Howes x's List: Leukemia

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  In a bone  marrow aspiration and biopsy, a doctor or nurse uses a thin needle to remove a  small amount of liquid bone marrow, usually from a spot in the back of your  hipbone called the posterior iliac crest. A bone marrow biopsy is often taken at  the same time. This second procedure removes a small piece of bone tissue and  the enclosed marrow

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  • Physical exam. Your doctor will look for physical signs of  leukemia, such as pale skin from anemia and swelling of your lymph nodes, liver  and spleen.  
  • Blood tests. By looking at a sample of your blood, your  doctor can determine if you have abnormal levels of white blood cells or  platelets — which may suggest leukemia.  
  • Bone marrow test. Your doctor may recommend a procedure to  remove a sample of bone marrow from your hipbone. The bone marrow is removed  using a long, thin needle. The sample is sent to a laboratory to look for  leukemia cells. Specialized tests of your leukemia cells may reveal certain  characteristics that are used to determine your treatment options.

• • Biological therapy. Biological therapy works by helping  your immune system recognize and attack leukemia cells.  
  • Targeted therapy. Targeted therapy uses drugs that attack  specific vulnerabilities within your cancer cells. For example, the drug  imatinib (Gleevec) stops the action of a protein within the leukemia cells of  people with chronic myelogenous leukemia. This can help control the disease.  
  • Radiation therapy. Radiation therapy uses X-rays or other  high-energy beams to damage leukemia cells and stop their growth. During  radiation therapy, you lie on a table while a large machine moves around you,  directing the radiation to precise points on your body. You may receive  radiation in one specific area of your body where there is a collection of  leukemia cells, or you may receive radiation over your whole body.  
  • Stem cell transplant. A stem cell transplant is a procedure  to replace your diseased bone marrow with healthy bone marrow. Before a stem  cell transplant, you receive high doses of chemotherapy or radiation therapy to  destroy your diseased bone marrow. Then you receive an infusion of blood-forming  stem cells that help to rebuild your bone marrow. You may receive stem cells  from a donor, or in some cases you may be able to use your own stem cells. A  stem cell transplant is very similar to a bone marrow transplant.

• Factors that may increase your risk of developing some types of leukemia  include:

   
   
  • Previous cancer treatment. People who've had certain types  of chemotherapy and radiation therapy for other cancers have an increased risk  of developing certain types of leukemia.  
  • Genetic diseases. Genetic abnormalities seem to play a role  in the development of leukemia. Certain genetic diseases, such as Down syndrome,  are associated with increased risk of leukemia.  
  • Certain blood disorders. People who have been diagnosed  with certain blood disorders, such as myelodysplastic syndromes, may have an  increased risk of leukemia.  
  • Exposure to high levels of radiation. People exposed to  very high levels of radiation, such as survivors of a nuclear reactor accident,  have an increased risk of developing leukemia.  
  • Exposure to certain chemicals. Exposure to certain  chemicals, such as benzene — which is found in gasoline and is used by the  chemical industry — also is linked to increased risk of some kinds of leukemia.  
  • Smoking. Smoking cigarettes increases the risk of acute  myelogenous leukemia.  
  • Family history of leukemia. If members of your family have  been diagnosed with leukemia, your risk of the disease may be increased.  

• Scientists don't understand the exact causes of leukemia. It seems to develop  from a combination of genetic and environmental factors
• How leukemia forms
  In general, leukemia occurs when some  blood cells acquire mutations in their DNA — the instructions inside each cell  that guide its action. The mutations cause the cell to grow and divide more  rapidly and to continue living when normal cells would die. Over time, these  abnormal cells can crowd out healthy blood cells, causing the signs and symptoms  of leukemia.

• Symptoms of leukemia depend on how much  the cancer has grown and 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

• Chemotherapy is the standard treatment for many types of leukemia. Even when a cure is  not 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. Other  drugs used to treat leukemia help prevent infection and help your body grow new  blood cells.
• Nausea  and vomiting are the most common side effects of chemotherapy for leukemia, and  the most feared. But having chemotherapy does not mean that you have to suffer  with nausea and vomiting. Your doctor may prescribe medicines  to control nausea and vomiting. There are also things you can do at home.

