LEUKEMIA
CANCER OF THE BLOOD
Professor Rolland Merch M. Arriza
Mindanao State University – General Santos City
Contents
I.
II.
III.
IV.
V.
VI.
Introduction
Causes
Symptoms
Types
Diagnosis
Treatment
VII.
References
Leukemia: Introduction
Leukemia causes almost one-third of all cancer deaths in children under the age 15.
What is Leukemia?
Leukemia is a type of cancer of the
blood or bone marrow characterized by
an abnormal increase of immature white
blood cells called "blasts". Leukemia is a
broad term covering a spectrum of
diseases. In turn, it is part of the even
broader group of diseases affecting the
blood, bone marrow, and lymphoid
system, which are all known as
hematological neoplasms.
A Wright's stained bone marrow aspirate
smear from a patient with precursor B-cell
acute lymphoblastic leukemia.
What is Leukemia?
Leukemia is a treatable disease. Most
treatments involve chemotherapy,
medical radiation therapy, or hormone
treatments. The rate of cure depends on
the type of leukemia as well as the age
of the patient. Children are more likely
to be permanently cured than adults.
Even when a complete cure is unlikely,
most people with a chronic leukemia and
many people with an acute leukemia
can be successfully treated for years.
Dr. Stephen A. Grupp examining Emma, recipient of
CTL019 therapy.
Leukemia: Causes
Experts do not know what causes leukemia. They do not know why some people get it
and others do not. It is likely that the different types of leukemia have different causes.
Causes of Leukemia
No one knows the exact causes of leukemia.
Doctors can seldom explain why one person
gets leukemia and another does not. Studies
have found the following risk factors for
leukemia:
Working with certain chemicals —
Exposure to high levels of benzene in the
workplace can cause leukemia. Benzene is
used widely in the chemical industry.
Formaldehyde is also used by the chemical
industry. Workers exposed to formaldehyde
also may be at greater risk of leukemia.

Benzene as a cause of leukemia had documented
since 1928. In 1948, the American Petroleum Institute
officially reported a link between this solvent used in
many of their industries used and cases of leukemia
in their workers. Their findings concluded that the
only safe level of benzene exposure is no exposure
at all.
Causes of Leukemia
No one knows the exact causes of leukemia.
Doctors can seldom explain why one person
gets leukemia and another does not. Studies
have found the following risk factors for
leukemia:
Very high levels of radiation — People
exposed to very high levels of radiation are
much more likely than others to develop
leukemia. Medical treatment that uses
radiation can be another source of high-level
exposure. Radiation used for diagnosis,
however, exposes people to much lower levels
of radiation and is not linked to leukemia.

Very high levels of radiation have been caused by
atomic bomb explosions (such as those in Japan
during World War II) and nuclear power plant
accidents (such as the Chernobyl [also called
Chornobyl] accident in 1986).
Causes of Leukemia
No one knows the exact causes of leukemia.
Doctors can seldom explain why one person
gets leukemia and another does not. Studies
have found the following risk factors for
leukemia:
Chemotherapy — Cancer patients treated
with certain cancer-fighting drugs sometimes
later develop leukemia. For example, drugs
known as alkylating agents are associated
with the development of leukemia many
years later.

For patients treated for Hodgkin lymphoma (HL),
cumulative doses of alkylating agent (AA) is
associated with the risk of therapy-related acute
myeloid leukemia/myelodysplastic syndrome (tAML/MDS), according to a study published online
Jan. 7 in the Journal of Clinical Oncology.
Causes of Leukemia
No one knows the exact causes of leukemia.
Doctors can seldom explain why one person
gets leukemia and another does not. Studies
have found the following risk factors for
leukemia:
Smoking— Tobacco products are the
single, major avoidable cause of cancer.
Smoking is also causally associated with
cancers of the pancreas, kidney, bladder,
stomach, and cervix and with myeloid
leukemia.

SMOKING cigarettes may increase a person's risk of
contracting leukemia by 30 percent and cause up to
3,600 cases of adult leukemia a year in the United
States. (Published February 3, 1993)
Causes of Leukemia
No one knows the exact causes of leukemia.
Doctors can seldom explain why one person
gets leukemia and another does not. Studies
have found the following risk factors for
leukemia:
Down syndrome and certain other
genetic diseases — Some diseases caused
by abnormal chromosomes may increase the
risk of leukemia.

Down syndrome was linked to leukemia for the first time in a
case report published in 1930. Since then, Down syndrome
has been recognized as one of the most important leukemiapredisposing syndromes and patients with Down syndrome
and leukemia have unique clinical features and significant
differences in treatment response and toxicity profiles
compared to patients without Down syndrome.
Leukemia: Symptoms
Over 1 million Americans are living with, or are in remission from, leukemia, lymphoma
or myeloma.
Symptoms
Like all blood cells, leukemia cells travel
through the body. Depending on the
number of abnormal cells and where
these cells collect, patients with leukemia
may have a number of leukemia
symptoms.
Acute leukemia symptoms appear and
get worse quickly. Chronic leukemia
symptoms may not appear for a long
time; when leukemia symptoms do
appear, they generally are mild at first
and get worse gradually.










