Leukemia

• Avoiding or quitting smoking

• Maintaining a healthy weight

• Avoiding certain harmful chemicals, such as benzene or formaldehyde

Successful treatment depends on a complete and accurate diagnosis.

Each of our patients receives a thorough evaluation so we can create an individualized plan. Because there are several types of leukemia, understanding any specific genetic alterations is vital so we can determine the best treatment approach.

Typically, we diagnose leukemia with the following:

• History and physical examination: We conduct a thorough examination and ask comprehensive questions about your full personal and family medical history.

• Blood work: We may take a blood sample to test your complete blood count (CBC), blood chemistry, and other factors.

• Biopsy: We use a hollow needle to remove a small sample of bone marrow, blood, and bone from the hip bone or breastbone. The samples are studied under a microscope and may get other testing, including analysis for genetic changes.

After collecting blood and tissue samples, our hematopathologists thoroughly analyze them to identify the molecular profile of the leukemia cells. We may also conduct additional testing to confirm the type and determine whether it has spread. These tests may include:

• Chest x-ray: Low-dose radiation is used to take pictures of the chest.

• CT (CAT) scan: Computed tomography takes a series of X-rays from different angles, then stitches them together into 3D images.

• MRI: Magnetic resonance imaging uses a powerful magnetic field and radio waves to create detailed 3D images at higher contrast than CT scans which can be useful for clarifying other test results.

• Lumbar puncture (LP, or Spinal Tap): A needle is inserted into the spinal column to take a sample of cerebrospinal fluid.

• Biopsy of testicles, ovaries, or skin: A needle is used to remove cells or tissues if the cancer has caused changes to the testicles, ovaries, or skin, and the samples are checked under a microscope.

Types of cancer

Leukemia is classified by the type of white blood cell involved and how quickly it develops.

Each type has different characteristics—the kind of cells they start in, their growth rate, how they are treated, and whether they are found mainly in adults, teens, or children.

It develops from the two types of bone marrow stem cells:

• Lymphoid stem cells, which turn into lymphoblasts and then most infection-fighting white blood cells (lymphocytes)

• Myeloid stem cells, which turn into oxygen-carrying red blood cells, clot-forming platelets, and another type of white blood cell

Cancer causes too many cells to form, and they don’t mature. This means they fail to function properly and also crowd out other cells the body needs. The cancers also take one of two forms, based on how quickly they develop:

• Acute: The immature cells quickly build up and kill most patients within months if the disease is not treated.

• Chronic: The cancer progresses more slowly, giving most people longer to live, but usually proving harder to treat than acute cases. Chronic leukemia is rare in children and teens.

Combining the type of stem cell with the rate of growth gives the four main types of leukemia:

• Acute lymphocytic leukemia (ALL):

  • Most pediatric leukemia is ALL (three out of four cases)
  • Least common type among adults
  • Can spread to the central nervous system (brain and spinal cord)

• Acute myeloid leukemia (AML):

  • Represents most of the remaining pediatric leukemia cases
  • Relapses more frequently than ALL

• Chronic lymphocytic leukemia (CLL):

  • Mainly affects older adults, as the average age at diagnosis is around 72
  • Rarely curable but most patients live with it for many years
  • Might not need treatment right away, but usually need it eventually

• Chronic myeloid leukemia (CML):

  • Mainly affects adults—average age at diagnosis is around 64
  • Treatment doesn’t usually cure the disease, but keeps it in check

Treatments

Leukemia treatment depends on the cell type, speed of progression, your age, and overall health.

We take a comprehensive approach to treating this blood cancer with input from a multidisciplinary team. Through weekly tumor boards, experts in chemotherapy, targeted therapy, stem cell transplantation, and cellular immunotherapy collaborate on the best way to treat your leukemia based on its genetic makeup.

Our recommendations for the best treatment approach for adults typically depend on the following:

• Leukemia type: ALL, AML, CLL or CML

• Type of cells the cancer began in and the leukemia subtype, as patients with different subtypes may have different prognoses and responses to treatment

• Patient’s age and overall health

• The presence of certain genetic changes, including the Philadelphia chromosome

• If the leukemia is newly diagnosed or has come back (a relapse)

• Number of immature cells versus healthy red blood cells, white blood cells and/or platelets

• Whether the patient received chemotherapy in the past for a different cancer

• Whether there is a history of a blood disorder like myelodysplastic syndrome 

• How quickly and how well the disease responds to initial treatment

• Size of the spleen (CLL and CML only)

• Size of the liver or lymph nodes (CML only)

• Whether the leukemia was likely caused by previous cancer treatment (AML only)

Chemotherapy

Chemotherapy is a common treatment for acute subtypes of this disorder. It's commonly given in the hospital as the initial treatment for patients with ALL or AML. The goal of this approach is to kill as many cancerous cells as possible and put the disease in remission, which means getting rid of any evidence of the disease. It's often followed by consolidation or maintenance chemotherapy, which is designed to ensure any remaining leukemia cells are destroyed.

Stem cell transplants and CAR T-cell therapy

Some patients with acute and chronic leukemia benefit from stem cell transplantation after other cancer treatment. Transplantation replaces damaged stem cells with healthy ones using cells from the patient's bloodstream (autologous) or a donor (allogeneic).

MedStar Health is the largest stem cell collection center in the nation and the only adult program accredited by the Foundation for the Accreditation of Cellular Therapy (FACT) in Washington, D.C. With decades of experience, our dedicated bone marrow transplant specialists, nurses, and staff have exceptional expertise in these life-saving treatments.

Immunotherapy and targeted therapy

For patients with subtypes of chronic leukemia, we offer the full range of targeted therapies that are very effective. Most of these treatments are given orally through a pill and are considered less toxic than chemotherapy. These innovative therapies can target specific characteristics of certain leukemic cells, which is why an accurate diagnosis and genetic profiling of blood cancer cells is so important. The type of targeted therapy we recommend will vary based on the molecular makeup of a patient's cancer but may include the following, among others:

 

• Tyrosine kinase inhibitors (TKIs): TKIs target the gene BCR-ABL, which is formed by an abnormal chromosome (the Philadelphia mutation) and makes a protein that helps cancer grow. TKIs are the main treatment for chronic myeloid leukemia (CML) and are also used for some acute lymphoblastic leukemia (ALL) patients who have the mutation.

• Monoclonal antibody: These drugs replicate a natural antibody and target certain substances on cancer cells either alone or with a drug, toxin, or radioactive material to kill the cells, block their growth, or keep them from spreading.

• FLT3 inhibitors: These drugs target mutations in the FLT3 gene in patients with acute myeloid leukemia (AML).