Leukemia facts

O Leukemia is a cancer oI the blood cells.

O hile the exact cause(s) oI leukemia is not known, risk Iactors have been identiIied.
O Leukemias are grouped by how quickly the disease develops (acute or chronic) as well as
by the type oI blood cell that is aIIected (lymphocytes or myelocytes). The Iour main
types oI leukemia include acute lymphocytic leukemia (ALL), chronic lymphocytic
leukemia (CLL), acute myelocytic leukemia (AML), and chronic myelocytic leukemia
(CML).
O !eople with leukemia are at signiIicantly increased risk Ior developing inIections,
anemia, and bleeding. Other symptoms and signs include easy bruising, weight loss, night
sweats, and unexplained Ievers.
O The diagnosis oI leukemia is supported by Iindings oI the medical history and
examination, and examining blood and bone marrow samples under a microscope.
O Treatment oI leukemia depends on the type oI leukemia, certain Ieatures oI the leukemia
cells, the extent oI the disease, and prior history oI treatment, as well as the age and
health oI the patient.
O Most patients with leukemia are treated with chemotherapy. Some patients also may have
radiation therapy and/or bone marrow transplantation.
O There is no known way to prevent leukemia.
O The prognosis oI leukemia depends upon several Iactors, including the patient's age, the
type oI leukemia, and the extent to which the cancer has spread.
$mptoms
Like all blood cells, leukemia cells travel through the body. The symptoms oI leukemia depend
on the number oI leukemia cells and where these cells collect in the body.
!eople with chronic leukemia may not have symptoms. The doctor may Iind the disease during a
routine blood test.
!eople with acute leukemia usually go to their doctor because they Ieel sick. II the brain is
aIIected, they may have headaches, vomiting, conIusion, loss oI muscle control, or seizures.
Leukemia also can aIIect other parts oI the body such as the digestive tract, kidneys, lungs, heart,
or testes.
Common symptoms oI chronic or acute leukemia may include:
O Swollen lymph nodes that usually don't hurt (especially lymph nodes in the neck or
armpit)
O evers or night sweats
O requent inIections
O eeling weak or tired
O leeding and bruising easily (bleeding gums, purplish patches in the skin, or tiny red
spots under the skin)
O Swelling or discomIort in the abdomen (Irom a swollen spleen or liver)
O eight loss Ior no known reason
O !ain in the bones or joints
Most oIten, these symptoms are not due to cancer. An inIection or other health problems may
also cause these symptoms. Only a doctor can tell Ior sure.
Anyone with these symptoms should tell the doctor so that problems can be diagnosed and
treated as early as possible.
%7eatment
!eople with leukemia have many treatment options. The options are watchIul waiting,
chemotherapy, targeted therapy, biological therapy, radiation therapy, and stem cell transplant. II
your spleen is enlarged, your doctor may suggest surgery to remove it. Sometimes a combination
oI these treatments is used.
The choice oI treatment depends mainly on the Iollowing:
O The type oI leukemia (acute or chronic)
O our age
O hether leukemia cells were Iound in your cerebrospinal Iluid
It also may depend on certain Ieatures oI the leukemia cells. our doctor also considers your
symptoms and general health.
!eople with acute leukemia need to be treated right away. The goal oI treatment is to destroy
signs oI leukemia in the body and make symptoms go away. This is called a remission. AIter
people go into remission, more therapy may be given to prevent a relapse. This type oI therapy is
called consolidation therapy or maintenance therapy. Many people with acute leukemia can be
cured.
