Leukemia - Part III

Today, we will wrap up our discussion of leukemia by talking about the treatment options. As you might expect, because there are several different types of leukemia, there are also several treatment options.

What factors determine the treatment of leukemia?

There are several things that influence what treatment is best for you. These factors include:

• Your age
• The type of leukemia
• Your overall health status
• How widespread your leukemia is

What are the treatments for leukemia?

Some chronic leukemias do not need treatment for many years. If you have chronic leukemia that does not need treatment yet, your doctor will want to see you regularly to monitor your condition, including:

• Regular blood work to keep track of your blood cell counts,
• Monitoring your symptoms,
• Doing regular physical exams to look for signs that your chronic leukemia may need treatment.

If you have an acute leukemia, or a chronic leukemia that has progressed to the need for treatment, here are some of the common treatments used to fight leukemia:

• Chemotherapy – Chemicals used to kill the leukemia cells. Your leukemia may need a single drug or a combination of drugs. Some of these drugs are given in an IV and some come in a pill form.
• Targeted therapy – Targeted drug treatments are designed to focus on blocking specific abnormalities in the cancer cells that are found on the specialized testing done on the bone marrow test. If your leukemia has certain specific abnormalities found, you may benefit from targeted therapy. More targeted drugs are being developed to try to fight more types of leukemia cells.
• Radiation therapy – Radiation uses X-rays or other high-energy beams to damage leukemia cells and stop their growth. The radiation is directed to precise points on your body where there are collections of leukemia cells. Radiation therapy can also be used to prepare you for a bone marrow transplant.
• Bone marrow transplant – Also called a stem cell transplant, this helps to reestablish healthy stem cells by replacing the leukemic bone marrow with stem cells that are free of leukemia. These stem cells then regenerate normal bone marrow. Sometimes you can use your own stem cells, but often a stem cell donor is needed.
• Immunotherapy –Cancer cells have the ability to hide from your immune system. Immunotherapy breaks down their ability to hide. If your immune system can see cancer better, it will fight against it.
• CAR-T cell therapy – This process takes your own T cells (germ fighting white blood cells) and engineers them to fight cancer cells, then infuses them back into your blood. This is an option for certain types of leukemia.
• Clinical trials – These are experiments to test new cancer treatments or new ways of using existing treatments. Before joining a clinical trial, you should discuss the benefits and risks of the particular trial in your very particular situation.

I hope that this series about leukemia has been informative for you.

If you have any questions about leukemia, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Leukemia – Part II

Last week, we started a discussion about leukemia, which is a type of blood cancer that starts in white blood cells. Today, we will continue that discussion to include the typical signs and symptoms, as well as how leukemia is diagnosed.

What are the symptoms and signs of leukemia?

Symptoms can vary depending on the type of leukemia. Chronic leukemias may cause milder symptoms than acute leukemias. Here are some of the common signs and symptoms:

• Fatigue and/or weakness
• Weight loss that is unintentional
• Fever
• Repeated infections, or recurrent mouth sores
• Swollen lymph nodes
• Enlarged liver and/or spleen
• Easy bruising or bleeding, including recurrent nosebleeds
• Excessive sweating, including night sweats
• Tiny red or purple spots in your skin, especially where clothing fits more closely
• Other types of skin changes, including chronic itching
• Bone pain or tenderness

What are the risk factors that increase your risk of developing some types of leukemia?

Many people with leukemia have no known risk factors, and most people with known risk factors don't get leukemia, but here are some factors that can increase your risk of developing leukemia:

• Previous cancer treatment – Some types of chemotherapy and radiation treatment can increase your risk of developing certain types of leukemia.
• Genetic conditions – Certain genetic conditions, including Down syndrome, are associated with an increased risk of leukemia.
• Chemical exposure – Exposure to some chemicals, such as benzene, increases risk.
• Smoking – Cigarette smoking increases the risk of acute myelogenous leukemia.
• Family history of leukemia

How is leukemia diagnosed?

