About Leukemia

Leukemia is a cancer that originates from cells in the bone marrow — the soft spongy material inside our bones that systemically churns out stem cells, the cells that will eventually become red blood cells, white blood cells and platelets. Leukemia is characterized by the uncontrolled growth of cells in the bone marrow. There are two major classifications of leukemia: myelogenous or lymphocytic, which can each be acute or chronic. Lymphocytic and myelogenous (or myeloid) refer to the two different cell types from which leukemias start. Lymphocytic leukemias develop from lymphocytes in the bone marrow. Myelogenous leukemia (sometimes referred to as myelocytic) develops from either granulocytes or monocytes, which are white blood cells. Acute lymphocytic leukemia is the most common childhood cancer.

There are four major types of leukemia: acute or chronic myelogenous leukemia and acute or chronic lymphocytic leukemia.

Acute leukemia is a rapidly progressing disease that results in the accumulation of immature, functionless cells in the bone marrow and blood. Because of this condition, the bone marrow often can no longer produce enough normal red blood cells, white blood cells and platelets. This can lead to the following: anemia, a deficiency of red cells; the inability to fight infection, the result of a low white blood cell count; easy bruising and bleeding, caused by a shortage of platelets. Chronic leukemia progresses more slowly and permits greater numbers of more mature, functional cells to be made.

Treatment for Leukemia

Most patients with leukemia are treated with chemotherapy. Some also may have radiation therapy and/or bone marrow transplantation or biological therapy. In some cases, surgery to remove the spleen (an operation called a splenectomy) may be part of the treatment plan. Patients must meet specific criteria to qualify for treatments described below.

Treatment for Acute Lymphocytic Leukemia (ALL)
At the Bone Marrow Transplant Center at Rush University Medical Center in Chicago, Illinois, we offer allogeneic transplants to patients with relapsed or refractory (that is, resistant to treatment) acute lymphocytic leukemia and patients with high-risk disease in first remission. These allogeneic transplants can either use cells from a matched related donor or an unrelated donor. We also offer autologous transplant for patients in remission when a suitable donor is not available.

Treatment for Acute Myeloid Leukemia (AML)
Patients with poor risk acute myeloid leukemia are offered an allogeneic bone marrow transplant in first remission if they have a matched sibling donor. Relapsed or refractory patients are offered an allogeneic transplant using a matched sibling or unrelated donor. Patients without an allogeneic donor are offered an autologous transplant in first remission if they have poor risk disease or in second remission. Immunotransplantation may also be an option for these patients.

Treatment for Chronic Lymphocytic Leukemia (CLL)
Patients who require treatment for chronic lymphyocytic leukemia are candidates for autologous blood stem cell transplantation using a Rituxan-purged autograft. Rituxan is a monoclonal antibody that attaches to B cells (the leukemia cells in CLL) and causes them to be destroyed. The Rituxan treatment is offered as part of an FDA-approved study that we hope will increase the disease-free survival of patients with CLL post-autograft. Patients with CLL who have a sibling with the same tissue type are candidates for allogeneic stem cell transplantation. Immunotransplantation may also be an option.

Treatment for Chronic Myeloid Leukemia (CML)
Target therapy using Gleevec is currently the treatment of choice for patients with newly diagnosed chronic myelogenous. However, allogeneic stem cell transplant is the only potential curative treatment for patients with CML. Patients with chronic myeloid leukemia who fail or progress after trial of Gleevec and who have a sibling who matches their own tissue type or who have a match from the National Marrow Donor Program registry will be considered for an allogeneic stem cell transplantation. For patients who do not have a suitable donor, their own marrow can be used for an autologous blood stem cell transplant after the patient has received purging chemotherapy. We will also consider harvesting stem cells for storage if patients achieve a molecular remission with Gleevec for possible autologous stem cell transplantation in the future. Immunotransplantation may also be an option.

Questions About Leukemia

Q: What are the symptoms of the acute leukemias?
A: The symptoms of both forms of acute leukemia are similar. The patient usually has a sudden high fever and a severe throat infection. There may also be nosebleeds, bruising under the skin, fatigue and pain in the joints. In some patients, the onset of symptoms is slower, with lethargy, anemia and increasing weakness.

Q: What forms of chronic leukemia are there?
A: There are two main forms of chronic leukemia, chronic myeloid leukemia (CML), and chronic lymphocytic leukemia (CLL). CML affects immature polymorphonuclear leukocytes and usually occurs after 35 years of age. CLL affects lymphoid tissue and lymphatic cells and usually occurs in men over the age of 50.

Q: What are the symptoms of the chronic leukemias?
A: The symptoms of both forms of chronic leukemia are similar. The onset is usually slow, with increasing fatigue, lethargy and weakness. The patient may also lose weight and suffer from loss of appetite. The course of the illness is slow and may last for several years without causing major problems. However, there may be various complications, such as anemia, bleeding under the skin, recurrent fever and the formation of nodules and ulcers under the skin.

Q: How is leukemia diagnosed?
A: The specific diagnosis of leukemia requires a blood count and a bone marrow biopsy. Leukemia is confirmed by the presence of large numbers of abnormal leukocytes in the blood and the typical leukemic cells in the bone marrow. With the chronic leukemias, the patient may be unaware of the disease, and a diagnosis is often made only when the patient is examined for another reason, such as during a routine checkup or before surgery.

Q: Can leukemia be cured?
A: Cure and remission — when cancer cells stop multiplying — depends largely on the individual patient, his or her particular disease and the treatment he or she receives.