WBC Module

2. LEUKEMIA
Cancer of blood

3. Contents
I. Introduction
II. Causes
III. Symptoms
IV. Types
V. Diagnosis
VI. Treatment
VII. References

4. What is Leukemia?
Leukemia is a type of cancer of the
blood or bone marrow characterized by
an abnormal increase of immature
white blood cells called "blasts".
Leukemia is a broad term covering a
spectrum of diseases. In turn, it is part
of the even broader group of diseases
affecting the blood, bone marrow, and
lymphoid system, which are all known
as hematological neoplasms.
A Wright's stained bone marrow aspirate
smear from a patient with precursor B-
cell acute lymphoblastic leukemia.

5. What is Leukemia?
Leukemia is a treatable disease. Most
treatments involve chemotherapy,
medical radiation therapy, or hormone
treatments. The rate of cure depends
on the type of leukemia as well as the
age of the patient. Children are more
likely to be permanently cured than
adults. Even when a complete cure is
unlikely, most people with a chronic
leukemia and many people with an
acute leukemia can be successfully
treated for years.
Dr. Stephen A. Grupp examining Emma, recipient of
CTL019 therapy.

6. Leukemia: Causes
Experts do not know what causes leukemia. They do not know why some
people get it and others do not. It is likely that the different types of leukemia
have different causes.
A serious fact ??????

7. Causes of Leukemia
No one knows the exact causes of
leukemia. Doctors can seldom explain why
one person gets leukemia and another does
not. Studies have found the following risk
factors for leukemia:
Working with certain chemicals —
Exposure to high levels of benzene in the
workplace can cause leukemia. Benzene is
used widely in the chemical industry.
Formaldehyde is also used by the chemical
industry. Workers exposed to formaldehyde
also may be at greater risk of leukemia.
Benzene as a cause of leukemia had documented
since 1928. In 1948, the American Petroleum
Institute officially reported a link between this
solvent used in many of their industries used and
cases of leukemia in their workers. Their findings
concluded that the only safe level of benzene
exposure is no exposure at all.

8. Causes of Leukemia
No one knows the exact causes of
leukemia. Doctors can seldom explain why
one person gets leukemia and another does
not. Studies have found the following risk
factors for leukemia:
Very high levels of radiation — People
exposed to very high levels of radiation are much
more likely than others to develop leukemia.
Medical treatment that uses radiation can be
another source of high-level exposure. Radiation
used for diagnosis, however, exposes people to
much lower levels of radiation and is not linked to
leukemia.
Very high levels of radiation have been caused by
atomic bomb explosions (such as those in Japan
during World War II) and nuclear power plant
accidents (such as the Chernobyl [also called
Chornobyl] accident in 1986).

9. Causes of Leukemia
Chemotherapy — Cancer patients
treated with certain cancer-fighting drugs
sometimes later develop leukemia. For
example, drugs known as alkylating agents
are associated with the development of
leukemia many years later.
For patients treated for Hodgkin lymphoma (HL),
cumulative doses of alkylating agent (AA) is
associated with the risk of therapy-related acute
myeloid leukemia/myelodysplastic syndrome (t-
AML/MDS), according to a study published online
Jan. 7 in the Journal of Clinical Oncology.

10. Causes of Leukemia
Smoking— Tobacco products are the
single, major avoidable cause of cancer.
Smoking is also causally associated with
cancers of the pancreas, kidney, bladder,
stomach, and cervix and with myeloid
leukemia.
SMOKING cigarettes may increase a person's risk of
contracting leukemia by 30 percent and cause up to
3,600 cases of adult leukemia a year in the United
States. (Published February 3, 1993)

11. Causes of Leukemia
Down syndrome and certain other
genetic diseases — Some diseases caused
by abnormal chromosomes may increase
the risk of leukemia.
Down syndrome was linked to leukemia for the first time in
a case report published in 1930. Since then, Down
syndrome has been recognized as one of the most
important leukemia-predisposing syndromes and patients
with Down syndrome and leukemia have unique clinical
features and significant differences in treatment response
and toxicity profiles compared to patients without Down

12. Leukemia: Symptoms
Over 1 million Americans are living with, or are in remission from,
leukemia, lymphoma or myeloma.

13. SymptomsLike all blood cells, leukemia cells travel through
the body. Depending on the number of abnormal
cells and where these cells collect, patients with
leukemia may have a number of leukemia
symptoms.
Acute leukemia symptoms appear and get worse
quickly. Chronic leukemia symptoms may not
appear for a long time; when leukemia symptoms
do appear, they generally are mild at first and get
worse gradually.
• Fever, chills, and other flu-like symptoms
• Weakness and fatigue
• Frequent infections
• Loss of appetite and/or weight
• Swollen or tender lymph nodes, liver, or
spleen;
• Easy bleeding or bruising
• Tiny red spots (called petechiae) under
the skin
• Swollen or bleeding gums;
• Sweating, especially at night; and/or
• Bone or joint pain.