II you have chronic leukemia without symptoms, you may not need cancer treatment right away.
our doctor will watch your health closely so that treatment can start when you begin to have
symptoms. Not getting cancer treatment right away is called watchIul waiting.
hen treatment Ior chronic leukemia is needed, it can oIten control the disease and its
symptoms. !eople may receive maintenance therapy to help keep the cancer in remission, but
chronic leukemia can seldom be cured with chemotherapy. However, stem cell transplants oIIer
some people with chronic leukemia the chance Ior cure.
our doctor can describe your treatment choices, the expected results, and the possible side
eIIects. ou and your doctor can work together to develop a treatment plan that meets your
medical and personal needs.
ou may want to talk with your doctor about taking part in a clinical trial, a research study oI
new treatment methods.
our doctor may reIer you to a specialist, or you may ask Ior a reIerral. Specialists who treat
leukemia include hematologists, medical oncologists, and radiation oncologists. !ediatric
oncologists and hematologists treat childhood leukemia. our health care team may also include
an oncology nurse and a registered dietitian.
henever possible, people should be treated at a medical center that has doctors experienced in
treating leukemia. II this isn't possible, your doctor may discuss the treatment plan with a
specialist at such a center.
eIore treatment starts, ask your health care team to explain possible side eIIects and how
treatment may change your normal activities. ecause cancer treatments oIten damage healthy
cells and tissues, side eIIects are common. Side eIIects may not be the same Ior each person, and
they may change Irom one treatment session to the next.
atchful aiting
!eople with chronic lymphocytic leukemia who do not have symptoms may be able to put oII
having cancer treatment. y delaying treatment, they can avoid the side eIIects oI treatment until
they have symptoms.
II you and your doctor agree that watchIul waiting is a good idea, you'll have regular checkups
(such as every 3 months). ou can start treatment iI symptoms occur.
Although watchIul waiting avoids or delays the side eIIects oI cancer treatment, this choice has
risks. It may reduce the chance to control leukemia beIore it gets worse.
ou may decide against watchIul waiting iI you don't want to live with an untreated leukemia.
Some people choose to treat the cancer right away.
II you choose watchIul waiting but grow concerned later, you should discuss your Ieelings with
your doctor. A diIIerent approach is nearly always available.
Chemothe7ap
Many people with leukemia are treated with chemotherapy. Chemotherapy uses drugs to destroy
leukemia cells.
Depending on the type oI leukemia, you may receive a single drug or a combination oI two or
more drugs.
ou may receive chemotherapy in several diIIerent ways:
O mouth: Some drugs are pills that you can swallow.
O nto a vein (': The drug is given through a needle or tube inserted into a vein.
O %h7ough a cathete7 (a thin, flexible tube: The tube is placed in a large vein, oIten in
the upper chest. A tube that stays in place is useIul Ior patients who need many IV
treatments. The health care proIessional injects drugs into the catheter, rather than
directly into a vein. This method avoids the need Ior many injections, which can cause
discomIort and injure the veins and skin.
O nto the ce7eb7ospinal fluid: II the pathologist Iinds leukemia cells in the Iluid that Iills
the spaces in and around the brain and spinal cord, the doctor may order intrathecal
chemotherapy. The doctor injects drugs directly into the cerebrospinal Iluid. Intrathecal
chemotherapy is given in two ways:
4 nto the spinal fluid: The doctor injects the drugs into the spinal Iluid.
4 &nde7 the scalp: Children and some adult patients receive chemotherapy through
a special catheter called an Ommaya reservoir. The doctor places the catheter
under the scalp. The doctor injects the drugs into the catheter. This method avoids
the pain oI injections into the spinal Iluid.
Intrathecal chemotherapy is used because many drugs given by IV or taken by mouth
can't pass through the tightly packed blood vessel walls Iound in the brain and spinal
cord. This network oI blood vessels is known as the blood-brain barrier.
Chemotherapy is usually given in cycles. Each cycle has a treatment period Iollowed by a rest
period.
ou may have your treatment in a clinic, at the doctor's oIIice, or at home. Some people may
need to stay in the hospital Ior treatment.
The side eIIects depend mainly on which drugs are given and how much. Chemotherapy kills
Iast-growing leukemia cells, but the drug can also harm normal cells that divide rapidly:
O lood cells: hen chemotherapy lowers the levels oI healthy blood cells, you're more
likely to get inIections, bruise or bleed easily, and Ieel very weak and tired. ou'll get
blood tests to check Ior low levels oI blood cells. II your levels are low, your health care
team may stop the chemotherapy Ior a while or reduce the dose oI drug. There also are
medicines that can help your body make new blood cells. Or, you may need a blood
transIusion.