Fever, chills, and other flu-like symptoms
Weakness and fatigue
Frequent infections
Loss of appetite and/or weight
Swollen or tender lymph nodes, liver, or
spleen;
Easy bleeding or bruising
Tiny red spots (called petechiae) under
the skin
Swollen or bleeding gums;
Sweating, especially at night; and/or
Bone or joint pain.
Symptoms

In acute leukemia, the abnormal cells
may collect in the brain or spinal
cord (also called the central nervous
system or CNS). The result may be
headaches, vomiting, confusion, loss
of muscle control, and seizures.
Leukemia cells also can collect in the
testicles and cause swelling. Also,
some patients develop sores in the
eyes or on the skin. Leukemia also
can affect the digestive tract,
kidneys, lungs, or other parts of the
body.

In chronic leukemia, the abnormal
blood cells may gradually collect in
various parts of the body. Chronic
leukemia may affect the skin, central
nervous system, digestive tract,
kidneys, and testicles.
Leukemia: Types
Leukemia is the 10th most frequently occurring type of cancer in all races or ethnicities.
Types
There are several types of leukemia.
The different types of leukemia are
grouped in two ways. One way is by
how quickly the disease develops
and gets worse. The other way is by
the type of blood cell that is
affected.


by how quickly the disease
develops

Chronic

Acute
by the type of blood cell
that is affected

Lymphoid cells

Myeloid cells
Types

In chronic leukemia, the leukemia
cells come from mature,
abnormal cells. The cells thrive
for too long and accumulate. The
cells grow slowly. It is not unusual
in chronic cases for symptoms to
take a long time to even appear.

Acute leukemia develop from
early cells, called "blasts". Blasts
are young cells, that divide
frequently. They target immature
cells, causing symptoms to
appear quickly. In acute
leukemia cells, they don't stop
dividing like their normal
counterparts do.
Types

Lymphocytic leukemia begins
from white blood cells called
lymphocytes or immature types
of lymphocytes. It commonly
affects lymph nodes in the body
but can invade all body tissues.

Myelogenous leukemia involves
the other 3 common types of
white blood cells known as
granulocytes. They are the
neutrophils, eosinophils, or
basophils.
Leukemia: Diagnosis
About 20 percent of adult acute myeloid leukemia cases are linked to smoking.
Diagnosis
The diagnosis
of leukemia frequently occurs
following a routine blood test that
results in an abnormal blood cell
count. If you have symptoms that
suggest leukemia, your doctor will
try to find out what's causing the
problems. Your doctor may ask
about your personal and family
medical history.
You may have one or more of the
following tests:

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.
Diagnosis
The diagnosis
of leukemia frequently occurs
following a routine blood test that
results in an abnormal blood cell
count. If you have symptoms that
suggest leukemia, your doctor will
try to find out what's causing the
problems. Your doctor may ask
about your personal and family
medical history.
You may have one or more of the
following tests:

Biopsy: Your doctor removes
tissue to look for cancer cells. A
biopsy is the only sure way to
know 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. There are two ways your
doctor can obtain bone marrow.
Some people will have both
procedures during the same
visit:
Diagnosis
The diagnosis
of leukemia frequently occurs
following a routine blood test that
results in an abnormal blood cell
count. If you have symptoms that
suggest leukemia, your doctor will
try to find out what's causing the
problems. Your doctor may ask
about your personal and family
medical history.
You may have one or more of the
following tests:

Biopsy


Bone marrow aspiration: The
doctor uses a thick, hollow
needle to remove samples of
bone marrow.
Bone marrow biopsy: The
doctor uses a very thick,
hollow needle to remove a
small piece of bone and bone
marrow.
Diagnosis

The tests that your doctor orders
for you depend on your
symptoms and type of leukemia.
You may have other tests:


Cytogenetics: The lab looks at the
chromosomes of cells from samples
of blood, bone marrow, or lymph
nodes. If abnormal chromosomes are
found, the test can show what type
of leukemia you have. For example,
people with CML have an abnormal
chromosome called the Philadelphia
chromosome.
Chest x-ray: An x-ray can show
swollen lymph nodes or other
signs of disease in your chest.
Diagnosis

The tests that your doctor orders
for you depend on your
symptoms and type of leukemia.
You may have other tests:

Spinal tap: Your doctor may remove
some of the cerebrospinal fluid (the
fluid that fills the spaces in and
around the brain and spinal cord).
The doctor uses a long, thin needle to
remove fluid from the lower spine.
The procedure takes about 30
minutes and is performed with local
anesthesia. You must lie flat for
several hours afterward to keep
from getting a headache. The lab
checks the fluid for leukemia cells or
other signs of problems.
Leukemia: Treatment
Hispanic children of all races under the age of 20 years have the highest rate of
leukemia.
Treatment
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. Many times,
leukemia is treated with one or more
types of treatment.
 Treatment for Acute Leukemia

Chemotherapy Chemotherapy is the use of
drugs that either kill cancer
cells or preventing the cells
from dividing. Chemotherapy
can be given in a variety of
ways, with IV infusion and pill
being more common. The type
of chemotherapy given
depends on the stage and
type of lung cancer.
Treatment
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. Many times,
leukemia is treated with one or more
types of treatment.
 Treatment for Acute Leukemia

