Leukemia: Symptoms, Signs, Causes, Types and Treatment (2023)

Overview

What is leukemia?

Leukemia is aKrebsof the blood, characterized by the rapid growth of abnormal blood cells. This uncontrolled growth occurs in the bone marrow, where most of the body's blood is produced. Leukemia cells are usually immature (still developing)white blood cells. The term leukemia comes from the Greek words for “white” (leukos) and “blood” (haima).

Unlike other types of cancer, leukemia usually does not form a mass (tumor) that shows up on imaging tests, such as x-rays or CT scans.

There are many types of leukemia. Some are more common in children, while others are more common in adults. Treatment depends on the type of leukemia and other factors.

How does leukemia evolve?

Leukemia begins in the bone marrow, the soft, spongy tissue in the inner cavity of bones where the body's blood cells are made. The globules go through several stages before reaching their fully mature form. Mature, normal blood cells include:

• Red blood cells:Cells that carry oxygen and other vital materials to all tissues and organs in the body.
• white blood cells:Cells that fight infection.
• platelets:Cells that help blood clot.

These blood cells start out as hematopoietic stem cells (heme = blood, poiesis = do). Stem cells become myeloid cells (MAI-uh-loyd) or lymphoid cells (LIM-foyd). If the blood cells continue to develop normally, the mature forms of these cells are as follows:

• myeloid cellsbecome red blood cells, platelets, and certain types of white blood cells (basophils, eosinophils, and neutrophils).
• lymphoid cellsbecome certain types of white blood cells (lymphocytes and natural killer cells).

However, when you have leukemia, one of the developing blood cells begins to multiply out of control. These abnormal cells, called leukemia cells, begin to take up space in the bone marrow. They crowd out cells trying to become healthy red blood cells, white blood cells, and platelets.

How does leukemia affect my body?

Having too many leukemia cells and too few normal cells is harmful for several reasons:

• The leukemia cells are not there to keep you healthy.
• Normal blood cells have very little space and support to mature and multiply in the bone marrow because they are outnumbered by leukemia cells.
• Fewer red blood cells, healthy white blood cells, and platelets are produced and released into the blood. As a result, the organs and tissues in your body don't get the oxygen they need to function properly. Also, your body can't fight infections or form blood clots when necessary.

What types of leukemia are there?

There are four main types of leukemia and several subtypes. Health professionals classify leukemia based on how quickly the disease gets worse and whether the leukemia cells arise from myeloid or lymphoid cells.

leukemia classifications

Health professionals classify leukemia based on how quickly it progresses and the type of blood cell involved.

By the speed of the course of the disease.

• acute leukemia.Leukemia cells divide rapidly and the disease progresses rapidly. If you have acute leukemia, you will feel sick for weeks after the leukemia cells form. Acute leukemia is life-threatening and requires immediate initiation of therapy. Acute leukemia is the most common cancer in children.
• chronic leukemia.Often these leukemia cells behave like immature and mature blood cells. Some cells develop to the point where they function like the cells they are supposed to become, but not to the extent that their normal counterparts do. The disease usually worsens slowly compared to acute leukemia. If you have chronic leukemia, you may not have noticeable symptoms for years. Chronic leukemia is more common in adults than in children.

By cell type

• Myeloid (mai-uh-lOW-juh-nuhs) or myeloid leukemiadevelops from myeloid cells. Normal myeloid cells become red blood cells, white blood cells, and platelets.
• lymphocytic leukemiaIt develops from lymphatic cells. Normal lymphoid cells become white blood cells, which are an important part of your body's immune system.

types of leukemia

There are four main types of leukemia:

• Acute Lymphocytic Leukemia (ALL)It is the most common type of leukemia in children, adolescents, and young adults up to age 39. ALL can affect adults of any age.
• Aguda myeloid leukemia (AML) It is the most common form of acute leukemia in adults. It is more common in older adults (over 65 years of age). AML also occurs in children.
• Chronic lymphocytic leukemia (CLL)it is the most common chronic leukemia in adults (more common in people older than 65 years). CLL may not show any symptoms for several years.
• Chronic myeloid leukemia (CML)it is more common in older adults (more common in people older than 65 years), but it can affect adults of any age. It rarely occurs in children. CML may not show symptoms for several years.

