LEUKEMIA

There are several different types of leukemia. It may be acute or chronic. Acute leukemia gets worse very fast and may make you feel sick right away. Chronic leukemia gets worse slowly and may not cause symptoms for years.  It may be lymphocytic or myelogenous.

The four main types of leukemia are:

• Acute lymphoblastic leukemia, or ALL.
• Acute myelogenous leukemia, or AML.
• Chronic lymphocytic leukemia, or CLL.
• Chronic myelogenous leukemia, or CML.

There are less common leukemias, such as hairy cell leukemia. There are also subtypes of leukemia, such as acute promyelocytic leukemia (a subtype of AML).

Experts don’t know what causes leukemia. Some things may increase your risk, such as being exposed to large amounts of radiation and being exposed to certain chemicals at work, such as benzene.

Symptoms may depend on what type of leukemia you have, but common symptoms include:

• Fever or chills.
• A new lump or swollen gland in your neck, under your arm, or in your groin.
• Frequent nosebleeds, bleeding from the gums or rectum, more frequent bruising, or very heavy menstrual bleeding.
• Frequent fevers.
• Night sweats.
• Bone pain.
• Unexplained appetite loss or recent weight loss.
• Feeling tired a lot without a known reason.
• Swelling and pain on the left side of the belly.

DIAGNOSIS

Tests to diagnose leukemia

If your doctor suspects leukemia, he or she may:

• Ask about your medical history.
• Check for enlarged lymph nodes in your neck, underarm, or groin.
• Check for an enlarged liver or spleen
• Do a complete blood count (CBC) and a blood chemistry. These tests let your doctor look into symptoms such as fatigue, weakness, fever, bruising, or weight loss.
• Do a bone marrow aspiration and biopsy. This is the key to diagnosing most leukemias and helps determine the type.

Finding the type of leukemia

If your blood work points to possible leukemia, your doctor will want to find out what kind you might have. Your treatment plan will depend on the specific kind of leukemia that you have.

• A blood test is usually enough to find signs of chronic lymphocytic leukemia (CLL).
• Tests that look closely at unusual cells, chromosomes, or proteins on cells can show what type or subtype of leukemia you have. These tests include:
  • A test that looks for certain changes in the cell chromosomes from a sample of blood or bone marrow (cytogenetic analysis).
  • A test that compares cancer cells to normal blood cells to find the specific kind of leukemia (immunophenotyping).
  • A test to look for genes that are “turned on” in several types of leukemia, such as acute myelogenous leukemia (AML). This test is called a reverse transcription-polymerase chain reaction test, or RT-PCR.

These tests can help guide treatment. Sometimes they can help your doctor and you know whether your leukemia is likely to go into remission or come back. In some cases, the tests can predict survival rates.

Your doctor may also order other tests, including:

• Chest X-rays, to find out if leukemia or an infection is the cause of lung problems such as persistent coughing, coughing up blood, chest pain, or trouble breathing.
• CT scan of the head, chest, and belly, to find out if leukemia has spread there.
• Lumbar puncture, to find out if leukemia cells are in your cerebrospinal fluid (CSF).
• MRI of the brain, to look into symptoms such as confusion, paralysis, numbness, vision problems, vertigo, or headaches. Those symptoms could mean that leukemia has spread to the brain.
• A biopsy of a lymph node or other tissues, to look for leukemia cells.

RECOMMENDED MEDICATIONS

Chemotherapy is the standard treatment for many types of leukemia. Even when a cure isn’t possible, chemotherapy may help you live longer and feel better.

Chemotherapy for leukemia is usually a combination of drugs. This is because different drugs attack leukemia cells in different ways. The combination also helps keep the leukemia cells from becoming resistant to any one drug.

Along with the chemotherapy drugs, other medicines may be given to help the chemotherapy drugs work better and prevent infection or bleeding. These drugs include epoetin and hematopoietic stimulants.

Some types of acute leukemia spread to the brain and spinal cord. Regular chemotherapy can’t 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.

Medicine choices

For acute leukemia

Your treatment plan will include the kind of medicine that works best for the specific type or subtype of leukemia that you have.

• Acute lymphoblastic leukemia (ALL) may be treated with chemotherapy medicines (asparaginase, clofarabine, daunorubicin, doxorubicin, methotrexate, nelarabine, or vincristine) and corticosteroids (dexamethasone or prednisone).
• Acute myelogenous leukemia (AML) may be treated with chemotherapy medicines (cytarabine, daunorubicin, idarubicin, or mitoxantrone).
• Acute promyelocytic leukemia (APL) may be treated with chemotherapy medicines (daunorubicin or idarubicin). Other medicines include arsenic trioxide and all-trans-retinoic acid (ATRA).

For chronic leukemia

• Chronic lymphocytic leukemia (CLL) may be treated with chemotherapy medicines (bendamustine, chlorambucil, cyclophosphamide, fludarabine, or vincristine), corticosteroids (such as prednisone), and monoclonal antibodies (such as alemtuzumab or rituximab).
• Chronic myelogenous leukemia (CML) may be treated with chemotherapy medicines (cyclophosphamide or cytarabine) and tyrosine kinase inhibitors (such as dasatinib, imatinib, or nilotinib).
• People who have CML who cannot have stem cell transplants and are unable to take tyrosine kinase inhibitors may be given busulfan, hydroxyurea, or interferon alfa (with or without cytarabine).

Medicines used for treatments for chronic lymphocytic leukemia (CLL) are taken orally (by mouth) or given intravenously for limited periods of time. If there is relapse, medicines are given again.

For chronic myelogenous leukemia (CML), medicine is usually taken by mouth for as long as needed.

Medicine for nausea and vomiting

Nausea and vomiting are common side effects of chemotherapy. They usually go away when treatment stops. Your doctor will prescribe medicines to help relieve nausea.