Some types of acute leukemia
spread to the brain and spinal
cord. Regular chemotherapy
cannot 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.
Treatment
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. Many times,
leukemia is treated with one or more
types of treatment.
 Treatment for Acute Leukemia

Radiation Therapy Radiation therapy uses high
doses of radiation, such as Xrays, to destroy cancer cells.
Radiation is usually given from
a machine outside the body
that directs radiation to the
cancer (external radiation).
Radiation is also used to treat
acute leukemia that has
spread to the brain and
spinal cord.
Treatment
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. Many times,
leukemia is treated with one or more
types of treatment.
 Treatment for Acute Leukemia

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, meaning the stem
cells are donated by someone
else. The goal of a transplant is
to destroy all the cells in your
bone marrow, including the
leukemia cells, and replace them
with new, normal cells.
Treatment
Sometimes leukemia gets worse in
spite of treatments. Sometimes it
gets better, or "goes into remission."
Sometimes it comes back, or
"relapses." Even when that happens,
there are several treatments that
may help to cure the leukemia or
help you live longer:
 Treatment if Acute Leukemia
gets Worse


Stem cell transplant .
Donated cells from a
"matched" donor can rebuild
your supply of
normal blood cells and
your immune system.
Chemotherapy. Sometimes
medicines or doses that are
different from those used
during your initial
chemotherapy can help.
Treatment
Chronic lymphocytic leukemia is not
always treated right away. It usually
gets worse more slowly than acute
leukemia.


Treatment of Chronic Leukemia

Chronic Lymphocytic Leukemia

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 - Radiation may
be used to destroy cancer cells. It
also may be used to shrink swollen
lymph nodes or a swollen spleen.
Sometimes radiation is used on the
whole body to prepare for a bone
marrow transplant.
Treatment
Chronic lymphocytic leukemia is not
always treated right away. It usually
gets worse more slowly than acute
leukemia.

Treatment of Chronic Leukemia



Chronic Lymphocytic Leukemia

Chemotherapy - Chemotherapy is
the use of medicines that attack
cancer cells. Many medicines are
available to fight leukemia and help
you live longer.
Surgery - If the spleen starts
destroying red blood cells and
platelets, it may need to be
removed. This operation is called
a splenectomy.
Targeted therapy with a monoclonal
antibody. These antibodies can kill
cancer cells, stop their growth, or
keep them from spreading.
Treatment
Chronic lymphocytic leukemia is not
always treated right away. It usually
gets worse more slowly than acute
leukemia.



Treatment of Chronic Leukemia

Chronic Myelogenous Leukemia

Targeted therapy with a tyrosine
kinase inhibitor, such
as imatinib or dasatinib, is the first
treatment used for CML.
Chemotherapy - Chemotherapy is
the use of medicines that attack
cancer cells. Many medicines are
available to fight leukemia and help
you live longer.
Biological therapy - This is the use
of special medicines that improve
your body's natural defenses against
cancer.
Treatment
Chronic lymphocytic leukemia is not
always treated right away. It usually
gets worse more slowly than acute
leukemia.



Treatment of Chronic Leukemia

Chronic Myelogenous Leukemia

High-dose chemotherapy with stem cell
transplant - After chemotherapy is
completed, stem cells that were
previously donated and frozen are
thawed and infused.
Donor lymphocyte infusion (DLI) - This
is a treatment that may be used after a
stem cell transplant. With DLI, a person is
given more of their donor's white blood
cells (lymphocytes).
Surgery - If the spleen starts destroying
red blood cells and platelets, it may
need to be removed. This operation is
called a splenectomy.
Overview: http://www.cancer.ca/Canada-wide/About cancer/Types of cancer/Treatment for leukemia.aspx
Leukemia: References
The incidence of leukemia is highest among whites, and lowest among American Indians,
and the Asian and Pacific Islander population.
References
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“New leukemia therapy destroys cancer by turning blood cells into assassins“, Ryan Jaslow, CBS News
http://www.cbsnews.com/8301-504763_162-20091135-10391704.html
“Mechanism behind acute leukemia identified by VUMC researchers”, Mary Beth Gardner, Vanderbilt
University Medical Center http://www.mc.vanderbilt.edu/reporter/index.html?ID=2190
“Understanding Leukemia - Diagnosis and Treatment, WebMD
http://www.webmd.com/cancer/understanding-leukemia-treatment
“Leukemia: Causes and Risk Factors”, CancerCompass http://www.cancercompass.com/leukemiainformation/causes-and-risk-factors.htm
Ontario Task Force on the Primary Prevention of Cancer.: Recommendations for the Primary Prevention of
Cancer. Toronto, Canada: Queen's Printer for Ontario, 1995.
“Cigarette Smoking: Health Risks and How to Quit”, National Cancer Institute
http://www.cancer.gov/cancertopics/pdq/prevention/control-of-tobacco-use/HealthProfessional/page2
Leukemia - Treatment Overview, WebMD http://www.webmd.com/cancer/tc/leukemia-treatmentoverview