Leukemia is a cancer of the body’s blood-forming tissues, such as bone marrow. The type of leukemia is determined by the kind of cell affected and the rate at which the disease progresses. Leukemia can progress quickly (acute) or slowly over time (chronic).
Acute leukemia involves a rapid overgrowth of very immature blood cells called myeloblasts or myeloid blasts. This condition is life-threatening because there are not enough normal functioning blood cells to prevent anemia, infection, and bleeding. A diagnosis of acute leukemia is made when there are 20 percent or more “blast cells” in the bone marrow or blood.
Chronic leukemia involves a slower accumulation of abnormal mature blood cells that only function normally for a period of time before causing any symptoms. Usually, people with chronic leukemia have enough mature blood cells to prevent serious bleeding and infection.
Why Choose MD Anderson Cancer Center at Cooper for Leukemia Treatment
Since 2013, we’ve partnered with MD Anderson Cancer Center in Houston, one of the nation’s top hospitals for cancer care. Our specialists are respected both regionally and nationally for our excellence in cancer diagnosis and treatment.
- Our hematologists and medical oncologists work as part of a multidisciplinary team of cancer experts, including surgical oncologists, radiation oncologists, radiologists, pathologists, and others. This coordination ensures a care approach that’s designed just for you.
- Locations throughout South Jersey: Our medical oncologists see patients at outpatient offices in Camden, Voorhees, Willingboro, Egg Harbor, and Sewell, New Jersey. They also provide inpatient care at Cooper University Hospital and consultation services at other South Jersey hospitals.
- Innovative cancer treatments: Our hematologists and medical oncologists are at the forefront of their fields. They’re developing new therapies and procedures for diagnosing and treating patients with cancer through clinical trials. Our partnership with MD Anderson gives us — and you — access to more trials, for more types of cancer, than ever before.
- Full range of support services: If you have cancer, we recognize the huge emotional toll it can take on your life. We offer a full range of support services to help you manage life during diagnosis, treatment, and recovery. Our services include complementary medicine therapies such as yoga and meditation, counseling support, and physical rehabilitation services. Read about our extensive cancer care support services.
Types of Leukemia
The types of leukemia tend to be linked with certain age groups. Acute lymphoblastic leukemia, for example, is most common during childhood and in early adulthood, although it can be diagnosed in people over 30. Acute myelogenous leukemia occurs most often in adults. Chronic leukemia is more commonly diagnosed in individuals between the ages of 40 and 70 and rarely in young people. However, there are always exceptions.
When looking for a specific type of leukemia, your doctor will look at the chromosome number and appearance, features on the bone marrow cell surface, and the appearance of the bone marrow cells under a microscope. The following is a list of the different types of leukemia.
- Acute undifferentiated leukemia.
- Acute myelogenous leukemia (AML).
- AML with recurrent genetic abnormalities:
- AML with t(8;21)(q22;q22).
- AML with abnormal bone marrow eosinophils and inv (16p13q22) or t(16;16)(p13;q22).
- Acute promyelocytic leukemia with t(15;17)(q22;q12), (PML/RAR alpha) and variants.
- AML with 11q23 (MLL) abnormalities.
- AML with multilineage dysplasia:
- Following MDS or MDS/MPD.
- Dysplasia in at least 50 percent of cells in two or more myeloid lineages.
- AML and MDS, therapy-related:
- Alkylating agent/radiation-related type.
- Topoisomerase II inhibitor-related type.
- AML, not otherwise categorized classified as:
- AML, minimally differentiated.
- AML without maturation.
- AML with maturation.
- Acute basophilic leukemia.
- Acute panmyelosis with myelofibrosis.
- Myeloid sarcoma.
- Acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma.
- Acute myelomonocytic leukemia.
- Acute monoblastic/acute monocytic leukemia.
- Acute erythroid leukemia.
- Acute megakaryoblastic leukemia.
- Chronic lymphocytic leukemia (CLL):
- Hairy cell leukemia.
- Mantle cell leukemia.
- Marginal zone leukemia.
- Splenic lymphoma with villous lymphocytes.
- Chronic myelogenous leukemia (CML).
- Myeloproliferative syndromes:
- Polycythemia vera
- Essential thrombocytosis.
- Idiopathic myelofibrosis.
- Hypereosinophilic syndrome (HES).
- Systemic mastocytosis.
- Aplastic anemia. Myelodysplastic Syndromes
- Refractory anemia.
- Refractory cytopenia with multilineage dysplasia.
- Refractory anemia with ringed sideroblasts.
- Myelodysplastic syndrome, unclassified.
- Myelodysplastic syndrome associated with del(5q).
- Refractory anemia with excess blasts (RAEB).
Causes of Leukemia and Myelodysplastic Syndrome
The specific cause of leukemia is still unknown. However, scientists suspect that there may be viral, genetic, environmental, or immunologic factors involved.
Some viruses can cause leukemia in animals. In humans, however, viruses cause only one rare type of leukemia. Even if a virus is involved, leukemia is not contagious. It cannot spread from one person to another. There is no increased occurrence of leukemia among people such as friends, family, and caregivers who have had close contact with leukemia patients.
There may also be a genetic predisposition to leukemia. There are rare cases where people born with chromosome damage may have genes that increase their chances of developing leukemia.
Environmental factors, such as high-dose radiation and exposure to certain toxic chemicals, have been directly related to leukemia. However, this has only been true in extreme cases, such as atomic bomb survivors in Nagasaki and Hiroshima or industrial workers exposed to benzene. Exposure to ordinary X-rays, like those give in a hospital or physician office, is not believed to be dangerous.
