NIHSeniorHealth Leukemia (Print Version)

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Leukemia

What Is Leukemia?

Leukemia is a cancer of the blood cells. It is the most common type of blood

cancer and affects 10 times as many adults as children. Most people

diagnosed with leukemia are over 50 years old.

Leukemia usually begins in the bone marrow, the soft

material in the center of most bones where blood cells areformed. The bone marrow makes three types of blood cells,

and each type has a special function.

White blood cells fight infection and disease.

Red blood cells carry oxygen throughout the body.

Platelets help control bleeding by forming blood clots.

In people with leukemia, the bone marrow produces abnormal white bloodcells, called leukemia cells. At first, leukemia cells function almost normally.

But over time, as more leukemia cells are produced, they may crowd out the

healthy white blood cells, red blood cells, and platelets. This makes it difficult

for the blood to carry out its normal functions.

There are four common types of adult leukemia. Two are chronic, meaningthey get worse over a longer period of time. The other two are acute, meaning

they get worse quickly.

chronic lymphocytic leukemia

chronic myeloid leukemiaacute myeloid leukemia

acute lymphocytic leukemia

Chronic lymphocytic leukemia, chronic myeloid leukemia, and acute myeloid

leukemia are diagnosed more often in older adults. Of these, chronic

lymphocytic leukemia is the most common. Acute lymphocytic leukemia is

found more often in children.

The symptoms for each type of leukemia differ but may include fevers,

frequent infections, fatigue, swollen lymph nodes, weight loss, and bleedingand bruising easily. However, such symptoms are not sure signs of leukemia.

An infection or another problem also could cause these symptoms. Only a

doctor can diagnose and treat the problem.

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Myeloma and lymphoma are other types of cancer that affect

blood cells, but these cancer cells are rarely found in the bloodstream. Myeloma is the second most common form of blood

cancer, and it affects plasma cells, a type of white blood cell that

is found in the bone marrow. Lymphoma accounts for about fivepercent of all the types of cancer in the United States. It starts in

the lymphatic system, which is part of the body's immune

system. Both myeloma and lymphoma are more commonamong older adults and occur more often in men than women.

There are many treatments available to treat acute and chronic leukemia. They

include chemotherapy, biological therapy, or stem cell transplantation. Somepeople receive a combination of treatments. Acute leukemia usually needs to

be treated right away. But there are many different kinds of acute leukemia.

Some respond well to treatment and can be cured in many cases, while others

are more difficult to treat. Treatment for chronic leukemia can often control the

disease and its symptoms, but it can seldom cure the disease. However, there

is a recent treatment for chronic myeloid leukemia that can control the diseasefor a long time.

Quiz

1. Leukemia is the most common form of

A. lung cancer.

B. blood cancer.

C. skin cancer.

B is the correct answer. Leukemia is the most common form of blood cancer.It affects 10 times as many adults as children. Most people diagnosed with

leukemia are over 50 years old.

2. Leukemia occurs in

A. platelets.

B. red blood cells.

C. white blood cells.

C is the correct answer. Leukemia occurs in white blood cells. People withleukemia produce too many abnormal white blood cells, the type of cells that

help fight infection and disease. When these cells, called leukemia cells,

build up in the blood, they interfere with the function of the healthy white

blood cells, red blood cells, and platelets.

3. The most common type of leukemia in adults is

A. acute myeloid leukemia.

B. chronic lymphocytic leukemia.

C. chronic myeloid leukemia.

B is the correct answer. Chronic lymphocytic leukemia is the most common

type of leukemia in adults.


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4. Lymphoma is a type of cancer that starts in the

A. brain.

B. lymphatic system of the body.

C. plasma cells.

B is the correct answer. Lymphoma is another type of cancer that affects

blood cells. It starts in the lymphatic system and is more common among

older adults.

Who Is at Risk?

No one knows why some people develop leukemia and others do not.

However, scientists have identified some risk factors for the disease. A risk

factor is anything that increases a person's chances of developing a disease.

Most people who have known risk factors do not get leukemia, while many

who do get the disease have none of these risk factors.

Studies have identified the following risk factors for leukemia: older, male,

white, working with certain chemicals, smoking, exposure to very high levels

of radiation, certain health conditions, and past treatment with chemotherapy

or radiation therapy.

More than 65 percent of people diagnosed with leukemia are over 55.

Leukemia occurs more often in men than women and is more common amongwhite people than other races.