How common is leukemia?

Leukemia is the 10th most common cancer in the United States, accounting for 3.2% of all new cancer cases. Leukemia can affect anyone, but it is more common in people who:

• 65 to 74 years.
• Male Assigned at Birth (AMAB).
• Caucasian/White.

Many people mistake leukemia for childhood cancer, but some forms are more common in adults. Although childhood leukemia is rare, it is the most common cancer in children and adolescents.

symptoms and causes

What are the symptoms of leukemia?

Symptoms depend in part on the type of leukemia. For example, if you have a chronic form of leukemia, you may not have any noticeable symptoms in the early stages.

Common signs and symptoms of leukemia include:

• Fatigue, gets tired easily.
• fever or night sweats.
• Frequent infections.
• Shortness of breath.
• Pale skin.
• Unexplained weight loss.
• Pain or tenderness in bones/joints.
• Pain or fullness under the ribs on the left side.
• swollen lymph nodesin the neck, armpit, groin, or enlarged stomach, spleen, or liver.
• Bruising and bleeding easily, includingnosebleeds, bleeding gums, a rash that looks like small red spots on the skin (petechiae) or purple/dark spots on the skin.

What causes leukemia?

Leukemia begins when the DNA of a single cell in the bone marrow changes (mutates). DNA is the "instruction code" that tells a cell when to grow, develop, and when to die. Due to the mutation or coding error, the leukemia cells continue to multiply. All cells that arise from the originally mutated cell also have the mutated DNA.

Scientists don't know what causes these developing cells to mutate. They were able to identify some common mutations shared by people diagnosed with different types of leukemia.

Are some people at higher risk of developing leukemia?

Anyone can get leukemia. Still, studies have shown that certain factors can increase your risk, including:

• Previous cancer treatment.Previous cancer treatments, such as radiation or chemotherapy, can make you more likely to develop some types of leukemia.
• To smoke.If you have smoked in the past or have been exposed to secondhand smoke, you are at increased risk of developing acute myelogenous leukemia.
• Exposure to industrial chemicals.Benzene and formaldehyde are known cancer-causing chemicals found in building materials and household chemicals. Benzene is used in the manufacture of plastics, rubber, dyes, pesticides, medicines, and detergents. Formaldehyde is found in building materials and household products such as soaps, shampoos, and detergents.
• Certain genetic disorders.genetic disorders such asneurofibromatosis,Klinefelter syndrome, Schwachman-Diamond syndrome andDown syndrome, may increase your risk.
• family history of leukemia.Research suggests that some types of leukemia can run in families. However, in most cases, a relative who has leukemia does not mean that you or another family member will also have leukemia. Tell your doctor if you or a family member has a genetic condition. They may recommend genetic testing to assess your risk.

diagnosis and test

How is leukemia diagnosed?

The results of routine blood tests can alert your doctor that you may have an acute or chronic form of leukemia that requires further testing. Or they may recommend an evaluation if you have symptoms of leukemia.

Diagnostic exams and tests may include:

