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Leukemia—Adult

Definition

Leukemia is a cancer of the blood cells. In cancer, cells become abnormal and grow out of control. As the number of abnormal blood cells increase, the healthy blood cells are outnumbered. There are three main types of blood cells. Each has a distinct job:
  • White blood cells (WBC), also called lymphocytes, are most often involved in leukemia. Their main job is to help the immune system.
  • Red blood cells (RBC) carry oxygen throughout the body.
  • Platelets help the blood clot at injury sites.
Leukemia cells cannot do the job of normal blood cells. This causes many of the symptoms of leukemia. The disease starts in the bone marrow where blood cells are made. The most common types of leukemia are:
White Blood Cells
Immune system white blood cell
Leukemia cells outnumber healthy white blood cells and gather in spleen and lymph nodes.
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Causes

The exact cause of leukemia is not known. Certain risk factors are thought to be related.

Risk Factors

These risk factors are thought to be related to leukemia. Tell your doctor if you have any of these risk factors:
  • Age—leukemia is most common in people over aged 60
    • AML and CLL are most common in adults
    • ALL is most common in children
  • Chemotherapy for previous cancer
  • Some genetic diseases such as Down syndrome
  • Chronic exposure to benzene that exceeds federally approved safety limits
  • Radiation therapy from previous therapy
  • Myelodysplastic syndrome —a blood disease; increases risk for AML
  • Exposure to tobacco smoke

Symptoms

If you have any of these symptoms, do not assume it is due to leukemia. They can also vary depending on the type of leukemia and where the cancer cells are located. Tell your doctor if you have any of these:
  • Fever or night sweats
  • Flu-like symptoms
  • Minor cuts that heal slowly
  • Excessive reaction to insect bites
  • Feeling weak or tired
  • Headache
  • Pale skin
  • Bleeding and bruising easily
  • Nosebleeds
  • Bleeding gums
  • Tiny red spots under the skin
Excess leukemia cells can gather in different parts of the body and organs creating:
  • Pain in the bones or joints
  • Puffy gums
  • Rash
  • Difficulty breathing
  • Swelling of testicles
  • Swelling or discomfort in the abdomen (from enlarged spleen)
  • Swollen lymph nodes (particularly in neck or armpit)
  • Weight loss
  • Meningitis with headache, nausea, loss of muscle control, seizures, symptoms of stroke

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. The doctor will check for swelling of the liver; spleen; or lymph nodes in the armpits, groin, and neck.
Tests may include the following:
  • Blood tests—to look for leukemia cells in blood
  • Bone marrow aspiration and biopsy —the removal of a sample of bone marrow to look for cancer cells
If cancer cells are found, additional tests may be done. These tests check if the cancer has spread and what systems may already be affected.
  • Lumbar puncture —removal of liquid that surrounds the brain and spinal cord
  • Chest x-rays —to look for signs of cancer in the chest
  • CT scan —type of x-ray that uses a computer to make pictures of structures inside the body
  • MRI scan —test that uses magnetic waves to make pictures of structures inside the body
  • Ultrasound —test that uses sound waves to examine masses and organs inside the body
  • Positron emission tomography (PET)—test makes images that show the amount of activity in body tissues

Treatment

The goal for acute leukemia is to destroy all signs of the disease and return the blood and bone marrow to normal. Chronic leukemia is rarely curable. Treatment focuses on slowing disease progression.
Talk with your doctor about the best treatment plan for you. Options include the following:

Medication

  • Imatinib mesylate (Gleevec)—used to treat myeloid leukemia by reducing the number of cancer cells in the blood and bone marrow
  • Nilotinib —targeted therapy similar to imatinib
  • Dasatinib —targeted therapy similar to imatinib (if leukemia cells become resistant to imatinib)
These drugs can cause infertility and early menopause . Talk to your doctor about your fertility options before you start treatment.
Your doctor may prescribe medicine to stimulate the production of healthy blood cells, such as:
  • Filgrastim (Neupogen)
  • Pegfilgrastim (Neulasta)
  • Epoetin alpha (Procrit, Epogen)

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. It may be given in many forms including pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells. Some healthy cells are killed as well. The specific combination of drugs will depend on the type of leukemia, your age, and condition.

Radiation Therapy

Radiation therapy is a type of treatment that uses radiation to kill cancer cells. Typically, it is only used to prepare for a bone marrow transplant or in some cases of chronic leukemia.

Procedures

  • Blood transfusions —Healthy blood cells from a donor are given through an intravenous line (IV). This may be done if the leukemia is causing shortness of breath, fatigue, or severe bleeding.
  • Bone marrow transplant —Stem cells from a donor’s healthy bone marrow are injected in you. Stem cells can make all types of blood cells. Once injected into your bloodstream, the stem cells should make healthy blood cells.
  • Splenectomy —The spleen may need to be removed if it becomes congested with leukemia cells.

Biological Therapy (Immunotherapy)

The therapy uses medications or substances made by the body to improve your body’s defense against cancer. This type of treatment is still fairly new and under investigation. Talk with you doctor about whether this treatment is an option for you and about clinical trials in your area.

Prevention

To help reduce your chance of getting leukemia, take the following steps:
  • Avoid exposure to benzene.
  • Avoid exposure to high levels of radiation when possible.
  • If you smoke, quit .

RESOURCES

American Cancer Society http://www.cancer.org/

The Leukemia & Lymphoma Society http://www.leukemia-lymphoma.org/

National Cancer Institute http://www.cancer.gov/

CANADIAN RESOURCES

Canadian Cancer Society http://www.cancer.ca/

Sick Kids http://www.sickkids.ca/

References

Cecil R, Goldman L, Bennett JC. Cecil Textbook ofMedicine . 21st ed. Philadelphia, PA: WB Saunders Company; 2000.

Conn HF, Rakel RE. Conn's Current Therapy 2001 . 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.

Leukemia. The Leukemia & Lymphoma Society website. Available at: http://www.leukemia-lymphoma.org/all%5Fpage?item%5Fid=7026 . Accessed October 10, 2008.

Leukemia. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/wyntk/leukemia/page1 . Accessed October 10, 2008.

Noble J. Textbook of Primary Care Medicine . 3rd ed. St. Louis, MO: Mosby, Inc.; 2001.

A PET scan may improve leukemia care. UW HealthAvailable website. Available at: http://www.uwhealth.org/news/apetscanmayimproveleukemiacare/14001 . Accessed November 2, 2009.

What is leukemia? American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/content/CRI%5F2%5F2%5F1X%5FWhat%5Fis%5Fadult%5Facute%5Fleukemia%5F57.asp?sitearea . Accessed October 10, 2008.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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