Memorial Hermann Cancer Centers provide advanced treatment for patients with leukemia. Leukemias are either acute and progress quickly or chronic and progress more slowly.
What is Leukemia?
Leukemia is a type of blood cancer that begins in the bone marrow, the soft tissue in the center of bones that produces blood cells. The term "leukemia" literally means "white blood."
White blood cells (leukocytes) made in the bone marrow are used by the body to fight off infections and other foreign substances. Leukemia leads to an uncontrolled increase in the number of white blood cells.
The cancerous cells prevent healthy red cells, platelets and mature white cells from being produced, causing life-threatening symptoms as they spread to the bloodstream and lymph nodes. They can also travel to the central nervous system (brain and spinal cord) and other parts of the body.
Types of Leukemia
We diagnose and treat the following types of leukemia:
- Acute Lymphocytic Leukemia: Acute lymphocytic leukemia (ALL) is a fast-growing cancer of white blood cells called lymphocytes found in the bone marrow and other parts of the body. ALL occurs when the body produces a large number of immature lymphocytes that grow quickly and replace normal cells in the bone marrow.
- Acute Myeloid Leukemia: Acute myeloid leukemia (AML) starts inside bone marrow and grows quickly, replacing healthy blood cells. One of the most common types of leukemia among adults, AML generally occurs around age 60 and is more common in men than women.
- Chronic Lymphocytic Leukemia: Chronic lymphocytic leukemia (CLL) causes a slow increase in white blood cells called B lymphocytes, or B cells. The cancerous cells spread from the bone marrow to the blood, and can also affect the lymph nodes or other organs such as the liver and spleen. CLL eventually causes the bone marrow to fail.
- Chronic Myelogenous Leukemia: Chronic myelogenous leukemia occurs most often in middle-aged adults and in children. It is usually associated with a chromosome abnormality called the Philadelphia chromosome.
- Hairy Cell Leukemia: Hairy cell leukemia (HCL) is an unusual cancer of the blood that affects B cells, a type of white blood cell, or lymphocyte. HCL is caused by the abnormal growth of B cells. The cells look "hairy" under the microscope because they have fine projections coming from their surface.
Affiliated specialists, specially trained staff and nurses offer leading cancer care personalized to meet the specific needs of each patient.
Different types of leukemia are diagnosed in different ways.
Diagnosis of Acute Lymphocytic Leukemia
Doctors diagnose acute lymphocytic leukemia based on a physical exam; complete blood count, including a white blood cell count; platelet count; bone marrow aspiration and biopsy; and lumbar puncture to check for leukemia cells in the spinal fluid.
Diagnosis of Acute myeloid leukemia
With acute myeloid leukemia, there may be signs of a swollen spleen, liver or lymph nodes. A complete blood count will show anemia and a low number of platelets. The white blood cell count can be high, low or normal. Bone marrow aspiration will show if leukemia cells are present.
If your doctor learns you do have this type of leukemia, further tests will be done to determine the specific type of AML. There are eight subtypes of the disease, ranging from M0 to M7, based on which blood cells are abnormal.
Diagnosis of Chronic Lymphocytic Leukemia (CLL)
Patients with chronic lymphocytic leukemia (CLL) usually have a higher-than-normal white blood cell count and may have signs of a swollen spleen, liver or lymph nodes.
Doctors diagnose and assess CLL with a complete blood count with white blood cell differential; bone marrow biopsy; CT scan of the chest, abdomen and pelvis; immunoglobulin testing; and lactate dehydrogenase test. If your doctor discovers you have CLL, tests will be done to stage the cancer.
Diagnosis of Chronic Myelogenous Leukemia
A physical examination of patients with chronic myelogenous leukemia often reveals a swollen spleen.
Tests include a complete blood count, bone marrow biopsy, blood and bone marrow testing for the presence of the Philadelphia chromosome, and platelet count.
Diagnosis of Hairy Cell Leukemia
During a physical exam, doctors may be able to feel a swollen spleen or liver in patients with hairy cell leukemia. An abdominal CT scan may be done to evaluate the swelling.
A complete blood count usually shows low levels of white and red blood cells as well as platelets. Blood tests and a bone marrow biopsy can detect hairy cells. Flow cytometry or a test called tartrate resistant acid phosphatase (TRAP) can confirm the diagnosis.
Treatment depends on the type of leukemia, the stage of the cancer when you were first diagnosed, your age and overall health and your symptoms. The goal of treatment is to get your blood counts back to normal. If this occurs and the bone marrow looks healthy under the microscope, the cancer is said to be in remission.
Chemotherapy is used to treat acute lymphocytic leukemia (ALL) and acute myeloid leukemia and may be recommended for early stage chronic lymphocytic leukemia (CLL).
Chemotherapy for Acute Lymphocytic Leukemia (ALL) and Acute Myeloid Leukemia (AML)
Patients typically receive their first course of chemotherapy in the hospital over a period of several weeks. Later, you may receive chemotherapy as an outpatient. If ALL spreads to the brain and spinal cord, you may receive chemotherapy directly into the space around your brain or in the spinal column, or radiation therapy to the brain. If your leukemia returns or does not respond to other treatments, a bone marrow or stem cells transplant is usually recommended.
Chemotherapy for Early Stage Chronic Lymphocytic Leukemia (CLL)
Usually, no treatment is prescribed for early stage chronic lymphocytic leukemia (CLL), but physicians closely monitor their patients. If chromosome testing suggests that you have a high-risk type of CLL, treatment may be started earlier.
Treatment may also be started if infections keep returning, leukemia is growing rapidly, you have low blood count (anemia and thrombocytopenia) or are suffering fatigue, loss of appetite, weight loss or night sweats.
Several chemotherapy drugs are commonly used to treat CLL. Rarely, radiation may be used for painfully enlarged lymph nodes. Blood transfusions or platelet transfusions may be required if blood counts are low. Bone marrow or stem cell transplantation may be used in younger patients with advanced or high-risk CLL. A transplant is the only therapy that offers a potential cure for CLL.
Medication for Leukemia
Medications are available for treatment of some types of leukemia.
Medication for Treatment of Chronic Myelogenous Leukemia (CML)
A medication called Gleevec is the first line of treatment for chronic myelogenous leukemia (CML). The medication is a pill, taken by mouth, and is associated with very high rates of remission and survival.
In some cases, a chemotherapy medicine called hydroxyurea (Hydrea) is used temporarily to reduce the white blood cell count if it is very high at diagnosis. Characterized by a very high count of leukemia cells, the blast crisis phase is very difficult to treat. Treatment is similar to AML or ALL. The only known cure for CML is a bone marrow transplant or stem cell transplant.
Treatment for Hairy Cell Leukemia
Treatment may not be necessary in the early stages of hairy cell leukemia. Some patients may need an occasional blood transfusion.
If treatment is needed because of very low blood counts, a variety of chemotherapy drugs can be used. Chemotherapy usually relieves symptoms for many years.
Removal of the spleen may improve blood counts, but is unlikely to cure the disease. Antibiotics can be used to treat infections. People with low blood counts may receive growth factors and, possibly, transfusions.