• Physical exam:Your doctor will ask about your symptoms, looking for swollen lymph nodes and an enlarged spleen or liver. They may also examine your gums for bleeding and swelling. You can look for a rash associated with leukemia, which can appear red, purple, or brown.
• Complete blood count (CBC):This blood test lets your doctor know if you have abnormal levels of red blood cells, white blood cells, and platelets. If you have leukemia, you may have a higher than normal white blood cell count.
• Blood cell test:Your doctor may take additional blood samples to look for markers that indicate the presence of leukemia cells or a specific type of leukemia.flow cytometryand a peripheral blood smear are additional tests your doctor may order.
• Knochenmark biopsy(bone marrow aspiration):Your doctor may do a biopsy if you have an abnormal white blood cell count. A long needle inserted into the bone marrow (usually the pelvic bone) draws out fluid during the procedure. The fluid sample is tested for leukemia cells in a laboratory. A bone marrow biopsy helps determine the percentage of abnormal cells in the bone marrow and confirms the diagnosis of leukemia.
• Imaging and other tests:Your doctor can order achest x-ray,computed tomography, oMagnetic resonance imaging (MRI).if your symptoms suggest that the leukemia has affected your bones, organs, or tissues. Leukemia cells do not appear on the image.
• lumbar puncture(spinal tap): Your doctor may test a sample of spinal fluid to see if the leukemia has spread to the spinal fluid that surrounds the brain and spinal cord.

management and treatment

How is leukemia treated?

Treatments for leukemia depend on the type of leukemia you have, your age and general health, and whether the leukemia has spread to other organs or tissues.

Common treatments generally involve a combination of the following:

• Chemotherapy:Chemotherapy is the most common form of leukemia treatment. Chemicals are used to kill leukemia cells or stop them from dividing. During treatment, you may be given the chemicals (medications) as pills, a shot into a vein, or an injection under the skin. Usually, you will receive a combination of chemotherapy drugs.
• Immunotherapy (biological therapy): This treatment uses certain medicines to stimulate your body's defense system, your immune system, to fight the leukemia. Immunotherapy helps the immune system recognize cancer cells and make more immune cells to fight them.
• targeted therapy:This treatment uses drugs that target specific parts of a leukemia cell (such as a protein or gene) that cause it to outgrow normal blood cells. Targeted therapies can stop the leukemia cells from dividing, cut off the blood supply to the cells, or kill them entirely. Targeted therapy is less likely to harm normal cells. Examples of targeted therapy drugs includemonoclonal antibodiesand tyrosine kinase inhibitors.
• Radiotherapy:This treatment uses powerful energy beams, or x-rays, to kill leukemia cells or keep them from growing. During treatment, a machine directs radiation at areas of the body where cancer cells are found or distributes radiation throughout the body. Radiation distribution throughout the body can occur prior to hematopoietic cell transplantation.
• Hematopoietic cell transplantation(mother cell orBone marrow transplant):This treatment replaces blood-forming cancer cells that have been destroyed by chemotherapy or radiation therapy with new, healthy blood-forming cells. Your doctor can remove these healthy cells from your blood or bone marrow before chemotherapy and radiation, or they can come from a donor. The new healthy cells multiply and form new bone marrow and blood cells, which become the red blood cells, white blood cells, and platelets your body needs.
• Chimeric Antigen Receptor (CAR) T Cell Therapy:This is a new therapy that takes infection-fighting T cells in your body (T cells or T lymphocytes is a type of immune cell), changes them to fight leukemia cells, and infuses them back into your body.

Clinical trials are also available to test new cancer treatments. Consider the possible benefits and risks of participating in a clinical trial with your doctor.

What are the stages of leukemia treatment?

Depending on your treatment plan, you may receive ongoing leukemia treatments over a long period of time or phased treatment. In general, a step-by-step treatment consists of three parts. Each phase has a specific objective.

1. induction therapy.The goal is to kill as many leukemia cells in the blood and bone marrow as possible to achieve remission. In remission, the blood cell count returns to normal levels, no leukemia cells are found in the blood, and all signs and symptoms of the disease disappear. Induction therapy usually lasts four to six weeks.
2. Consolidation (also called escalation).The goal is to kill any remaining undetected leukemia cells to prevent the cancer from coming back. Typically, you will receive consolidation therapy in cycles lasting four to six months.
3. maintenance therapy.The goal is to destroy any leukemia cells that may have survived the first two phases of treatment and prevent the cancer from coming back (recurrence). Treatment lasts about two years.

Your doctor may continue or change your treatment if the leukemia comes back.