O Cells in hai7 7oots: Chemotherapy may cause hair loss. II you lose your hair, it will grow
back, but it may be somewhat diIIerent in color and texture.
O Cells that line the digestive t7act: Chemotherapy can cause poor appetite, nausea and
vomiting, diarrhea, or mouth and lip sores. Ask your health care team about medicines
and other ways to help you cope with these problems.
O $pe7m o7 egg cells: Some types oI chemotherapy can cause inIertility.
4 Child7en: Most children treated Ior leukemia appear to have normal Iertility
when they grow up. However, depending on the drugs and doses used and the age
oI the patient, some boys and girls may be inIertile as adults.
4 dult men: Chemotherapy may damage sperm cells. Men may stop making
sperm. ecause these changes to sperm may be permanent, some men have their
sperm Irozen and stored beIore treatment (sperm banking).
4 dult women: Chemotherapy may damage the ovaries. omen may have
irregular menstrual periods or periods may stop altogether. omen may have
symptoms oI menopause, such as hot Ilashes and vaginal dryness. omen who
may want to get pregnant in the Iuture should ask their health care team about
ways to preserve their eggs beIore treatment starts.
%a7geted %he7ap
!eople with chronic myeloid leukemia and some with acute lymphoblastic leukemia may receive
drugs called targeted therapy. Imatinib (Gleevec) tablets were the Iirst targeted therapy approved
Ior chronic myeloid leukemia. Other targeted therapy drugs are now used too.
Targeted therapies use drugs that block the growth oI leukemia cells. or example, a targeted
therapy may block the action oI an abnormal protein that stimulates the growth oI leukemia cells.
Side eIIects include swelling, bloating, and sudden weight gain. Targeted therapy can also cause
anemia, nausea, vomiting, diarrhea, muscle cramps, or a rash. our health care team will monitor
you Ior signs oI problems.
iological %he7ap
Some people with leukemia receive drugs called biological therapy. iological therapy Ior
leukemia is treatment that improves the body's natural deIenses against the disease.
One type oI biological therapy is a substance called a monoclonal antibody. It's given by IV
inIusion. This substance binds to the leukemia cells. One kind oI monoclonal antibody carries a
toxin that kills the leukemia cells. Another kind helps the immune system destroy leukemia cells.
or some people with chronic myeloid leukemia, the biological therapy is a drug called
interIeron. It is injected under the skin or into a muscle. It can slow the growth oI leukemia cells.
ou may have your treatment in a clinic, at the doctor's oIIice, or in the hospital. Other drugs
may be given at the same time to prevent side eIIects.
The side eIIects oI biological therapy diIIer with the types oI substances used, and Irom person
to person. iological therapies commonly cause a rash or swelling where the drug is injected.
They also may cause a headache, muscle aches, a Iever, or weakness. our health care team may
check your blood Ior signs oI anemia and other problems.

%7eatment
!eople with leukemia have many treatment options. The options are watchIul waiting,
chemotherapy, targeted therapy, biological therapy, radiation therapy, and stem cell transplant. II
your spleen is enlarged, your doctor may suggest surgery to remove it. Sometimes a combination
oI these treatments is used.
The choice oI treatment depends mainly on the Iollowing:
O 1he Lype of leukemla (acuLe or chronlc)
O our age
O JheLher leukemla cells were found ln your cerebrosplnal fluld
It also may depend on certain Ieatures oI the leukemia cells. our doctor also considers your
symptoms and general health.
!eople with acute leukemia need to be treated right away. The goal oI treatment is to destroy
signs oI leukemia in the body and make symptoms go away. This is called a remission. AIter
people go into remission, more therapy may be given to prevent a relapse. This type oI therapy is
called consolidation therapy or maintenance therapy. Many people with acute leukemia can be
cured.