• Acute leukemia

   

  Different types of leukemia are best treated with different kinds of  medicine.

   
   
  • Acute  lymphoblastic leukemia (ALL) drugs include prednisone,  vincristine, daunorubicin,  L-asparaginase  or pegaspargase,  methotrexate,  and cyclophosphamide.  Imatinib (Gleevec) and  nelarabine  (Arranon) are  sometimes used to treat ALL. Dasatinib  (Sprycel) is  a newer drug for treating some ALL that has not improved with other drugs.  
  • Acute  myelogenous leukemia (AML) drugs include daunorubicin, idarubicin, cytosine arabinoside,  and mitoxantrone.⁹  Gemtuzumab (Mylotarg) may  be given to people whose AML has relapsed. It helps your body destroy cancer  cells.  
  • Acute  promyelocytic leukemia (APL) drugs include all-trans-retinoic acid (ATRA)  and chemotherapy with arsenic  trioxide, idarubicin, or  daunorubicin. ATRA helps control the risk of life-threatening bleeding from disseminated  intravascular coagulation (DIC). Later treatment can include ATRA with or  without methotrexate  and 6-mercaptopurine.  Or if a first round of ATRA and chemotherapy does not work, arsenic trioxide may  be used.⁹  
  • To treat leukemia in the brain or prevent it from spreading to the brain and  central nervous system, methotrexate  and cytarabine/cytosine  arabinoside are injected into the spinal canal. This is called  intrathecal chemotherapy.
   

  Supportive treatments during cancer treatment include:

   
   
  • Antibiotics and immunoglobulins  help to prevent or fight infections. This is important when you do not have  enough normal white blood cells to fight infections on your own.  
  • Transfusions of red blood cells and platelets.  
  • Epoetin and hematopoietic  stimulants help your body make new blood cells.  
  • Allopurinol  to prevent kidney problems and gout.  
  • Saline or steroid eyedrops for relief during treatment with cytarabine/cytosine  arabinoside.

• Chronic leukemia

   

  Treatments for chronic  lymphocytic leukemia (CLL) are usually 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 the rest  of your life. Treatment choices may include:

   
   
  • Chemotherapy for chronic leukemia can involve a single drug or a combination  of drugs. For example, you may be given a combination of cyclophosphamide,  vincristine, and prednisone.  Other drug choices include fludarabine, chlorambucil, hydroxyurea  (hydroxycarbamide), cytarabine, busulfan, rituximab, and alemtuzumab.  
  • Allopurinol  may be given to prevent kidney problems and gout.  
  • Dasatinib (Sprycel) blocks the growth of cancer cells. It can be used for  CML that has not been helped by imatinib or  other drugs.  
  • Imatinib  (Gleevec) blocks the growth of cancer cells. It is often given to people who  have CML. Nilotinib  (Tasigna) may  be given to people who cannot take imatinib.  
  • Immune globulin (IG)  helps prevent infections. It is sometimes used for people with chronic  lymphocytic leukemia (CLL), because CLL weakens the immune system. Bendamustine  hydrochloride (Treanda) is  sometimes given to slow the progression of CLL.

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• 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. In many cases, treatment makes acute leukemia go  into remission. Some doctors prefer the term "remission" to "cure," because  there is a chance the cancer could come back.  
  • If you have chronic lymphocytic leukemia, you may not need to be treated  until you have symptoms. But chronic myelogenous leukemia will probably be  treated right away. Chronic leukemia can rarely be cured, but treatment  can help control the disease.
   

  Treatments for leukemia include:

   
   
  • Chemotherapy, which uses  powerful medicines to kill cancer cells. This is the main treatment for most  types of leukemia.  
  • Radiation treatments.  Radiation therapy uses high-dose X-rays to destroy cancer cells and shrink  swollen lymph nodes or an enlarged spleen. It may also be used before a stem  cell transplant.  
  • Stem cell  transplant. Donated stem cells can rebuild your supply of normal blood cells  and boost your immune system. Before the transplant, radiation or chemotherapy  is used to destroy cells in bone marrow and make room for donated cells.  
  • Biological therapy.  This is the use of special medicines that improve your body's natural defenses  against cancer.