Chronic exposure to certain chemicals may lead to the development of

leukemia. Benzene is a widely used chemical that has been linked to leukemia.

The greatest risk of exposure to high concentrations of benzene is worksites

such as chemical plants and gasoline-related industries. However,

government agencies have regulated the amount of benzene exposure in theU.S. industry, so cases of leukemia linked to benzene now are rare in this

country.

Benzene is usually found in low levels in the general environment. However,areas around gasoline stations, high vehicular traffic, and industrial sources

may have higher levels. Benzene is also found in tobacco smoke. It is

estimated that about half of the benzene exposure in the United States is fromcigarette smoke. Smoking is a risk factor for leukemia.

Certain disorders and genetic diseases, such as Down syndrome, may

increase the risk of leukemia. About 3 out of 10 people with a blood disorder

known as myelodysplastic syndrome develop acute myeloid leukemia. In this

disorder, as in leukemia, abnormal cells are formed in the bone marrow and

too few healthy blood cells enter the bloodstream.

People exposed to very high levels of radiation, such as the atomic bomb

blast in Hiroshima, Japan or nuclear power plant accidents, also are at risk of

developing leukemia. Studies of atomic blasts have estimated that survivors


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have a five and a half times greater risk of developing leukemia than the

general public.

Although chemotherapy and radiation therapy have been helpful to a lot of

people in the treatment of many forms of cancer, and indeed are often

lifesaving. They have been linked to the development of second cancers,

including leukemia, many years after treatment. Chemotherapy for a first

cancer is a stronger risk factor for developing leukemia later than is radiationtherapy. The combination of chemotherapy and radiation can significantly

increase the risk of leukemia after a first cancer.

Powerful cancer-fighting chemotherapy drugs, known as alkylating agents and

epipodophyllotoxins, have been associated with leukemia. The dose given andlength of treatment as well as other factors may contribute to a person's risk

of developing leukemia. Acute myeloid leukemia is the most common type of

cancer that has been linked to chemotherapy treatment.

Radiation therapy may increase a person's chance of developing leukemia.

Several factors influence this risk, such as the dose of radiation administered.A person's age at the time of therapy does not seem to be a risk factor forleukemia.

Quiz

1. A risk factor is something that

A. increases a person's chances of getting a disease.

B. decreases a person's chances of getting a disease.

C. does not affect a person's chances of getting a disease.

A is the correct answer. A risk factor is something that increases a person's

chances of getting a disease. The exact cause of leukemia is not known, but

scientists have identified some risk factors. Having a risk factor, or even

several risk factors, does not mean that a person will develop leukemia,

however. And many people who get the disease do not have any known riskfactors.

2. Leukemia is more common in

A. infants.

B. people over 55.

C. young adults.

B is the correct answer. More than 65 percent of people diagnosed with

leukemia are over 55. However, people at any age can get leukemia.

3. Risk factors for leukemia include

A. age.B. past treatment with chemotherapy or radiation therapy.

C. working with certain chemicals.

D. all of the above


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D is the correct answer. Risk factors include older age, past treatment withchemotherapy or radiation therapy, and working with certain chemicals.

Other risk factors for leukemia are sex (male), race (white), smoking,

exposure to very high levels of radiation, and certain health conditions.However, most people who have known risk factors do not get leukemia,

while many who do get the disease have none of these risk factors.

4. Benzene is a chemical

A. found in the environment.

B. that has been linked to the development of leukemia.C. found in tobacco smoke.

D. all of the above

D is the correct answer. Benzene is a widely used chemical that has been

linked to leukemia. The greatest risk of exposure to high concentrations of

benzene is in the workplace. Although it is usually found in low levels in thegeneral environment, areas around gasoline stations, high vehicular traffic,

and industrial sources may have higher levels. It is estimated that about half

of the benzene exposure in the United States is from cigarette smoke.

Symptoms and Diagnosis

During the early stages of leukemia, there may be no symptoms. Many of the

symptoms of leukemia don't become apparent until a large number of normal

blood cells are crowded out by leukemia cells.

In chronic leukemia, symptoms develop gradually and are

generally not as severe as in acute leukemia. Chronic

leukemia is usually found during a routine doctor's exam

before symptoms are present. When symptoms appear,

they generally are mild at first and gradually get worse, but

sometimes they don't worsen until many years after an initial diagnosis.

Recently, researchers discovered that abnormal white blood cells can be

present in the blood of chronic lymphocytic leukemia patients more than six

years before a diagnosis. This finding may lead to a better understanding ofthe cellular changes that occur in the earliest stages of the disease and how

the disease progresses.

