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Adult Leukemia Facts

Cancer Information Service
Holden Comprehensive Cancer Center
University of Iowa Hospitals and Clinics

Creation Date: May 2004
Last Revision Date: May 2004
Peer Review Status: Internally Peer Reviewed

There are two major types of white blood cells that become cancerous. These are either myeloid or lymphocytic. Myeloid refers to the type of white cell that is important in killing bacteria (germs). Lymphocytic cells are the white cells that have a broad role in immunity.

The four most common types of adult leukemia are:

• Acute lymphocytic leukemia
• Acute myeloid leukemia
• Chronic lymphocytic leukemia
• Chronic myeloid leukemia

Who Gets Leukemia?

Many times the cause of leukemia is not known. Heredity, radiation, chemical exposure and treatment for cancer with certain anti cancer drugs are known to cause some forms of leukemia. Benzene exposure is linked to Acute Myeloid Leukemia. A virus, HTLV-1, is thought to play a role in some cases of Acute Lymphocytic Leukemia.

What Are the Symptoms of Leukemia?

The symptoms of acute leukemia appear and get worse quickly. In chronic leukemia, symptoms may not appear for a long time. When they do appear, they usually are mild at first and get worse slowly. Many times chronic leukemia is found during a routine check-up.

Some of the common symptoms of leukemia are:

• Fever, chills or flu-like symptoms
• Night sweats
• Weakness and tiredness
• Easy bleeding or bruising
• Tiny red spots under the skin
• Swollen or bleeding gums
• Nights sweats
• Swollen lymph glands

How Is Leukemia Diagnosed?

An abnormal blood test is many times the first sign of leukemia. A blood test can tell that a person has leukemia, but it cannot determine which type of leukemia it is. A bone marrow test is needed for examination of the tissue under a microscope. A pathologist can identify which type of leukemia is present. Chromosome studies, on the leukemia cells, will be done in order to help plan therapy. When leukemia cells are found in the bone marrow, the doctor will order other tests to find out the extent of the disease. Often times a spinal tap will be done to check for leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord. A chest x-ray might be ordered to check for signs of the disease in the chest.

Stages

There is no staging for leukemia since it spreads through the body by the blood. The choice of treatment depends on the type of leukemia, age and whether the patient has been treated in the past.

What are the treatment options for leukemia?

Most patients with leukemia are treated with drugs. Anticancer drugs are called chemotherapy and are used in treating leukemia. A highly effective new drug that blocks signals in leukemia cells is highly effective in chronic myeloid leukemia. Blood & marrow transplantation is an important component in some cases. Biologic and antibody therapy are playing increasing roles. Radiation therapy is used along with chemotherapy, in treating a few types of leukemia.

Most chemotherapy drugs are given in the vein (IV). Some anticancer drugs can be given by mouth, however. When drugs are given in the vein or by mouth, the medicine will enter the bloodstream and affect leukemia cells in most parts of the body. However, the drugs often do not reach cells near or around the brain and spinal cord because they are stopped by the "blood brain barrier". This barrier is formed by a network of blood vessels that filter blood going to the brain and spinal cord. To reach leukemia cells in that area, doctors will give the anticancer drugs directly into the cerebrospinal fluid, especially in acute lymphocytic leukemia.

Anticancer drugs are given in cycles–a treatment period followed by a recovery period, then another treatment period and so on. Some times the chemotherapy is given as an outpatient at the hospital or doctor’s office. Sometimes, however, the drugs will need to be given in the hospital, depending on the drug to be given and the patient’s overall health.

Radiation therapy is used along with chemotherapy for some kinds of leukemia. Radiation is the use of high-energy rays that will damage cancer cells and stop them from growing. The radiation will come from a large machine. Radiation is given two ways to treat leukemia. For some patients, the doctor will direct the radiation beam to a specific place, such as the spleen or testicles. Other times the patient will receive radiation to the whole body. This type of radiation is called total body irradiation and is given before a bone marrow transplant.

Blood & marrow transplantation (BMT) also may be used for some patients. High doses of chemotherapy and radiation are given to destroy the bone marrow that is making the leukemia cells. Healthy bone marrow or selected stem cells from the donor’s blood is then given into the body by giving it through a vein. The healthy bone marrow may come from a donor, or it may be marrow that has been removed from the patient and stored before the high dose chemotherapy. If the patient’s own bone marrow is used, it may first be treated outside the body to remove the leukemia cells. Patients who have a BMT will stay in the hospital for several weeks–until the transplanted bone marrow begins to produce enough white blood cells. The patient will need to be protected from infections until there are enough white blood cells to protect the patient from infection.

Side Effects of Treatment

Chemotherapy–side effects of anticancer drugs depends on the drug that is used. Like many other drugs, the effects of chemotherapy will differ from one person to the next. Usually, anticancer drugs will cause some lowering of blood counts to the point the patient will need to be careful to not get an infection. Some patients may have less energy and may bruise or bleed easily. Hair may fall out. Nausea, vomiting and mouth sores can be a problem for some patients. Side effects will go away. Some chemotherapy drugs will affect a patient’s fertility.

Women’s periods may become irregular or stop altogether. Some women may have symptoms of the change of life, such as hot flashes. Men may stop producing sperm. This side effect may be permanent. If the male patient still wants to have children, he should talk to his doctor about storing sperm for use later.

Blood & Marrow Transplantation–patients who have a BMT will face an increased risk of infection, bleeding and other side effects of the large doses of chemotherapy and radiation. Graft versus host disease (GVHD) may occur in patients who receive bone marrow from a donor. In GVHD, the donated marrow reacts against the patient’s tissues (most often the liver, skin and the digestive tract). GVHD can be mild or very severe. It can occur any time after the transplant–even years later. Drugs may be given to reduce the risk of GVHD and to treat the problem if it occurs. The one benefit of GVHD is that the graft attacks the leukemia itself (graft versus leukemia) and this side effect can help cure the patient.

Radiation Therapy–side effects of radiation depend on where the beam of radiation is aimed. If the radiation is given to the head, the hair will fall out. If the spleen receives radiation, there might be some nausea. Tiredness is another side effect that patients may experience. Redness or itching of the skin in the area of treatment is a common side effect of radiation. These symptoms will all go away after the treatment is finished.