What is leukemia?
Leukemia is a general term used to describe different types of cancer that are found in the blood and bone marrow. The exact type of leukemia depends on the blood cells that are affected and if the cancer grows quickly (acute) or slowly (chronic). Leukemia affects the bone marrow, white blood cells, red blood cells and platelets.
Types of leukemia include:
- Acute lymphoblastic leukemia (ALL) – a cancer of the blood and bone marrow that develops when bone marrow makes abnormal white blood cells (lymphoblasts) and affects red blood cell and platelet production. ALL progresses quickly.
- Acute myeloid leukemia (AML) – a cancer of the blood and bone marrow that develops when bone marrow makes abnormal white blood cells (myeloblasts) and affects red blood cell and platelet production. AML progresses quickly.
- Chronic lymphocytic leukemia (CLL) – a cancer that affects the blood, lymph nodes and bone marrow resulting in too many white blood cells and is the most common leukemia in adults.
- Chronic myeloid leukemia (CML) – a rare blood cancer that develops when the bone marrow makes too many of the white blood cells known as myeloid cells. About 95% of all CML cases are caused by an abnormal chromosome called the Philadelphia chromosome.
- Hairy cell leukemia (HCL) – a rare form of cancer in the blood and bone marrow that affects white blood cells.
- Myelodysplastic syndrome – a rare blood cancer that develops when the bone marrow is unable to produce normal, healthy blood cells, and patients typically have low white blood cells and platelets. These abnormal cells are unable to function properly.
Leukemia and other blood cancers listed here may be diagnosed in adults at any age, but those 55 and older are more likely to develop AML, CLL and MDS. ALL is the most frequently diagnosed cancer in children younger than 15, but can be found in adults as well.
There is no routine cancer. Each patient’s leukemia is different, behaving differently in the body it’s in and calling for a tailored, individualized treatment plan for each patient. Our internationally recognized leukemia specialists work closely with patients to develop the best personalized treatment plan and offer the latest treatment options available, all while providing thoughtful, compassionate expert care.
How does leukemia form?
While the exact causes of leukemia are not well understood, researchers and clinicians at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) are among the global leaders in studying leukemia to uncover possible causes and to develop even better ways to treat it. The Leukemia Program research scientists are at the forefront of developing breakthrough treatment protocols and targeted therapies aimed at improving the lives of those diagnosed with leukemia.
Here’s what we know about where leukemia begins and its impact: leukemia occurs when cells within the bone marrow and blood begin to change (mutate) abnormally. These abnormal cells may grow rapidly and build up. As leukemia cells grow and flourish, healthy white blood cells, red blood cells and platelets are pushed out. This may cause infection, anemia and easy bleeding.
For example, AML, begins when the bone marrow makes too many white blood cells, which are what the body uses to help fight off infections. When there are too many of these white blood cells, they’re called myeloblasts. As these abnormal cells continue to accumulate in the blood and bone marrow, they crowd out the healthy white blood cells, red blood cells and platelets, making it harder for the body’s immune system to fight off infections like colds and pneumonia.
What are the risk factors of leukemia?
A leukemia risk factor is anything that increases your chance of getting this disease. These factors may be environmental, behavioral or genetic. For example, people who have had past cancer treatments — like chemotherapy or radiation therapy — may be at a higher risk of developing certain types of leukemia.
Additional risk factors may include:
- Age: adults 55 years old and older are more likely to be diagnosed with leukemia.
- Tobacco use: a history of smoking has been linked to an increased risk of developing certain types of leukemia, like ALL and AML.
- Chemical or radiation exposure: those who have been exposed to radiation in the environment (such as nuclear radiation or an atomic bomb) or exposed to the chemical benzene are at a higher risk.
- Health history: having a personal history of a blood disorder such as myelodysplastic syndrome can increase your risk of leukemia.
- Inherited disorders: several inherited disorders, such as Fanconi anemia, Shwachman-Diamond syndrome and Diamond-Blackfan anemia, may increase the risk of leukemia.
- Genetic disorders: certain genetic disorders, like Down syndrome, increase the risk of developing leukemia.
Not everyone with risk factors will develop leukemia. If you have risk factors, it’s important to talk with your doctor. If you have an inherited family syndrome that may cause leukemia, you may want to consider genetic counseling.
What are the signs and symptoms of leukemia?