14. Symptoms• In acute leukemia, the abnormal cells may
collect in the brain or spinal cord (also called
the central nervous system or CNS). The
result may be headaches, vomiting,
confusion, loss of muscle control, and
seizures. Leukemia cells also can collect in
the testicles and cause swelling. Also, some
patients develop sores in the eyes or on the
skin. Leukemia also can affect the digestive
tract, kidneys, lungs, or other parts of the
body.
• In chronic leukemia, the
abnormal blood cells may
gradually collect in various
parts of the body. Chronic
leukemia may affect the
skin, central nervous
system, digestive tract,
kidneys, and testicles.

15. Leukemia: Types
Leukemia is the 10th most frequently occurring type of cancer in all races
or ethnicities.

16. Types
There are several types of leukemia.
The different types of leukemia are
grouped in two ways. One way is by
how quickly the disease develops and
gets worse. The other way is by the
type of blood cell that is affected.
• by how quickly the disease
develops
– Chronic
– Acute
• by the type of blood cell that is
affected
– Lymphoid cells
– Myeloid cells

17. Types
• In chronic leukemia, the leukemia
cells come from mature,
abnormal cells. The cells thrive
for too long and accumulate. The
cells grow slowly. It is not unusual
in chronic cases for symptoms to
take a long time to even appear.
• Acute leukemia develop from
early cells, called "blasts". Blasts
are young cells, that divide
frequently. They target immature
cells, causing symptoms to
appear quickly. In acute leukemia
cells, they don't stop dividing like
their normal counterparts do.

18. Types
• Lymphocytic leukemia begins
from white blood cells called
lymphocytes or immature types
of lymphocytes. It commonly
affects lymph nodes in the body
but can invade all body tissues.
• Myelogenous leukemia involves
the other 3 common types of
white blood cells known as
granulocytes. They are the
neutrophils, eosinophils, or
basophils.

19. Leukemia: Diagnosis
About 20 percent of adult acute myeloid leukemia cases are linked to
smoking.

20. Diagnosis
The diagnosis of leukemia frequently
occurs following a routine blood test that
results in an abnormal blood cell count. If
you have symptoms that suggest
leukemia, your doctor will try to find out
what's causing the problems. Your doctor
may ask about your personal and family
medical history.
You may have one or more of the
following tests:
• Blood tests: The lab does
a complete blood count to check
the number of white blood cells,
red blood cells, and platelets.
Leukemia causes a very high level
of white blood cells. It may also
cause low levels of platelets
and hemoglobin, which is found
inside red blood cells.

21. Diagnosis
The diagnosis of leukemia frequently
occurs following a routine blood test that
results in an abnormal blood cell count. If
you have symptoms that suggest
leukemia, your doctor will try to find out
what's causing the problems. Your doctor
may ask about your personal and family
medical history.
You may have one or more of the
following tests:
• Biopsy: Your doctor removes tissue to
look for cancer cells. A biopsy is the
only sure way to know Your doctor
removes some bone marrow from
your hipbone or another large bone.
A pathologist uses a microscope to
check the tissue for leukemia
cells. There are two ways your doctor
can obtain bone marrow. Some
people will have both procedures
during the same visit:

22. Diagnosis
The diagnosis of leukemia frequently
occurs following a routine blood test that
results in an abnormal blood cell count. If
you have symptoms that suggest
leukemia, your doctor will try to find out
what's causing the problems. Your doctor
may ask about your personal and family
medical history.
You may have one or more of the
following tests:
• Biopsy
– Bone marrow aspiration: The
doctor uses a thick, hollow
needle to remove samples of
bone marrow.
– Bone marrow biopsy: The
doctor uses a very thick,
hollow needle to remove a
small piece of bone and bone
marrow.

23. Diagnosis• The tests that your doctor orders for you depend on your
symptoms and type of leukemia. You may have other tests:
• Cytogenetics: The lab looks at the
chromosomes of cells from samples of blood,
bone marrow, or lymph nodes. If abnormal
chromosomes are found, the test can show
what type of leukemia you have. For
example, people with CML have an abnormal
chromosome called the Philadelphia
chromosome.
• Chest x-ray: An x-ray can show
swollen lymph nodes or other signs
of disease in your chest.

24. Diagnosis
• The tests that your doctor orders
for you depend on your
symptoms and type of leukemia.
You may have other tests:
• Spinal tap: Your doctor may remove
some of the cerebrospinal fluid (the
fluid that fills the spaces in and
around the brain and spinal cord).
The doctor uses a long, thin needle
to remove fluid from the lower
spine. The procedure takes about
30 minutes and is performed with
local anesthesia. You must lie flat
for several hours afterward to keep
from getting a headache. The lab
checks the fluid for leukemia cells
or other signs of problems.