As I mentioned last week, chronic leukemia often has few if any symptoms in the early stages. It may be found on routine blood tests done on a yearly physical exam or for other reasons. If you have some of the signs or symptoms of leukemia, or your routine blood work results are concerning for leukemia, your doctor will do a physical exam to look for signs of leukemia, such as swollen lymph nodes, pale skin or mucous membranes, or an enlarged liver or spleen.

Blood tests are the next thing after the physical exam to look for leukemia. A complete blood count (CBC) tells us the levels of white blood cells, red blood cells, and platelets in the blood, along with some other things like the size of the cells. An extra test can be added to the CBC, where a pathologist looks at the blood cells under the microscope to count the different types of white blood cells, and to look for abnormal leukemia cells (although leukemia cells may not be in the blood sample even when leukemia is present).

The next test would be a bone marrow test. Your doctor will use a long, thin needle to remove a small sample of bone marrow from your hip bone. This sample is sent to the lab for several tests to look for leukemia cells. If leukemia cells are present, other tests will be done to look for characteristics to classify the leukemia and to determine the best treatment options for your particular leukemia.

Next week, we will wrap up our discussion of leukemia by talking about the different treatment options.

If you have any questions about Leukemia, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Leukemia

Leukemia is the most common type of blood cancer. Most people have heard of leukemia and have an idea about how scary the diagnosis might be. It may surprise you to know that some leukemias are not as scary as others. Leukemia is a big subject, so we will talk about it this week and next. Let's get started.

What is leukemia?

Leukemia is a type of blood cancer that starts in white blood cells. The name leukemia comes from the word leukocyte, which is another name for white blood cells (WBCs). Leukocytes grow in the bone marrow from stem cells. Stem cells in the bone marrow can develop into red blood cells, white blood cells (leukocytes), or platelets. They each have a specific function within the blood. WBCs help to fight infections. Once they are formed from the stem cells, WBCs don't usually divide and make more cells on their own. They wait in the bone marrow until they are needed, then are released into the circulation. Most WBCs live for a short time, hours to days.

Leukemia happens when the genetic material inside the cell, called DNA, is damaged or altered in some way. The damaged DNA tells the cells to continue growing and dividing and keeps them from maturing properly. As they multiply, they overwhelm the bone marrow. This slows down and eventually stops the production of normal WBCs, red blood cells, and platelets.

How are leukemias classified?

Leukemias are put into categories based on two things:

How fast the condition is developing:

• Acute leukemia - In acute leukemia, the abnormal WBCs are very immature. They can't carry out any normal function, and they multiply quite rapidly. The disease progresses quickly. These leukemias require aggressive and timely treatment.
• Chronic leukemia - These abnormal cells are more mature. They can perform some of their functions for a period of time. They multiply and accumulate more slowly. Some forms of chronic leukemia can go unnoticed or undiagnosed for years. They are often discovered by accident when a patient comes in for another issue that requires blood work, sometimes a wellness exam.

Which type of white blood cell is involved:

• Lymphocytes - Lymphocytic leukemia affects the lymphocytes, which include T cells and B cells, and natural killer cells. Each of these cell types has a specialized role in the immune system. Some produce antibodies. Some directly fight infections (or direct other cells to fight). They are the best fighters against viruses.
• Myeloid cells - Myelogenous leukemia affects the cells that give rise to white blood cells called granulocytes and monocytes. These make up most of the white blood cells circulating in the blood. They carry enzymes to fight infections or actually swallow up bacteria and fungi.

What are the different types of leukemia?

The major types of leukemia are:

• Acute lymphocytic leukemia (ALL) - The most common type of leukemia in young children but can also occur in adults.
• Acute myelogenous leukemia (AML) - A common type of leukemia, which occurs in children and adults. AML is the most common type of acute leukemia in adults.
• Chronic lymphocytic leukemia (CLL) - The most common chronic adult leukemia. Someone with CLL may feel well for years without needing treatment.
• Chronic myelogenous leukemia (CML) - Mainly affects adults. A person with CML may have few or no symptoms for months or years before entering a phase in which the leukemia cells grow more quickly.
• Other types - Other, rarer types of leukemia exist, including hairy cell leukemia, myelodysplastic syndromes and myeloproliferative disorders.

Next week, we will continue our discussion of leukemia.

If you have any questions about Leukemia, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor