Leukemia occurs when abnormal white blood cells in the bone marrow quickly increase and destroy normal blood cells. This leaves a person prone to infection. The four most common types of leukemia are:
1) Acute lymphocytic leukemia
2) Acute myeloid leukemia
3) Chronic lymphocytic leukemia
4) Chronic myeloid leukemia
Signs and symptoms of leukemias vary from easy bruising or bleeding to paleness or easy fatigue, and/or recurrent minor infections, or poor healing. These signs and symptoms are not unique to leukemia and may be caused by other, more common conditions. However, individuals with chronic leukemia may be asymptomatic or have non-specific complaints. Thereby, diagnosis of the leukemia needs specific blood tests, including an examination of cells present in the blood and bone marrow. They are often diagnosed as a result of a periodic physical examination and testing.
The goal of leukemia treatment is to bring about a complete remission. Treatment approaches for leukemia depend on the type of white blood cell affected and whether the disease is acute or chronic. Acute leukemia progresses very fast. Hence, patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) need to start treatment as early as possible following a diagnosis. Treatment may include chemotherapy, targeted therapies, monoclonal antibody therapy, immunotherapy, and stem cell transplantation.
In contrast to acute leukemia, chronic leukemia grows more slowly and takes longer to progress. Patients diagnosed with chronic myeloid leukemia (CML) are usually treated with tyrosine kinase inhibitors, oral drugs that may need to be taken indefinitely to keep CML under control. Some patients diagnosed with chronic lymphocytic leukemia (CLL) might not require treatment for a long period of time after diagnosis. However, patients who need treatment may receive chemotherapy, targeted therapy, monoclonal antibody therapy, or treatments in combination.
Doctors may find chronic leukemia in a routine blood test, before symptoms begin. If this happens, or if you have signs or symptoms that suggest leukemia, you may undergo the following diagnostic exams:
Your doctor will look for physical signs of leukemia, such as pale skin from anemia, swelling of the lymph nodes, and enlargement of liver and spleen.
By looking at a sample of your blood, a doctor can determine if you have abnormal levels of red or white blood cells or platelets — which may suggest leukemia. A blood test may also show the presence of leukemia cells, though not all types of leukemia cause the leukemia cells to circulate in the blood. Sometimes, the leukemia cells stay in the bone marrow.
The 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 the leukemia cells may reveal certain characteristics that are used to determine your treatment options.
Treatment for leukemia depends on many factors. Your doctor determines the leukemia treatment options based on age and overall health, the type of leukemia you have, and whether it has spread to other parts of the body, including the central nervous system.
Common treatments used to fight leukemia include:
Chemotherapy is the major form of treatment for leukemia. Depending on the type of leukemia you have, you may receive a single drug or a combination of drugs. These drugs may come in the form of a pill, or they may be injected directly into a vein.
Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Your leukemia cells will be tested to see if targeted therapy may be helpful for you.
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 the whole body. Radiation therapy may be used to prepare for a bone marrow transplant.
Prior to a bone marrow transplant, you receive very high doses of chemotherapy or radiation therapy to destroy your leukemia-producing bone marrow. Then you receive an infusion of blood-forming stem cells that help rebuild your bone marrow.
You may receive stem cells from a donor or may be able to use your own stem cells.
Immunotherapy uses your immune system to fight cancer. Your body’s disease-fighting immune system may not attack the cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.
A specialized treatment called Chimeric Antigen Receptor (CAR)-T cell therapy takes your body’s germ-fighting T cells, engineers them to fight cancer, and infuses them back into your body. CAR-T cell therapy might be an option for certain types of leukemia.
Clinical trials are experiments to test new cancer treatments and new ways of using existing treatments. While clinical trials give you or your child a chance to try the latest cancer treatment, treatment benefits and risks may be uncertain. Discuss the benefits and risks of clinical trials with your doctor.