Outlook / Forecast

What outcome can I expect if I am diagnosed with leukemia?

It is difficult to predict the prognosis of leukemia because each person's experience is different. Results depend on a variety of factors, including:

• Genetic abnormalities or mutations.Mutations in leukemic cells are the most important predictor of outcome.
• type of leukemia.Certain types of leukemia are associated with more favorable outcomes than others.
• Number of blood cells at the time of diagnosis.The number of leukemia cells at your diagnosis may play a role in your outcome.
• Years.In general, the younger you are when diagnosed, the better the outcome.
• Health.In general, the healthier you are when you are diagnosed, the better the outcome.
• response to treatment.The time it takes for cancer to go into remission often shows how successful a treatment can be.
• Presence of leukemic cells in your central nervous system.Cerebrospinal fluid cells are often more difficult to treat.

Ultimately, your doctor is the most trusted source for understanding how your cancer affects your individual prognosis. Ask about the results of the treatment.

What is the survival rate for leukemia?

Although the number of new leukemia cases in the United States has remained relatively constant or increased slightly since the 1970s, survival rates have also improved. Still, long-term results vary for each person.

The National Cancer Institute reports the following survival data for the four main types of leukemia:

Table title:

ALL = acute lymphocytic leukemia; AML = acute myeloid leukemia; CLL = chronic lymphocytic leukemia; CML = chronic myelogenous leukemia

*Survival rate compares patients diagnosed with cancer to people of the same age, race, and sex who do not have cancer.

Datenquelle: SEER Cancer Statistics Review, 1975-2017, National Cancer Institute. Bethesda, MD.

Can leukemia be cured?

There is no cure for leukemia, but that doesn't mean some people can't achieve long-term remission. Being cured of leukemia means the cancer is gone, won't come back, and no further treatment is needed, but it's hard to say for sure with leukemia.

On the other hand, long-term remission means that there are no signs of cancer with or without treatment. Remission can last from a few weeks to many years. The leukemia may never come back. If that's the case, your doctor may recommend new treatments to help you achieve remission.

Your medical team can best answer the question, "Am I cured of my leukemia?" Your team will work closely with you to monitor your health and develop a personalized treatment plan.

live with

What questions should I ask my provider?

Empower yourself by learning all you can about how a cancer diagnosis can uniquely affect you. It's a good idea to take notes and bring a friend to your appointments. Don't be afraid to ask questions.

Questions can be:

• What kind of leukemia do I have? In which cell? Is it a fast-growing or slow-growing cancer?
• How early was the leukemia discovered?
• What are my treatment options?
• What are the benefits and risks of each type of treatment?
• What treatment plan is best for me? Why?
• When should treatment start?
• How long does the treatment (and each phase of the treatment) last?
• How long will I be in the hospital?
• What are the side effects of treatment? What can be done to prevent or reduce these side effects?
• What if I want to have children? What options do I have to preserve my fertility?
• What is the success/survival rate for my type of leukemia?
• Should I enroll in a clinical trial?

frequent questions

Where can I find clinical studies on leukemia?

For more information on clinical trials for leukemia, visit:

• Leukemia and Lymphoma SocietyClinical Trials Support Center.
• National Cancer Institute.Information about clinical trials for patients and caregivers.
• American Cancer Society.clinical trials.
• cancer studiesat the Cleveland Clinic.

Where can I find self-help groups?

To connect with people living with leukemia or to find additional support from people who understand what it means to live with a cancer diagnosis, visit their locationKapitel der Leukemia & Lymphoma Society.

A note from the Cleveland Clinic

Any cancer diagnosis is scary, but a leukemia diagnosis can feel special. It can be hard to imagine what the treatment experience will be like without a tumor that can be removed. The prognosis can be intimidating to imagine. Remember that leukemia is not something with results. Your treatment and the chance of long-term remission depend on many factors. No one can predict your results without understanding your health and your leukemia, even the characteristics of the leukemia cells. Talk to your doctor about what a leukemia diagnosis means to you.