In acute leukemia, symptoms usually appear and get worse quickly. Peoplewith this disease usually go to their doctor because they feel sick.

People with leukemia may have very high levels of white blood cells, but

because the cells are abnormal, they are unable to fight infection. Therefore,

patients may develop frequent fevers or infections. A shortage of red blood

cells, called anemia, can cause a person to feel tired. Not having enough bloodplatelets may cause a person to bleed and bruise easily.

Some symptoms depend on where leukemia cells collect in the body.

Leukemia cells can collect in many different tissues and organs, such as the


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digestive tract, kidneys, lungs, lymph nodes, or other parts of the body,

including the eyes, brain, and testicles.

Other common symptoms of leukemia include headache, weight loss, pain in

the bones or joints, swelling or discomfort in the abdomen (from an enlarged

spleen), and swollen lymph nodes, especially in the neck or armpit. Symptoms

of acute leukemia may include vomiting, confusion, loss of muscle control,

and seizures.

Some of the symptoms of leukemia are similar to those caused by the flu or

other common diseases, so these symptoms are not sure signs of leukemia. It

is important to check with your doctor if you have these symptoms. Only a

doctor can diagnose and treat leukemia.

To find the cause of leukemia symptoms, the doctor will ask about medical

history and conduct a physical exam. During the exam, the doctor will check

for signs of disease such as lumps, swelling in the lymph nodes, spleen, and

liver, or anything else that seems unusual.

The doctor will need to do blood tests that check the levels and types of blood

cells and look for changes in the shape of blood cells. The doctor also maylook at certain factors in the blood to see if leukemia has affected other organs

such as the liver or kidneys.

Even if blood tests suggest leukemia, the doctor may look

for signs of leukemia in the bone marrow by doing a biopsy

before making a diagnosis. A biopsy is a procedure where

a small amount of bone marrow is removed from a bone. Apathologist examines the sample under a microscope to

look for abnormal cells.

There are two ways the doctor can obtain bone marrow. In a bone marrow

aspiration, marrow is collected by inserting a needle into the hipbone or

another large bone and removing a small amount of bone marrow. A bone

marrow biopsy is performed with a larger needle and removes bone marrowand a small piece of bone.

If leukemia cells are found in the bone marrow sample, the doctor may

perform more tests to determine if the disease has spread to other parts of the

body. The doctor may collect a sample of the fluid around the brain and spinalcord by performing a spinal tap and checking for leukemia cells or other signs

of problems.

Chest x-rays, computed tomography (CT) scans, and ultrasounds are tests

used to determine if leukemia has spread from the bone marrow. These tests

produce pictures of the inside of the body. With these tests, the doctor looksfor abnormalities such as enlarged organs or signs of infection.

Quiz

1. Symptoms of leukemia include

A. frequent infections.

B. weakness.


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C. weight loss.

D. all of the above

D is the correct answer. Common symptoms of leukemia include fevers or

night sweats, frequent infections, feeling weak or tired, and headache.Symptoms also include bleeding and bruising easily, pain in the bones or

joints, weight loss, swelling or discomfort in the abdomen, and swollen

lymph nodes, especially in the neck or armpit.

2. Chronic leukemia is usually found

A. at a routine doctor's visit before symptoms are present.B. after symptoms develop.

C. after the patient has become very sick.

A is the correct answer. Chronic leukemia is usually found at a routine

doctor's visit before symptoms are present. In the early stages of chronic

leukemia, cells function almost normally. When symptoms do appear, theyare generally mild at first and get worse gradually.

3. A doctor performs blood tests to

A. check the number of red blood cells, white blood cells, and platelets.

B. look for changes in the shape of blood cells.

C. see if leukemia has affected other organs such as the liver or kidneys.D. all of the above

D is the correct answer. Blood tests are used to determine the levels of red

blood cells, white blood cells, and platelets, and to look for leukemia cells.

The doctor also may look for other factors in the blood to determine if

leukemia has affected other organs in the body.

4. Chest x-rays, computed tomography (CT) scans, and ultrasound are tests

used to determine if leukemia

A. cells are present in the blood.

B. has spread from the bone marrow.C. has affected other types of blood cells.

B is the correct answer. Chest x-rays, computed tomography (CT) scans, and

ultrasound are tests used to determine if leukemia has spread from the bonemarrow. These tests are imaging tests that produce pictures of the inside of

the body. With these tests, the doctor looks for abnormalities such as

enlarged organs or signs of infection. A spinal tap also can be used to

determine if leukemia has spread.

