includes
resting your stomach and being alert for signs of dehydration. Check with your
doctor before you use any nonprescription medicines for your
diarrhea.
- Home treatment for constipation
includes gentle exercise along with drinking enough fluids and eating a diet that
is high in fruits, vegetables, and fiber. Check with your doctor before you use a
laxative for your constipation.
Other problems that can be treated at home include:
- Sleep problems.
If you have trouble sleeping, going to bed at a regular time and getting exercise daily are some things that can help.
- Feeling very tired. If you lack energy or become weak easily, try to manage your energy and get extra rest.
- Hair loss. Tips include using a mild shampoo and a soft hairbrush.
- Pain. Home treatment can help you manage pain.
Handling the stress of having cancer
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:
- Get the support you need. Spend time with people who care about you, and let them help you.
- Take good care of yourself. Get plenty of rest, and eat nourishing foods.
- Talk about your feelings. Find a support group where you can share your experience.
- Try new ways to relax. And do things each day that help you stay calm and relaxed. Stress reduction techniques may help.
Medications
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.
Medication choices
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.
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 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.
Medicine for nausea and vomiting
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.
Cancer: Controlling Nausea and Vomiting From Chemotherapy
Surgery
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.
Other Treatment
- Radiation therapy may be used to destroy cancer cells and shrink
tumors. Radiation can be applied to one area or to the whole body. Sometimes it
is used to treat leukemia that has spread to the brain and central nervous
system or to prevent this spread. It also may be used to shrink swollen lymph
nodes or to prepare your body for a bone marrow transplant.
- Stem cell transplant may be used to destroy all the cells in your bone
marrow, including the leukemia cells, and replace them with new, normal cells. Most transplants are
allogeneic. This means that the stem cells are donated by
someone else. Transplants can also be autologous. This means that the stem cells come from your own
body.
Complementary therapy
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 Places To Get Help
Organizations
| Leukemia and Lymphoma Society |
| 1311 Mamaroneck Avenue |
| White Plains, NY 10605 |
| Phone: |
1-800-955-4572
(914) 949-5213 |
| Fax: |
(914) 949-6691 |
| Web Address: |
http://www.leukemia.org |
| |
|
The Leukemia and Lymphoma Society is the world's largest voluntary
health organization dedicated to funding blood cancer research, education, and
patient services. The Society's mission is to cure leukemia, lymphoma,
Hodgkin's lymphoma, and myeloma and to improve the quality of life for patients
and their families.
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| American Cancer Society (ACS) |
| Phone: |
1-800-ACS-2345 (1-800-227-2345) |
| TDD: |
1-866-228-4327 toll-free |
| Web Address: |
www.cancer.org |
| |
|
The American Cancer Society (ACS) conducts educational
programs and offers many services to people with cancer and to their families.
Staff at the toll-free numbers have information about services and activities
in local areas and can provide referrals to local ACS divisions.
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| National Cancer Institute (NCI) |
| 6116 Executive Boulevard |
| Suite 300 |
| Bethesda, MD 20892-8322 |
| Phone: |
1-800-4-CANCER (1-800-422-6237) |
| Web Address: |
www.cancer.gov (or
https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help
online) |
| |
|
The National Cancer Institute (NCI) is a U.S. government
agency that provides up-to-date information about the prevention, detection,
and treatment of cancer. NCI also offers supportive care to people who have cancer
and to their families. NCI information is also available to doctors, nurses,
and other health professionals. NCI provides the latest information about
clinical trials. The Cancer Information Service, a service of NCI, has trained
staff members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
|
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References
Citations
- American Cancer Society (2010). Cancer Facts and Figures 2010. Atlanta: American Cancer Society. Available online: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-026238.pdf.
- Liesveld JL, Lichtman MA (2006). Acute myelogenous leukemia. In MA Lichtman et al., eds., Williams Hematology, 7th ed., pp. 1183–1236. New York: McGraw-Hill.
- Johnston JB, et al. (2009). Chronic lymphocytic leukemia. In JP Greer et al., eds., Wintrobe's Clinical Hematology, 12th ed., vol. 2, pp. 2214–2255. Philadelphia: Lippincott Williams and Wilkins.
Other Works Consulted
- Leung LLK (2010). Disseminated intravascular coagulation section of Coagulation disorders. In EG Nabel, ed., ACP Medicine, section 15, chap. 5. Hamilton, ON: BC Decker.
- Levi M, Seligsohn U (2010). Disseminated intravascular coagulation. In K Kaushanksy et al., eds., Williams Hematology, 8th ed., pp. 2101–2120. New York: McGraw-Hill.
- National Cancer Institute (2009). Adult Acute Lymphoblastic Leukemia PDQ: Treatment – Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/adultALL/Patient.
- National Cancer Institute (2009). Adult Acute Myeloid Leukemia PDQ: Treatment – Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/adultAML/patient.
- National Cancer Institute (2009). Childhood Acute Lymphoblastic Leukemia PDQ: Treatment – Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/childALL/Patient.
- National Cancer Institute (2010). Adult Acute Lymphoblastic Leukemia Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/adultALL/healthprofessional.
- National Cancer Institute (2010). Adult Acute Myeloid Leukemia Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/adultAML/healthprofessional.
- National Cancer Institute (2010). Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/childAML/healthprofessional.
- National Cancer Institute (2010). Childhood Acute Lymphoblastic Leukemia Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/childALL/healthprofessional.
- National Cancer Institute (2010). Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies PDQ: Treatment – Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/childAML/Patient.
- National Cancer Institute (2010). Chronic Lymphocytic Leukemia PDQ: Treatment – Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/CLL/patient.
- National Cancer Institute (2010). Chronic Lymphocytic Leukemia Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/CLL/healthprofessional.
- National Cancer Institute (2010). Chronic Myelogenous Leukemia Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/CML/healthprofessional.
- National Cancer Institute (2010). Hairy Cell Leukemia PDQ: Treatment – Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/hairy-cell-leukemia/patient.
- National Cancer Institute (2010). Hairy Cell Leukemia Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/hairy-cell-leukemia/healthprofessional.
- National Comprehensive Cancer Network (2010). Acute myeloid leukemia, version 1.2011. Available online: http://www.nccn.org/professionals/physician_gls/PDF/aml.pdf.
- National Comprehensive Cancer Network (2010). Chronic myelogenous leukemia. Clinical Practice Guidelines in Oncology, version 1.2011. Available online: http://www.nccn.org/professionals/physician_gls/PDF/cml.pdf.
- National Comprehensive Cancer Network (2010). Non-Hodgkin's lymphomas. Clinical Practice Guidelines in Oncology, version 1.2010. Available online: http://www.nccn.org/professionals/physician_gls/PDF/nhl.pdf.
- Rodgers GM (2009). Disseminated intravascular coagulation section of Acquired coagulation disorders. In JP Greer et al., eds., Wintrobe's Clinical Hematology, 12th ed., vol. 2, pp. 1430–1440. Philadelphia: Lippincott Williams and Wilkins.
Credits
| By |
Healthwise Staff |
| Primary Medical Reviewer |
Kathleen Romito, MD - Family Medicine |
| Specialist Medical Reviewer |
Brian Leber, MDCM, FRCPC - Hematology |
| Last Revised |
May 10, 2012 |