• leukemia cells travel through the body. The symptoms of leukemia depend on the  number of leukemia cells and where these cells collect in the body.
• chronic leukemia may not have symptoms. The doctor may find the disease during a  routine blood test.
• People with acute leukemia usually go to their doctor because they feel sick. If  the brain is affected, they may have headaches, vomiting, confusion, loss of  muscle control, or seizures. Leukemia also can affect other parts of the body  such as the digestive tract, kidneys, lungs, heart, or testes.

• Common symptoms of chronic or acute leukemia may include:

   
   
  • Swollen lymph nodes that usually don't hurt (especially lymph nodes in the  neck or armpit)
    
     
  • Fevers or night sweats
    
     
  • Frequent infections
    
     
  • Feeling weak or tired
    
     
  • Bleeding and bruising easily (bleeding gums, purplish patches in the skin,  or tiny red spots under the skin)
    
     
  • Swelling or discomfort in the abdomen (from a swollen spleen or  liver)
    
     
  • Weight loss for no known  reason
    
     
  • Pain in the bones or joints
• Most often, these symptoms are not due to cancer. An infection or other health  problems may also cause these symptoms.

• Diagnosis
• • Physical exam: Your doctor checks for swollen lymph nodes, spleen, or  liver.
    
     
  • 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 whether leukemia cells are in your bone marrow.  Before the sample is taken, local anesthesia is used to numb the area. This  helps reduce the pain. 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.
    
    

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• No one knows the exact causes of leukemia.

• The risk factors may be different for the different types of leukemia:

   
   
  • Radiation: People  exposed to very high levels of radiation are much more likely than others to get  acute myeloid leukemia, chronic myeloid leukemia, or acute lymphocytic  leukemia.
    
     
     
    • Atomic bomb explosions: Very high levels of radiation have been  caused by atomic bomb explosions (such as those in Japan during World War II).  People, especially children, who survive atomic bomb explosions are at increased  risk of leukemia.
      
       
    • Radiation therapy:  Another source of exposure to high levels of radiation is medical treatment for  cancer and other conditions. Radiation therapy can increase the risk of  leukemia.
      
       
    • Diagnostic x-rays: Dental x-rays and other diagnostic x-rays (such as  CT scans) expose people to  much lower levels of radiation. It's not known yet whether this low level of  radiation to children or adults is linked to leukemia. Researchers are studying  whether having many x-rays may increase the risk of leukemia. They are also  studying whether CT scans during childhood are linked with increased risk of  developing leukemia.
      
      
     
  • Smoking: Smoking  cigarettes increases the risk of acute myeloid leukemia.
    
     
  • Benzene: Exposure to benzene in the workplace can cause acute myeloid  leukemia. It may also cause chronic myeloid leukemia or acute lymphocytic  leukemia. Benzene is used widely in the chemical industry. It's also found in  cigarette smoke and gasoline.
    
     
  • Chemotherapy:  Cancer patients treated with certain types of cancer-fighting drugs sometimes  later get acute myeloid leukemia or acute lymphocytic leukemia. For example,  being treated with drugs known as alkylating agents or topoisomerase inhibitors  is linked with a small chance of later developing acute leukemia.
    
     
  • Down syndrome and  certain other inherited diseases: Down syndrome and certain other inherited  diseases increase the risk of developing acute leukemia.
    
     
  • Myelodysplastic syndrome and certain other blood disorders: People  with certain blood disorders are at increased risk of acute myeloid  leukemia.
    
     
  • Human T-cell leukemia virus type I (HTLV-I): People with HTLV-I  infection are at increased risk of a rare type of leukemia known as adult T-cell  leukemia. Although the HTLV-I virus may cause this rare disease, adult T-cell  leukemia and other types of leukemia are not contagious.
    
     
  • Family history of leukemia: It's rare for more than one person in a  family to have leukemia. When it does happen, it's most likely to involve  chronic lymphocytic leukemia. However, only a few people with chronic  lymphocytic leukemia have a father, mother, brother, sister, or child who also  has the disease.
   

  Having one or more risk factors does not mean that a person will get  leukemia. Most people who have risk factors never develop the disease.