Treatment and Research

There are many treatment options for people with leukemia. The choice of

treatment depends on your age and general health, the type of leukemia you


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have, whether or not it has spread outside the bone marrow, and other factors.

Treatment and Research - Planning Treatment

If tests show that you have leukemia, you should talk with

your doctor and make treatment decisions as soon as

possible, although many patients with chronic lymphocytic

leukemia do not require treatment for many years.

A team of specialists often treats people with leukemia. The team will keep the

primary doctor informed about the patient's progress. The team may include ahematologist who is a specialist in blood and blood-forming tissues, a medical

oncologist who is a specialist in cancer treatment, and a radiation oncologist

who is a specialist in radiation therapy.

Before starting treatment, you may want another doctor to review the

diagnosis and treatment plan. Some insurance companies require a second

opinion. Others may pay for a second opinion if you or your doctor requests it.

Some leukemia patients take part in studies of new treatments.

These studies, called clinical trials, are designed to find out

whether a new treatment is safe and effective and better thancurrent treatments. Talk to your doctor if you are interested in

taking part in a clinical trial.

The U.S. National Institutes of Health, through its National Library of Medicine

and other Institutes, maintains a database of clinical trials at ClinicalTrials.gov.

Click here to search for current clinical trials on leukemia. A separate window

will open. Click the "x" in the upper right hand corner of the "Clinical Trials"window to return here.

Quiz

1. A person with leukemia is usually treated by

A. their primary doctor only.

B. a team of specialists.

C. a dermatologist.

B is the correct answer. Leukemia is a complex type of cancer, so a team ofspecialists often treats a person with this disease. The team may include a

hematologist who is a specialist in blood and blood-forming tissues, a

medical oncologist who is a specialist in cancer treatment, and a radiation

oncologist who is a specialist in radiation therapy.

2. If you are diagnosed with leukemia, your doctor may request that you

A. get a second opinion.

B. go to work.

C. start exercising.

A is the correct answer. If you are diagnosed with leukemia, your doctor may

request that you get a second opinion. Before starting treatment, you may


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want another doctor to review the diagnosis and treatment plan.

3. Clinical trials often compare

A. two diseases.

B. older versus newer treatments.

C. clinics and hospitals.

B is the correct answer. Clinical trials are research studies in which new

treatments -- drugs, diagnostics, procedures, vaccines, and other therapies

-- are tested in people to see if they are safe, effective, and better than the

current standard of care.

4. If you are interested in participating in a clinical trial, you should

A. talk with your accountant.

B. talk with your lawyer.C. talk with your doctor.

C is the correct answer. If you are interested in participating in a clinical trial,

you should talk to your doctor. You and your doctor can discuss the risks

and benefits of participating in a clinical trial.

Treatment and Research - Standard Treatments

Unlike other types of cancer, leukemia isn't a tumor that your doctor can

surgically remove. Leukemia cells are produced in the bone marrow and travel

throughout the body.

Treatment depends on a number of factors, including the type of leukemia, the

patient's age and general health, whether leukemia cells are present in the

fluid around the brain or spinal cord, and whether the leukemia has beentreated before. It also may depend on certain features of the leukemia cells

and the patient's symptoms.

If a person has acute leukemia, they will need treatment right away. The

purpose of treatment is to stop the rapid growth of leukemia cells and to bringabout remission, meaning the cancer is under control. In many cases, a

person will continue treatment after signs and symptoms disappear to prevent

the disease from coming back. Some people with acute leukemia can be

cured.

Chronic leukemia may not need to be treated until symptoms appear.Treatment can often control the disease and its symptoms. However, chronic

leukemia can seldom be cured.

The goal of treatment for leukemia is to destroy the leukemia cells and allow

normal cells to form in the bone marrow. Depending on the type and extent of

the disease, patients may have chemotherapy, biological therapy, radiation

therapy, or stem cell transplantation. Some patients receive a combination oftreatments.


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Chemotherapy uses drugs to kill cancer cells. This is the most common

treatment for most types of leukemia. Chemotherapy may be taken by mouthin pill form, by injection directly into a vein, or through a catheter. If leukemia

cells are found in the fluid around the brain or spinal cord, the doctor may

inject drugs directly into the fluid to ensure that the drugs reach the leukemiacells in the brain.