II you have chronic leukemia without symptoms, you may not need cancer treatment right away.
our doctor will watch your health closely so that treatment can start when you begin to have
symptoms. Not getting cancer treatment right away is called watchIul waiting.
hen treatment Ior chronic leukemia is needed, it can oIten control the disease and its
symptoms. !eople may receive maintenance therapy to help keep the cancer in remission, but
chronic leukemia can seldom be cured with chemotherapy. However, stem cell transplants oIIer
some people with chronic leukemia the chance Ior cure.
our doctor can describe your treatment choices, the expected results, and the possible side
eIIects. ou and your doctor can work together to develop a treatment plan that meets your
medical and personal needs.
ou may want to talk with your doctor about taking part in a clinical trial, a research study oI
new treatment methods.
our doctor may reIer you to a specialist, or you may ask Ior a reIerral. Specialists who treat
leukemia include hematologists, medical oncologists, and radiation oncologists. !ediatric
oncologists and hematologists treat childhood leukemia. our health care team may also include
an oncology nurse and a registered dietitian.
henever possible, people should be treated at a medical center that has doctors experienced in
treating leukemia. II this isn't possible, your doctor may discuss the treatment plan with a
specialist at such a center.
eIore treatment starts, ask your health care team to explain possible side eIIects and how
treatment may change your normal activities. ecause cancer treatments oIten damage healthy
cells and tissues, side eIIects are common. Side eIIects may not be the same Ior each person, and
they may change Irom one treatment session to the next.

atchful aiting
!eople with chronic lymphocytic leukemia who do not have symptoms may be able to put oII
having cancer treatment. y delaying treatment, they can avoid the side eIIects oI treatment until
they have symptoms.
II you and your doctor agree that watchIul waiting is a good idea, you'll have regular checkups
(such as every 3 months). ou can start treatment iI symptoms occur.
Although watchIul waiting avoids or delays the side eIIects oI cancer treatment, this choice has
risks. It may reduce the chance to control leukemia beIore it gets worse.
ou may decide against watchIul waiting iI you don't want to live with an untreated leukemia.
Some people choose to treat the cancer right away.
II you choose watchIul waiting but grow concerned later, you should discuss your Ieelings with
your doctor. A diIIerent approach is nearly always available.
Chemothe7ap
Many people with leukemia are treated with chemotherapy. Chemotherapy uses drugs to destroy
leukemia cells.
Depending on the type oI leukemia, you may receive a single drug or a combination oI two or
more drugs.
ou may receive chemotherapy in several diIIerent ways:
O 8y mouth Some drugs are pllls LhaL you can swallow
O to a ve| (I% 1he drug ls glven Lhrough a needle or Lube lnserLed lnLo a veln
O @hrough a catheter (a th| f|ex|b|e tube% 1he Lube ls placed ln a large veln ofLen ln Lhe upper
chesL A Lube LhaL sLays ln place ls useful for paLlenLs who need many lv LreaLmenLs 1he healLh
care professlonal ln[ecLs drugs lnLo Lhe caLheLer raLher Lhan dlrecLly lnLo a veln 1hls meLhod
avolds Lhe need for many ln[ecLlons whlch can cause dlscomforL and ln[ure Lhe velns and skln
O to the cerebrosp|a| f|u|d lf Lhe paLhologlsL flnds leukemla cells ln Lhe fluld LhaL fllls Lhe
spaces ln and around Lhe braln and splnal cord Lhe docLor may order lnLraLhecal chemoLherapy
1he docLor ln[ecLs drugs dlrecLly lnLo Lhe cerebrosplnal fluld lnLraLhecal chemoLherapy ls glven
ln Lwo ways
4 to the sp|a| f|u|d 1he docLor ln[ecLs Lhe drugs lnLo Lhe splnal fluld
4 Dder the sca|p Chlldren and some adulL paLlenLs recelve chemoLherapy Lhrough a
speclal caLheLer called an Cmmaya reservolr 1he docLor places Lhe caLheLer under Lhe
scalp 1he docLor ln[ecLs Lhe drugs lnLo Lhe caLheLer 1hls meLhod avolds Lhe paln of
ln[ecLlons lnLo Lhe splnal fluld
Intrathecal chemotherapy is used because many drugs given by IV or taken by mouth
can't pass through the tightly packed blood vessel walls Iound in the brain and spinal
cord. This network oI blood vessels is known as the blood-brain barrier.