• Chronic leukemia: Early in the disease, the leukemia cells can still do  some of the work of normal white blood cells.
• As the number of leukemia cells in the blood increases, people get symptoms,  such as swollen lymph nodes  or infections.
• Acute leukemia: The leukemia cells can't do any of the work of normal  white blood cells. The number of leukemia cells increases rapidly. Acute  leukemia usually worsens quickly.
• • Chronic lymphocytic  leukemia (CLL): CLL affects lymphoid cells and usually grows slowly. It  accounts for more than 15,000 new cases of leukemia each year. Most often,  people diagnosed with the disease are over age 55. It almost never affects  children.
• • Chronic myeloid  leukemia (CML): CML affects myeloid cells and usually grows slowly at  first. It accounts for nearly 5,000 new cases of leukemia each year. It mainly  affects adults.
• • Acute lymphocytic  (lymphoblastic) leukemia (ALL): ALL affects lymphoid cells and grows  quickly. It accounts for more than 5,000 new cases of leukemia each year. ALL is  the most common type of leukemia in young children. It also affects adults.
• Acute myeloid  leukemia (AML): AML affects myeloid cells and grows quickly. It accounts  for more than 13,000 new cases of leukemia each year. It occurs in both adults  and children.

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• Stem cells are cells that have the potential to develop into many different or  specialized cell types.

• Leukemia is cancer of the body's blood-forming tissues, including the bone  marrow and the lymphatic system.

• Leukemia usually starts in the white blood cells. Your white blood cells are  potent infection fighters — they normally grow and divide in an orderly way, as  your body needs them. But in people with leukemia, the bone marrow produces a  large number of abnormal white blood cells, which don't function properly.

• • Fatigue
   
  • Malaise (vague feeling of bodily discomfort)
   
  • Abnormal bleeding
• • Excessive bruising
   
  • Weakness
   
  • Reduced exercise tolerance
   
  • Weight loss
   
  • Bone or joint pain
   
  • Infection and fever
   
  • Abdominal pain or "fullness"
   
  • Enlarged spleen, lymph nodes, and liver

• When you are healthy, your bone marrow makes:

   
   
  • White blood  cells, which help your body fight infection.  
  • Red blood  cells, which carry oxygen to all parts of your body.  
  • Platelets, which help your  blood clot.
   

  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

• The four main types of leukemia are:

   
   
  • Acute  lymphoblastic leukemia, or ALL. ALL is the most common leukemia in children.  Adults can also get it.  
  • Acute  myelogenous leukemia, or AML. AML affects both children and adults.  
  • Chronic  lymphocytic leukemia, or CLL. CLL is the most common leukemia in adults,  mostly those who are older than 55. Children almost never get it.  
  • Chronic  myelogenous leukemia, or CML. CML occurs mostly in adults.

• What causes leukemia?

   

  Experts don't know what causes leukemia. But some things are known to  increase the risk of some kinds of leukemia. These things are called risk  factors. You are more likely to get leukemia if you:

   
   
  • Were exposed to large amounts of radiation.   
  • Were exposed to certain chemicals at work, such as benzene.  
  • Had some types of chemotherapy to treat another cancer.  
  • Have Down syndrome or some  other genetic problems.  
  • Smoke.
   

  But most people who have these risk factors don't get leukemia. And most  people who get leukemia do not have any known risk factors.

   

  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.

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• blood cells develop from cells in the bone marrow called stem cells.
• Bone marrow is the soft material in the center of most bones.

• Stem cells mature into different kinds of blood cells. Each kind has a  special job:

   

  
  White blood cells help fight infection. There are several types of  white blood cells.

   

  
  Red blood cells carry oxygen to tissues throughout the body.

   

  
  Platelets help form blood clots that control  bleeding.
• Leukemia is cancer that  starts in the tissue that forms blood.

• The white blood cells that form from myeloid blasts are different from the  white blood cells that form from lymphoid blasts.

   

  
• n a person with leukemia, the bone marrow makes abnormal white blood cells. The  abnormal cells are leukemia cells.
• leukemia cells don't die when they should. They may crowd out normal white blood  cells, red blood cells, and platelets. This makes it hard for normal blood cells  to do their work.

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