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What to know about leukemia


 


Leukemia is a cancer of the blood or bone marrow. Bone marrow produces blood cells. Leukemia can develop due to a problem with blood cell production. It usually affects the leukocytes, or white blood cells.


Leukemia is most likely to affect people over the age of 55 yearsTrusted Source, but it is also the most common cancer in those aged under 15 years.


The National Cancer Institute estimates that 61,780 peopleTrusted Source will receive a diagnosis of leukemia in 2019. They also predict that leukemia will cause 22,840 deaths in the same year.


Acute leukemia develops quickly and worsens rapidly, but chronic leukemia gets worse over time. There are several different types of leukemia, and the best course of treatment and a person’s chance of survival depends on which type they have.

Causes

Treament for leukemia depends on the type a person has.

Leukemia develops when the DNA of developing blood cells, mainly white cells, incurs damage. This causes the blood cells to grow and divide uncontrollably.


Healthy blood cells die, and new cells replace them. These develop in the bone marrow.


The abnormal blood cells do not die at a natural point in their life cycle. Instead, they build up and occupy more space.


As the bone marrow produces more cancer cells, they begin to overcrowd the blood, preventing the healthy white blood cells from growing and functioning normally.


Eventually, the cancerous cells outnumber healthy cells in the blood.


Risk factors

There is a range of risk factors for leukemia. Some of these risk factors have more significant links to leukemia than others:


Artificial ionizing radiation: This could include having received radiation therapy for a previous cancer, although this is a more significant risk factor for some types than others.


Certain viruses: The human T-lymphotropic virus (HTLV-1) has links to leukemia.


Chemotherapy: People who received chemotherapy treatment for a previous cancer have a higher chance of developing leukemia later in life.


Exposure to benzene: This is a solvent that manufacturers use in some cleaning chemicals and hair dyes.


Some genetic conditions: Children with Down syndrome have a third copy of chromosome 21. This increases their risk of acute myeloid or acute lymphocytic leukemia to 2–3%Trusted Source, which is higher than in children without this syndrome.


Another genetic condition with links to leukemia is Li-Fraumeni syndrome. This causes a change to the TP53 gene.


Family history: Having siblings with leukemia can lead to a low but significant risk of leukemia. If a person has an identical twin with leukemia, they have a 1 in 5 chance of having the cancer themselves.


Inherited problems with the immune system: Certain inherited immune conditions increase the risk of both severe infections and leukemia. These include:


ataxia-telangiectasia

Bloom syndrome

Schwachman-Diamond syndrome

Wiskott-Aldrich syndrome

Immune suppression: Childhood leukemia may develop due to the deliberate suppression of the immune system. This might occur following an organ transplant as a child takes medications to prevent their body from rejecting the organ.


Several risk factors need further studies to confirm their link to leukemia, such as:


exposure to electromagnetic fields

exposure to certain chemicals in the workplace, such as gasoline, diesel, and pesticides

smoking

using hair dyes


Types

There are four main categories of leukemia:


acute

chronic

lymphocytic

myelogenous

Chronic and acute leukemias


During its lifespan, a white blood cell goes through several stages.


In acute leukemia, developing cells multiply quickly and collect in the marrow and blood. They exit the bone marrow too early and are not functional.


Chronic leukemia progresses more slowly. It allows for the production of more mature, useful cells.


Acute leukemia overcrowds the healthy blood cells more quickly than chronic leukemia.


Lymphocytic and myelogenous leukemias


Doctors classify leukemia according to the type of blood cell they affect.


Lymphocytic leukemia occurs if cancerous changes affect the type of bone marrow that makes lymphocytes. A lymphocyte is a white blood cell that plays a role in the immune system.


Myelogenous leukemia happens when the changes affect bone marrow cells that produce blood cells, rather than the blood cells themselves.


Acute lymphocytic leukemia

Children under 5 years old are at the highest riskTrusted Source of developing acute lymphoblastic leukemia (ALL). However, It can also affect adults, typically over the age of 50 years. Out of every five deaths from ALL, four occur in adults.


Read more about ALL.


Chronic lymphocytic leukemia

This is most common among adults over 55 years, but younger adults can also develop it. About 25%Trusted Source of adults with leukemia have chronic lymphocytic leukemia (CLL). It is more common in men than in women and rarely affects children.


Learn more about CLL here.


Acute myelogenous leukemia

Acute myelogenous leukemia (AML) is more commonTrusted Source in adults than in children, but overall, it is a rare cancer. It develops more often in men than in women.


It develops quickly, and symptoms include fever, difficulty breathing, and pain in the joints. Environmental factors can trigger this type.


Here, learn more about AML.


Chronic myeloid leukemia

Chronic myelogenous leukemia (CML) mostly develops in adults. About 15%Trusted Source of all leukemia cases in the United States are CML. Children rarely develop this type of leukemia.


Treatment 

Treatment options will depend on the type of leukemia a person has, their age, and their overall state of health.


The primary treatment for leukemia is chemotherapy. A cancer care team will tailor this to suit the type of leukemia.


If treatment starts early, the chance of a person achieving remission is higher.


Types of treatment include:


Watchful waiting: A doctor may not actively treat slower growing leukemias, such as chronic lymphocytic leukemia (CLL).


Chemotherapy: A doctor administers medications intravenously (IV), using either a drip or a needle. These target and kill cancer cells. However, they can also damage noncancerous cells and cause severe side effects, including hair loss, weight loss, and nausea.


Chemotherapy is the primary treatment for AML. Sometimes, doctors may recommend a bone marrow transplant.


Targeted therapy: This type of treatment uses tyrosine kinase inhibitors that target cancer cells without affecting other cells, reducing the risk of side effects. Examples include imatinib, dasatinib, and nilotinib.


Many people with CML have a gene mutation that responds to imatinib. One study found that people who received treatment with imatinib had a 5-year survival rate of around 90%Trusted Source.


Interferon therapy: This slows and eventually stops the development and spread of leukemia cells. This drug acts in a similar way to substances that the immune system naturally produces. However, it can cause severe side effects.


Radiation therapy: In people with certain types of leukemia, such as ALL, doctors recommend radiation therapy to destroy bone marrow tissue before a transplant.


Surgery: Surgery often involves removing the spleen, but this depends on the type of leukemia a person has.


Stem cell transplantation: In this procedure, a cancer care team destroys the existing bone marrow with chemotherapy, radiation therapy, or both. Then, they infuse new stem cells into the bone marrow to create noncancerous blood cells.


This procedure can be effective in treating CML. Younger people with leukemia are more likely to undergo a successful transplant than older adults.

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