Chemotherapy is usually given in cycles. Each cycle has a treatment period Iollowed by a rest
period.
ou may have your treatment in a clinic, at the doctor's oIIice, or at home. Some people may
need to stay in the hospital Ior treatment.
The side eIIects depend mainly on which drugs are given and how much. Chemotherapy kills
Iast-growing leukemia cells, but the drug can also harm normal cells that divide rapidly:
O 8|ood ce||s Jhen chemoLherapy lowers Lhe levels of healLhy blood cells youre more llkely Lo
geL lnfecLlons brulse or bleed easlly and feel very weak and Llred oull geL blood LesLs Lo check
for low levels of blood cells lf your levels are low your healLh care Leam may sLop Lhe
chemoLherapy for a whlle or reduce Lhe dose of drug 1here also are medlclnes LhaL can help
your body make new blood cells Cr you may need a blood Lransfuslon
O e||s | ha|r roots ChemoLherapy may cause halr loss lf you lose your halr lL wlll grow back buL
lL may be somewhaL dlfferenL ln color and LexLure
O e||s that ||e the d|gest|ve tract ChemoLherapy can cause poor appeLlLe nausea and vomlLlng
dlarrhea or mouLh and llp sores Ask your healLh care Leam abouL medlclnes and oLher ways Lo
help you cope wlLh Lhese problems
O perm or egg ce||s Some Lypes of chemoLherapy can cause lnferLlllLy
4 h||dre MosL chlldren LreaLed for leukemla appear Lo have normal ferLlllLy when Lhey
grow up Powever dependlng on Lhe drugs and doses used and Lhe age of Lhe paLlenL
some boys and glrls may be lnferLlle as adulLs
4 du|t me ChemoLherapy may damage sperm cells Men may sLop maklng sperm
8ecause Lhese changes Lo sperm may be permanenL some men have Lhelr sperm frozen
and sLored before LreaLmenL (sperm banklng)
4 du|t wome ChemoLherapy may damage Lhe ovarles Jomen may have lrregular
mensLrual perlods or perlods may sLop alLogeLher Jomen may have sympLoms of
menopause such as hoL flashes and vaglnal dryness Jomen who may wanL Lo geL
pregnanL ln Lhe fuLure should ask Lhelr healLh care Leam abouL ways Lo preserve Lhelr
eggs before LreaLmenL sLarLs
%a7geted %he7ap
!eople with chronic myeloid leukemia and some with acute lymphoblastic leukemia may receive
drugs called targeted therapy. Imatinib (Gleevec) tablets were the Iirst targeted therapy approved
Ior chronic myeloid leukemia. Other targeted therapy drugs are now used too.
Targeted therapies use drugs that block the growth oI leukemia cells. or example, a targeted
therapy may block the action oI an abnormal protein that stimulates the growth oI leukemia cells.
Side eIIects include swelling, bloating, and sudden weight gain. Targeted therapy can also cause
anemia, nausea, vomiting, diarrhea, muscle cramps, or a rash. our health care team will monitor
you Ior signs oI problems.
iological %he7ap
Some people with leukemia receive drugs called biological therapy. iological therapy Ior
leukemia is treatment that improves the body's natural deIenses against the disease.
One type oI biological therapy is a substance called a monoclonal antibody. It's given by IV
inIusion. This substance binds to the leukemia cells. One kind oI monoclonal antibody carries a
toxin that kills the leukemia cells. Another kind helps the immune system destroy leukemia cells.
or some people with chronic myeloid leukemia, the biological therapy is a drug called
interIeron. It is injected under the skin or into a muscle. It can slow the growth oI leukemia cells.
ou may have your treatment in a clinic, at the doctor's oIIice, or in the hospital. Other drugs
may be given at the same time to prevent side eIIects.