Chemotherapy uses drugs to kill cancer cells. This is the mostcommon treatment for most types of leukemia. Chemotherapy

may be taken by mouth in pill form, by injection directly into a

vein, or through a catheter. If leukemia cells are found in the

fluid around the brain or spinal cord, the doctor may injectdrugs directly into the fluid to ensure that the drugs reach the

leukemia cells in the brain.

Biological therapy uses special substances that improve the body's natural

defenses against cancer. Some patients with chronic lymphocytic leukemia

receive monoclonal antibodies, which are man-made proteins that can identify

leukemia cells. Monoclonal antibodies bind to the cells and assist the body in

killing them.

Although monoclonal antibodies are being used to treatleukemia, researchers are studying more innovative ways

to use them in treatment. Some antibodies are used alone

to try to prompt the immune system to attack leukemia

cells. Other antibodies are attached to substances that can

poison cancer cells. These modified antibodies, called immunotoxins, deliver

the toxins directly to the cancer cells.

A natural substance called interferon is used to treat some patients with

chronic myeloid leukemia. This substance can slow the growth of leukemia

cells. The newest therapies target an enzyme responsible for the growth of themyeloid cells, and are very effective.

Radiation therapy uses high-energy x-rays to destroy cancer cells. A machine

outside the body directs high-energy beams at the spleen, the brain, or other

parts of the body where leukemia cells have collected. Radiation therapy is

used primarily to control disease in bones that are at risk of fracture or at sites

that are causing pain.

Stem cell transplantation uses high doses of chemotherapy and total body

irradiation to kill the leukemia cells. After these treatments, the patient's

immune system is usually very weak, because normal cells in the bone

marrow are killed along with the leukemia cells. Healthy stem cells must be

given to the patient to restore the immune system so it can fight infection and

disease.

There are several types of stem cell transplantation.

Bone marrow transplantation replaces a patient's bone marrow with

leukemia-free stem cells from bone marrow.

Peripheral stem cell transplantation uses stem cells that are collected

from the bloodstream.


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Umbilical cord blood transplantation uses stem cells from a newborn

baby.

Stem cells used for transplants come from the patient or a donor whose cells

match the patient's cells. Use of the patient's own cells is called autologous

stem cell transplantation. The cells are collected, treated to remove leukemia

cells, and stored. After the patient receives high-dose chemotherapy or

radiation treatment, their stored cells are returned to them.

Use of stem cells from a donor is called an allogeneic transplant. Allogeneic

transplantation can be done using cells from a sibling or from another

individual who has a similar immune system.

Quiz

1. The type of leukemia treatment that a doctor recommends depends on

A. the type of leukemia.

B. the patient's age and general health.C. whether a person has been treated for leukemia before.

D. all of the above

D is the correct answer. Treatment depends on a number of factors,

including the type of leukemia, the patient's age and general health, whether

leukemia cells are present in the fluid around the brain or spinal cord, and

whether the leukemia has been treated before. It also may depend on certain

features of the leukemia cells and the patient's symptoms.

2. Chronic lymphocytic leukemia patients who do not have symptoms

A. may not require immediate treatment.

B. need to be treated immediately.

C. may require surgery.

A is the correct answer. Chronic lymphocytic leukemia patients who do nothave symptoms may not require immediate treatment. The health care team

may suggest watchful waiting for some patients with chronic leukemia. They

will carefully monitor the patient's health so that treatment can begin once

symptoms occur.

3. Chemotherapy is a treatment that kills cancer cells with

A. radiation.

B. the body's natural defenses.

C. drugs.

C is the correct answer. Chemotherapy is a treatment that kills cancer cells

with drugs. It is the most common treatment for most types of leukemia.

These anti-cancer drugs may be taken by mouth in pill form, by injection

directly into a vein, or through a catheter. They also may be injected into the

cerebrospinal fluid if leukemia cells are found in the fluid around the brain orspinal cord.


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4. Monoclonal antibodies are

A. used in stem cell transplants.

B. man-made proteins that assist the body in killing the cancer cells.

C. natural proteins that destroy cancer cells.

B is the correct answer. Monoclonal antibodies are man-made proteins that

assist the body in killing the cancer cells. The use of monoclonal antibodies

is a form of biological therapy. The antibodies are produced in the lab and

they help improve the body's natural defenses against cancer. When an

antibody binds to a cancer cell, it prompts immune cells to attack and kill thecancer cell.

