LEUKEMIA

CANCER OF THE
BLOOD
Professor Rolland Merch M. Arriza
Mindanao State University – General Santos City
Contents
I. Introduction VII. References
II. Causes
III. Symptoms
IV. Types
V. Diagnosis
VI. Treatment
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 Dr. Stephen A. Grupp examining
acute leukemia can be successfully Emma, recipient of CTL019 therapy.
treated for years.
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
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
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.
Causes of Leukemia
Very high levels of radiation have been caused
by atomic bomb explosions (such as those in
Japan during World War II) and nuclearpower
plant accidents (such as the Chernobyl [also
called Chornobyl] accident in 1986).
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
 Causes of Leukemia
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 (t-AML/MDS), according to a study
published online Jan. 7 in the Journal ofClinical
Oncology.
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.
 Causes of Leukemia
SMOKING cigarettes may increase a person's
risk of contracting leukemia by 30 percentand
cause up to 3,600 cases of adult leukemia a
year in the United States. (Published February
3, 1993)
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, an
d cervix and with myeloid leukemia.
 Causes 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 leukemia-predisposing syndromes
and patients with Down syndrome and leukemia have
unique clinical features and significant differences in
treatment response and toxicity profiles compared to
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.
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  In chronic leukemia, the
cells may collect in the brain or abnormal blood cells may
spinal cord (also called the
central nervous system or CNS). gradually collect in various parts
The result may be headaches, of the body. Chronic leukemia
vomiting, confusion, loss of may affect the skin, central
muscle control, and seizures. nervous system, digestive
Leukemia cells also can collect in
the testicles and cause swelling. tract, kidneys, and testicles.
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.
Leukemia: Types
Leukemia is the 10th most frequently occurring type of cancer in all races or
ethnicities.
Types
There are several types of  by how quickly the
leukemia. The different types of disease develops
leukemia are grouped in two
 Chronic
ways. One way is by how quickly
the disease develops and gets  Acute
worse. The other way is by the  by the type of blood cell
type of blood cell that is affected. 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  Myelogenous leukemia
leukemia begins from white involves the other 3 common
blood cells called types of white blood cells
lymphocytes or immature known as granulocytes. They
types of lymphocytes. It are the neutrophils,
commonly affects lymph eosinophils, or basophils.
nodes in the body but can
invade all body tissues.
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
 Biopsy
following a routine blood test  Bone marrow aspiration:
that results in an abnormal blood The doctor uses a
cell count. If you have symptoms
that suggest leukemia, your thick, hollow needle to
doctor will try to find out what's remove samples of bone
causing the problems. Your marrow.
doctor may ask about your
 Bone marrow biopsy:
personal and family medical
history. The doctor uses a very
You may have one or more of thick, hollow needle to
the following tests: remove a small piece of
bone and bone marrow.
Diagnosis
 The tests that your doctor  Cytogenetics: The lab looks at
the chromosomes of cells from
orders for you depend on samples of blood, bone
your symptoms and type of marrow, or lymph nodes. If
abnormal chromosomes are
leukemia. You may have found, the test can show what
other tests: 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  Spinal tap: Your doctor may
orders for you depend on
your symptoms and type of
leukemia. You may have
other tests:
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 X-
rays, 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
 High-dose chemotherapy
Chronic lymphocytic leukemia is with stem cell transplant - After
not always treated right away. It chemotherapy is completed, stem
cells that were previously donated
usually gets worse more slowly and frozen are thawed and infused.
than acute leukemia.  Donor lymphocyte infusion (DLI) -
This is a treatment that may be used
 Treatment of Chronic after a stem cell transplant. With
Leukemia DLI, a person is given more of their
donor's white blood cells
 Chronic Myelogenous (lymphocytes).
Leukemia  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
 ―Newleukemia 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/leukemia-information/causes-and-risk-factors.htm
 Ontario Task Force on the Primary Prevention of Cancer.: Recommendations for thePrimary
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-
treatment-overview