The side eIIects oI biological therapy diIIer with the types oI substances used, and Irom person
to person. iological therapies commonly cause a rash or swelling where the drug is injected.
They also may cause a headache, muscle aches, a Iever, or weakness. our health care team may
check your blood Ior signs oI anemia and other problems.
#adiation %he7ap
Radiation therapy (also called radiotherapy) uses high-energy rays to kill leukemia cells. !eople
receive radiation therapy at a hospital or clinic.
Some people receive radiation Irom a large machine that is aimed at the spleen, the brain, or
other parts oI the body where leukemia cells have collected. This type oI therapy takes place 5
days a week Ior several weeks. Others may receive radiation that is directed to the whole body.
The radiation treatments are given once or twice a day Ior a Iew days, usually beIore a stem cell
transplant.
The side eIIects oI radiation therapy depend mainly on the dose oI radiation and the part oI the
body that is treated. or example, radiation to your abdomen can cause nausea, vomiting, and
diarrhea. In addition, your skin in the area being treated may become red, dry, and tender. ou
also may lose your hair in the treated area.
ou are likely to be very tired during radiation therapy, especially aIter several weeks oI
treatment. Resting is important, but doctors usually advise patients to try to stay as active as they
can.
Although the side eIIects oI radiation therapy can be distressing, they can usually be treated or
controlled. ou can talk with your doctor about ways to ease these problems.
It may also help to know that, in most cases, the side eIIects are not permanent. However, you
may want to discuss with your doctor the possible long-term eIIects oI radiation treatment.
$tem Cell %7ansplant
Some people with leukemia receive a stem cell transplant. A stem cell transplant allows you to
be treated with high doses oI drugs, radiation, or both. The high doses destroy both leukemia
cells and normal blood cells in the bone marrow. AIter you receive high-dose chemotherapy,
radiation therapy, or both, you receive healthy stem cells through a large vein. (It's like getting a
blood transIusion.) New blood cells develop Irom the transplanted stem cells. The new blood
cells replace the ones that were destroyed by treatment.
Stem cell transplants take place in the hospital. Stem cells may come Irom you or Irom someone
who donates their stem cells to you:
O 7om ou: An autologous stem cell transplant uses your own stem cells. eIore you get
the high-dose chemotherapy or radiation therapy, your stem cells are removed. The cells
may be treated to kill any leukemia cells present. our stem cells are Irozen and stored.
AIter you receive high-dose chemotherapy or radiation therapy, the stored stem cells are
thawed and returned to you.
O 7om a famil membe7 o7 othe7 dono7: An allogeneic stem cell transplant uses healthy
stem cells Irom a donor. our brother, sister, or parent may be the donor. Sometimes the
stem cells come Irom a donor who isn't related. Doctors use blood tests to learn how
closely a donor's cells match your cells.
O 7om ou7 identical twin: II you have an identical twin, a syngeneic stem cell transplant
uses stem cells Irom your healthy twin.
Stem cells come Irom a Iew sources. The stem cells usually come Irom the blood (peripheral
stem cell transplant). Or they can come Irom the bone marrow (bone marrow transplant).
Another source oI stem cells is umbilical cord blood. Cord blood is taken Irom a newborn baby
and stored in a Ireezer. hen a person gets cord blood, it's called an umbilical cord blood
transplant.
AIter a stem cell transplant, you may stay in the hospital Ior several weeks or months. ou'll be
at risk Ior inIections and bleeding because oI the large doses oI chemotherapy or radiation you
received. In time, the transplanted stem cells will begin to produce healthy blood cells.
Another problem is that graIt-versus-host disease (GVHD) may occur in people who receive
donated stem cells. In GVHD, the donated white blood cells in the stem cell graIt react against
the patient's normal tissues. Most oIten, the liver, skin, or digestive tract is aIIected. GVHD can
be mild or very severe. It can occur any time aIter the transplant, even years later. Steroids or
other drugs may help.