Signs and symptoms of leukemia can vary based on the exact type of leukemia and its stage. For some types of leukemia, like ALL and AML, symptoms may develop and become severe quickly. For other types of leukemia, like CLL and CML, symptoms may develop slowly and mimic the symptoms of other benign conditions.
Signs and symptoms may include:
- fatigue
- weakness
- anemia which can cause bleeding and bruising
- recurring or severe infections (like pneumonia)
- bleeding
- night sweats
- weight loss or difficulty eating
- enlarged lymph nodes that may be uncomfortable
- enlarged spleen
- skin rash or spots
Having these symptoms does not necessarily mean you have leukemia. But if you have one or a combination of these symptoms, you should talk to your doctor immediately.
How is leukemia diagnosed?
Your doctor will do a physical exam to check overall health and to look for signs of disease, as well as discuss health habits, past illnesses and treatments.
After the initial exam and depending on your symptoms, your doctor may suggest a variety of additional screenings and diagnostic tests to determine the cause of your symptoms.
The tests may include:
- complete blood count (CBC) with differential
- blood chemistry analysis
- peripheral blood smear
- bone marrow biopsy
How is leukemia treated?
Leukemia treatment varies by type of leukemia and are based not only on age and overall health, but also on a patient’s specific blood cell classification. At the OSUCCC – James, our experts work with patients to design an individualized and compassionate approach to care.
Depending on the type of leukemia, doctors may sometimes recommend that the leukemia is treated in phases. These treatments and phases may include:
Remission induction
The first treatment phase is designed to destroy leukemia cells (blasts) and put the cancer into remission. This treatment usually begins with chemotherapy.
Post-remission therapy or remission continuation therapy
This second phase is designed to kill any leukemia cells that could be remaining after remission induction and to help prevent a relapse.
Patients might also receive a stem cell transplant. A stem cell transplant replaces abnormal blood-forming cells or cells that are killed during chemotherapy. The OSUCCC – James is the only central Ohio hospital to offer stem cell transplantation.
Chemotherapy
Chemotherapy destroys the leukemia cells or stops them from dividing. Chemotherapy drugs can be taken by mouth or injected into a vein or muscle. When the drugs enter the bloodstream, they can reach cancer cells throughout the body (called systemic chemotherapy). Combination chemotherapy uses more than one anticancer drug.
Chemotherapy with stem cell transplant
Stem cell transplants enable patients to receive chemotherapy treatment and then replace blood-forming cells that have been destroyed by cancer treatment. Stem cells, which are immature blood cells, are removed from the blood or bone marrow of either the patient or a donor, and then they are frozen and stored. After chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into and restore the body’s blood cells.
Targeted therapy
Targeted therapies are drugs that attack cancer cells without destroying healthy surrounding cells. These therapies are called tyrosine kinase inhibitors, and they’re used to treat certain kinds of adult ALL, CLL, CML, AML and hairy cell leukemia.
The drugs work by blocking the enzyme (called tyrosine kinase) that causes stem cells to develop into more white blood cells (leukemia cells or blasts) than the body needs.
Tumor sequencing and genomic analysis
OSUCCC – James specialists and subspecialists use genomic sequencing to analyze bone marrow cells and to determine exactly how to treat a specific leukemia. This test evaluates the DNA, or genetic material, in cancer cells. By detecting changes in the cells, the experts can determine how to design the best personalized treatment plan to specifically target those changes — as well as predict how well a patient’s body will respond to particular therapies.
Immunotherapy
Immunotherapy, also sometimes called biologic therapy, boosts a patient’s immune system to help fight cancer. Substances made by the body or in a laboratory are used to direct or restore the body’s natural defenses against cancer.
The OSUCCC – James leukemia specialists and subspecialists reach across multiple medical disciplines and modes of treatment to offer patients the latest treatments and the most advanced tools to understand leukemia at the molecular and genetic levels — the levels that drive each patient’s specific disease.
Our team includes nationally and internationally renowned hematologic experts who understand that each patient’s disease is unique and who are continually studying, discovering and treating each type of leukemia as well as developing and delivering world-class treatments and interventions — even those that are often not available anywhere else in central Ohio.
If you have been diagnosed with leukemia or would like to speak with an expert at the OSUCCC – James, please call 614-293-9441 or 800-293-5066 to make an appointment.