Treatment and Research - Latest Research

Researchers are conducting clinical trials in many parts of the country.Clinical trials already have led to advances, and researchers continue tosearch for more effective ways to treat and diagnose leukemia. They are

studying various drugs, immunotherapy, stem cell transplantation, and other

types of treatments. They are also studying the effectiveness of using

combinations of treatments.

The drug imatinib (Gleevec) is important in the treatment of chronic myeloid

leukemia. Imatinib targets an abnormal protein that is present in mostleukemia cells. By blocking the abnormal protein, imatinib kills the leukemia

cells, but it does not kill normal cells. However, imatinib stops working insome people with leukemia because the cells become resistant.

Fortunately, two drugs, dasatinib (Sprycel) and nilotinib (Tasigna), have

been effective in clinical trials for the treatment of people who stop

responding to imatinib. These drugs work against the same abnormal protein

targeted by imatinib, but in different ways.

Immunotherapy is a treatment that uses immune cells or antibodies to fight

leukemia or stop it from getting worse. The idea is to zero in on leukemia cells

so the treatment is less toxic to normal cells.

Leukemia vaccines are not vaccines in the way that most people think of them.

Unlike most vaccines, which help prevent diseases, leukemia vaccines are

used to treat someone who already has cancer.

A vaccine introduces a molecule called an antigen into the body. The immune

system recognizes the antigen as a foreign invader and attacks it.Researchers are studying a vaccine in which the antigen is the same abnormal

protein that imatinib targets. The vaccine causes immune cells to destroy

leukemia cells that contain this protein.

Gene therapy -- replacing, manipulating, or supplementing nonfunctional

genes with healthy genes -- is being explored for treatment of leukemia. It is

being studied as a way to stimulate a patient's immune system to kill leukemiacells and also to interfere with the production of proteins that cause cells to


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become cancerous.

Researchers also are investigating ways to improve current stem celltransplant techniques, such as more precise matching of donors to patients

and better ways to prepare the patient's immune system to accept the

transplanted cells.

A modified form of stem cell transplant, called a mini-transplant, has been

developed. Compared with standard stem cell transplants, this technique

requires less intensive radiation and chemotherapy before a patient is given

donor cells. This approach has made stem cell transplants a treatment option

for older adults and others who may not be able to tolerate high doses of

radiation or chemotherapy.

Because leukemia is a complicated disease, using more than one type of

treatment may be beneficial. Combining therapies can complement and

enhance the effects of each. For example, patients receiving a stem cell

transplant also undergo chemotherapy or radiation to prepare their body for

the new stem cells.

A clinical trial at the National Cancer Institute is taking this combinationtreatment one step further. The researchers are looking at giving drugs to

patients before and after the transplant so that the patient's immune system

will stop attacking the transplanted cells.

Quiz

1. Recent research in leukemia includes studies on

A. drug development.B. immunotherapy.

C. stem cell transplantation.

D. all of the above

D is the correct answer. Scientists are searching for more effective ways to

treat and diagnose leukemia. They are studying various drugs,immunotherapy, stem cell transplantation, and other types of treatments.

They are also looking at treating leukemia by combining treatment options.

2. The drug imatinib (Gleevec)

A. targets an abnormal protein that is present in most leukemia cells.

B. kills the leukemia cells, but it does not kill normal cells.C. stops working in some people with leukemia because the cells become

resistant.

D. all of the above

D is the correct answer. The drug imatinib (Gleevec) is important in the

treatment of chronic myeloid leukemia. Imatinib targets an abnormal protein

that is present in most leukemia cells. By blocking the abnormal protein,

imatinib kills the leukemia cells, but it does not kill normal cells. However,

imatinib stops working in some people with leukemia because the cellsbecome resistant. Fortunately, two drugs, dasatinib (Sprycel) and nilotinib


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(Tasigna), have been effective in clinical trials for the treatment of people

who stop responding to imatinib.

3. Leukemia vaccines

A. are used to prevent leukemia.

B. are given only to young people.

C. are used to treat someone who already has the disease.

C is the correct answer. Leukemia vaccines are used to treat someone who

already has the disease. Leukemia vaccines are not vaccines in the way that

most people think of them. Unlike most vaccines, which help preventdiseases, leukemia vaccines help immune cells target and kill leukemia cells

in someone who already has cancer.

4. A mini-stem cell transplant uses

A. fewer stem cells than a standard transplant.

B. smaller cells than a standard transplant.C. less intense radiation and chemotherapy than a standard transplant.

C is the correct answer. A mini-stem cell transplant uses less intense

radiation and chemotherapy than a standard transplant. A mini-transplant

may be an option for older adults who are not candidates for a standard

transplant because they are unable to tolerate high doses of radiation orchemotherapy.