People with immune-system deficiencies appear to be at greater risk for cancer because of their body’s decreased ability to resist foreign cells. There is evidence that patients treated for other types of cancer with certain chemotherapy drugs and/or high-dose radiation therapy may later develop leukemia.
All of these factors may explain why a small number of people develop leukemia. But, in most cases, the cause of leukemia is not known.
Diagnosis of Leukemia and Myelodysplastic Syndrome
The diagnosis of leukemia is based on the results of both blood and bone marrow tests, such as bone marrow aspiration and bone marrow biopsy.
Bone Marrow Aspiration: Before the procedure begins, the aspiration site is numbed with anesthesia. During the procedure, a sample of bone marrow cells is removed from the hip bone with an aspiration needle. Most people feel pressure as the needle is inserted and a few seconds of sharp pain when the bone marrow fluid is removed.
Bone Marrow Biopsy: With a bone marrow biopsy, a small piece of bone is removed. A biopsy may be slightly more painful, but only during the time that the procedure is being done.
Treatment of Leukemia and Myelodysplastic Syndrome
Treatment for blood cancer may include one or more of the following: chemotherapy, radiation therapy, biological therapy, surgery, and stem cell transplantation.
The most effective treatment for leukemia is chemotherapy, which may involve only one or a combination of anticancer drugs that destroy cancer cells. Specific types of leukemia are sometimes treated with radiation therapy or biological therapy.
Each type of leukemia is sensitive to different combinations of chemotherapy. Medications and length of treatment vary from person to person. Initial treatment time is typically from one to two years. During this time, your care is managed as an outpatient at MD Anderson Cancer Center at Cooper or through your local doctor.
Your treatment may consist of different chemotherapy drugs and biological therapies. The short-term goal is for a complete remission (CR). CR in acute leukemia means the bone marrow has less than five percent blasts, the absolute neutrophil count is over 1,000, and the platelet count is over 100,000. The long-term goal is for an extended disease-free state and cure.
A course or cycle is the period of time from the start of your chemotherapy until either the blood and bone marrow cell counts are back to normal or when you are able to receive further treatment. In some cases, the leukemia cells are destroyed only from the blood and not from the bone marrow during the first course of chemotherapy. In these cases, a second course may be needed.
If the leukemia does not respond to one or two courses of treatment, a different drug program may be used to get CR. A different drug program may also be used if a relapse occurs.
A specific treatment plan is called a protocol. Each protocol is usually named by letters with each letter standing for a particular drug. A protocol may be considered either standard or experimental therapy. Your doctor will discuss with you the advantages and disadvantages of a particular type of therapy.
Once your protocol is determined, you will receive more specific information about the drug(s) that will be used to treat your leukemia. Common side effects of many chemotherapy drugs include hair loss, nausea, vomiting, decreased blood counts, and infections.
Radiation therapy may be used along with chemotherapy for some kinds of leukemia. Radiation therapy (also called radiotherapy) uses high-energy rays to damage cancer cells and stop them from growing. The radiation comes from a large machine.
Radiation therapy for leukemia patients may be given in two ways. For some patients, the doctor may direct the radiation to one specific area of the body where there is a collection of leukemia cells, such as the spleen or testicles. Other patients may receive radiation that is directed to the whole body. This is called total-body irradiation. This type of radiation is sometimes given before a stem cell transplant.
Biological therapy is sometimes used to treat leukemia. Biological therapies include growth factors, interleukins, and monoclonal antibodies. Some patients receive only biological therapy, while others receive chemotherapy at the same time. You will receive more detailed information about biological therapy if it is used as a treatment for your type of leukemia.
A splenectomy is the surgical removal of the spleen. The spleen is located on the left side of the abdomen. It acts as a filtering system for blood cells. When a patient has chronic leukemia, the spleen tends to collect leukemia cells, transfused platelets, and red blood cells. Frequently the spleen enlarges from storing these cells. This makes it difficult for the chemotherapy to reduce the quantity of diseased cells. If the spleen is not removed, it can grow so large that it compresses on other organs and cause breathing difficulties. In that case, a splenectomy may be needed.
Stem Cell Transplant
A stem cell transplant (SCT) (previously referred to as a bone marrow transplant) can be used to restore healthy bone marrow in people with leukemia. Although MD Anderson at Cooper does not currently offer SCT, we will refer you to an outside center if this is the optimal choice of treatment for your disease.
SCT consists of destroying leukemic bone marrow cells using high doses of chemotherapy and, in some cases, radiation therapy. Because high-dose chemotherapy severely damages the bone marrow’s ability to produce cells, healthy stem cells are provided intravenously to stimulate new bone marrow growth.
There are two types of stem cell transplantation: autologous SCT and allogeneic SCT.
Autologous stem cell transplant involves infusion of your own healthy bone marrow cells. Your doctor may plan to store some of your bone marrow while you are in remission for an autologous transplantation.
Allogeneic stem cell transplant involves the infusion of compatible stem cells from the bone marrow of matching donors, which could be a relative, an unrelated individual, or umbilical cord blood.
Like other leukemia treatments, SCT is based very much on the individual. Different factors will help your doctor decide what specific treatment to use, including the type of leukemia you have, your past response to chemotherapy treatment, the availability of stem cells for replacement, your age, and the status of your leukemia. You will receive more information on this treatment option if you are a candidate for SCT.
Make an Appointment With an MD Anderson at Cooper Leukemia Expert
To learn more about the hematology and medical oncology services available at MD Anderson at Cooper or to schedule an appointment, please call 855.MDA.COOPER (855.632.2667).