Frequently Asked Questions

1. What is cancer?

Cancer begins in cells, which make up the blood and other tissues. Normally,cells grow, divide, and produce more cells as needed to keep the body healthy

and functioning properly. Sometimes, however, the process of creating a new

cell goes wrong -- cells become abnormal and form more cells in an

uncontrolled way.

2. What is leukemia?

Leukemia is a cancer of the blood cells. It usually begins inthe bone marrow where blood cells are formed. In

leukemia, the bone marrow produces abnormal white blood

cells. Over time, as the number of abnormal white bloodcells builds up in the blood, they crowd out healthy blood

cells. This makes it difficult for the blood to carry out its

normal functions.

3. What is the difference between acute leukemia and chronic leukemia?

Acute leukemia gets worse quickly. In chronic leukemia, symptoms develop

gradually and are generally not as severe as in acute leukemia.


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4. What are the most common types of leukemia?

There are four common types of leukemia. They are chronic lymphocyticleukemia, chronic myeloid leukemia, acute myeloid leukemia, and acute

lymphocytic leukemia. Chronic lymphocytic leukemia, chronic myeloid

leukemia, and acute myeloid leukemia are diagnosed more often in older

adults. Acute lymphocytic leukemia is found more often in children.

5. What are other cancers that affect blood cells?

Myeloma and lymphoma are other types of blood cancers. Bothare common among older adults and occur more often in men

than women. Myeloma affects plasma cells, a type of white

blood cells typically found in the bone marrow. Lymphomastarts in the lymphatic system, which is part of the body's

immune system.

6. Am I at risk of developing leukemia?

No one knows why some people develop leukemia and others do not. Most

people who have known risk factors do not get leukemia, while many who get

the disease do not have any risk factors. The following risk factors increase aperson's chance of developing leukemia: older, male, white, past treatment

with chemotherapy or radiation therapy, working with certain chemicals,

smoking, exposure to very high levels of radiation, and certain health

conditions.

7. Why does smoking increase a person's chance of developing leukemia?

Cigarette smoke contains the chemical benzene as well as many other toxicsubstances. Chronic exposure to high levels of benzene has been associated

with leukemia. Although benzene is found in low levels in most environments,

cigarette smoke is estimated to account for about half of the benzene

exposure in the United States.

8. What are the symptoms of leukemia?

Common symptoms of leukemia may include fevers; frequent infections;

feeling weak or tired; headache; bleeding and bruising easily; pain in thebones or joints; swelling or discomfort in the abdomen (from an enlarged

spleen); swollen lymph nodes, especially in the neck or armpit; and weight

loss. Symptoms of acute leukemia may include vomiting, confusion, loss of

muscle control, and seizures.

9. What are some tests for leukemia?

There are no standard or over-the-counter tests for leukemia. Your doctor can

request lab analyses for leukemia that include blood tests that check the

levels and types of blood cells and look for changes in the shape of blood

cells. The doctor may also look for signs of leukemia in the bone marrow or

the fluid around the brain or the spinal cord

10. How does a doctor collect bone marrow?


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There are two ways that a doctor can obtain bone marrow:

through a bone marrow aspiration or a bone marrowbiopsy. A bone marrow aspiration is performed by inserting

a needle into the hipbone or another large bone to remove

a small amount of bone marrow. In a bone marrow biopsy,marrow is collected with a larger needle. During this procedure, a small piece

of bone may also be removed.

11. Can my primary doctor treat leukemia?

A team of specialists often treats people with leukemia. The team may include

a hematologist who is a specialist in blood and blood-forming tissues, a

medical oncologist who is a specialist in cancer treatment, and a radiationoncologist who is a specialist in radiation therapy. The team keeps the primary

doctor informed of the patient's progress.

12. How does my doctor decide which leukemia treatment is best for me?

Treatment depends on a number of factors, including thetype of leukemia, the patient's age and general health,

where leukemia cells have collected in the body, andwhether the leukemia has been treated before. Certain

features of the leukemia cells and the patient's symptoms

also may determine treatment options.

13. What are the standard treatments for leukemia?

Standard treatments for leukemia include chemotherapy, biological therapy,

radiation therapy, and stem cell transplantation. Some patients receive acombination of treatments.

14. What is chemotherapy?

Chemotherapy is a cancer treatment that uses drugs to kill

cancer cells. This is the most common treatment for most types

of leukemia. Chemotherapy may be taken by mouth in pill form,

by injection directly into a vein, or through a catheter. Ifleukemia cells are found in the fluid around the brain or spinal

cord, the doctor may inject drugs directly into the fluid to

ensure that the drugs reach the leukemia cells in the brain.

15. What is biological therapy?

Biological therapy is a treatment that uses a person's own

immune system to fight leukemia. This therapy uses

special substances to stimulate the immune system's

ability to fight cancer. Some patients with chronic

lymphocytic leukemia receive monoclonal antibodies,

which are man-made proteins that can identify leukemia cells and help the

body kill them. Interferon is used to treat some people with chronic myeloidleukemia. It is a natural substance that can slow the growth of leukemia cells.

The newest therapies target an enzyme responsible for the growth of the

myeloid cells, and are very effective in many patients.


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16. What is radiation therapy?

Radiation therapy is a cancer treatment that uses high-energy x-rays todestroy cancer cells. Some patients received radiation treatment that is

directed at the whole body. Total-body irradiation usually is given before a

bone marrow transplant.

17. What is stem cell transplantation?

In stem cell transplantation, high doses of chemotherapy and total body

irradiation are used to kill leukemia cells. Since normal cells in the bonemarrow are also killed, the patient's immune system is very weak. After what is

called depletion therapy, healthy stem cells are given to the patient to restore

the immune system.

18. What are the different types of stem cell transplantation?

There are three different types of stem cell transplantation. Each uses stem

cells from different sources.

Bone marrow transplantation replaces a patient's bone marrow with

leukemia-free stem cells from bone marrow.

Peripheral stem cell transplantation uses stem cells that are collected

from the bloodstream.

Umbilical cord blood transplantation uses stem cells from a newborn

baby.

19. What is a clinical trial?

Clinical trials are research studies in which new treatments --drugs, diagnostics, procedures, vaccines, and other therapies --are tested in people to see if they are safe, effective, and better

than the current standard of care. Clinical trials often compare a

new treatment with a standard treatment to determine which one

gives better results. People with leukemia who are interested in taking part in

a clinical trial should contact their doctor or go to www.clinicaltrials.gov.

20. What new treatments for leukemia are being developed?

Researchers are studying various drugs, immunotherapies, stem cell

transplantation techniques, and other types of treatments. Because leukemia

is a complicated disease, researchers are also studying the effectiveness of

using combinations of treatments. Following are a few examples of some

areas of current research.

Because leukemia is a complex disease, using more than one type oftreatment may be beneficial. Combining therapies can complement and

enhance the effects of each. For example, patients receiving a stem cell

transplant also undergo chemotherapy or radiation to prepare their body for

the new stem cells. Also, researchers at the National Cancer Institute are

looking at giving drugs to patients before and after the transplant that will stopthe patient's immune system from attacking the transplanted cells.

The drug imatinib (Gleevec) is important in the treatment of chronic myeloid

leukemia. However, imatinib stops working in some people with leukemia


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because the cells become resistant. Fortunately, two drugs, dasatinib

(Sprycel) and nilotinib (Tasigna), have been shown to be effective in clinicaltrials for the treatment of people who stop responding to imatinib. Both are

approved by the FDA for use in patients. These drugs work against the same

abnormal protein targeted by imatinib, but in different ways.

Gene therapy -- replacing, manipulating, or supplementing nonfunctional

genes with healthy genes -- is being explored for treatment of leukemia. It isbeing studied as a way to stimulate a patient's immune system to kill leukemia

cells and also to interfere with the production of proteins that cause cells to

become cancerous.

A modified form of stem cell transplant, called a mini-transplant, has beendeveloped. Compared with standard stem cell transplants, this technique

requires less intensive radiation and chemotherapy before a patient is given

donor cells. This approach has made stem cell transplants a treatment option

for older adults and others who may not be able to tolerate high doses of

radiation or chemotherapy.

21. Where can I find more information about research on leukemia?

The National Cancer Institute has developed a comprehensive online cancer

database called the Physician Data Query, or PDQ, to present evidence from

the most recent research on leukemia. Click here to see the PDQ. A window

will open. Click the "x" in the upper right hand corner of the "PDQ" window to

return here.

Topic las t rev iew ed: 06 January 2011

Topic f i rs t publ ished: 23 Oct ober 2008


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NIHSeniorHealth Leukemia (Print Version)