25. Leukemia: Treatment
Hispanic children of all races under the age of 20 years have the highest
rate of leukemia.

26. Treatment
The goal of treatment for leukemia
is to destroy the leukemia cells and
allow normal cells to form in your
bone marrow. Treatment decisions
are based on the kind of leukemia
you have, its stage, and your age
and general health. Many times,
leukemia is treated with one or
more types of treatment.
 Treatment for Acute Leukemia
 Chemotherapy -
Chemotherapy is the use of
drugs that either kill cancer
cells or preventing the cells
from dividing. Chemotherapy
can be given in a variety of
ways, with IV infusion and pill
being more common. The
type of chemotherapy given
depends on the stage and
type of lung cancer.

27. Treatment
The goal of treatment for leukemia
is to destroy the leukemia cells and
allow normal cells to form in your
bone marrow. Treatment decisions
are based on the kind of leukemia
you have, its stage, and your age
and general health. Many times,
leukemia is treated with one or
more types of treatment.
 Treatment for Acute Leukemia
 Some types of acute leukemia
spread to the brain and spinal
cord. Regular chemotherapy
cannot 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.

28. Treatment
The goal of treatment for leukemia
is to destroy the leukemia cells and
allow normal cells to form in your
bone marrow. Treatment decisions
are based on the kind of leukemia
you have, its stage, and your age
and general health. Many times,
leukemia is treated with one or
more types of treatment.
 Treatment for Acute Leukemia
 Radiation Therapy -
Radiation therapy uses high
doses of radiation, such as X-
rays, to destroy cancer cells.
Radiation is usually given
from a machine outside the
body that directs radiation to
the cancer (external
radiation). Radiation is also
used to treat acute leukemia
that has spread to the brain
and spinal cord.

29. Treatment
The goal of treatment for leukemia
is to destroy the leukemia cells and
allow normal cells to form in your
bone marrow. Treatment decisions
are based on the kind of leukemia
you have, its stage, and your age
and general health. Many times,
leukemia is treated with one or
more types of treatment.
 Treatment for Acute Leukemia
 Stem cell transplant may be
part of the treatment plan for
people who have high-risk
acute leukemia. Most stem
cell transplants for leukemia
are allogeneic, meaning the
stem cells are donated by
someone else. The goal of a
transplant is to destroy all the
cells in your bone marrow,
including the leukemia cells, and
replace them with new, normal
cells.

30. Treatment
Sometimes leukemia gets worse in
spite of treatments. Sometimes it
gets better, or "goes into
remission." Sometimes it comes
back, or "relapses." Even when that
happens, there are several
treatments that may help to cure
the leukemia or help you live
longer:
 Treatment if Acute Leukemia
gets Worse
 Stem cell transplant .
Donated cells from a
"matched" donor can rebuild
your supply of
normal blood cells and
your immune system.
 Chemotherapy. Sometimes
medicines or doses that are
different from those used
during your initial
chemotherapy can help.

31. Treatment
Chronic lymphocytic leukemia is
not always treated right away. It
usually gets worse more slowly
than acute leukemia.
 Treatment of Chronic Leukemia
 Chronic Lymphocytic Leukemia
 Watchful waiting - CLL usually gets
worse very slowly, and you may
have no symptoms for some time.
You and your doctor may decide to
hold off on treatment for a while.
During this time your doctor will
watch you carefully.
 Radiation therapy - Radiation may
be used to destroy cancer cells. It
also may be used to shrink swollen
lymph nodes or a swollen spleen.
Sometimes radiation is used on the
whole body to prepare for a bone
marrow transplant.

32. Treatment
Chronic lymphocytic leukemia is not always treated right away. It
usually gets worse more slowly than acute leukemia.
 Treatment of Chronic Leukemia
 Chronic Lymphocytic Leukemia
• Chemotherapy - Chemotherapy is the use
of medicines that attack cancer cells. Many
medicines are available to fight leukemia
and help you live longer.
• Surgery - If the spleen starts destroying red
blood cells and platelets, it may need to be
removed. This operation is called
a splenectomy.
• Targeted therapy with a monoclonal
antibody. These antibodies can kill cancer
cells, stop their growth, or keep them from
spreading.

33. Treatment
Chronic lymphocytic leukemia is
not always treated right away. It
usually gets worse more slowly
than acute leukemia.
 Treatment of Chronic Leukemia
 Chronic Myelogenous Leukemia
• Targeted therapy with a tyrosine
kinase inhibitor, such
as imatinib or dasatinib, is the first
treatment used for CML.
• Chemotherapy - Chemotherapy is
the use of medicines that attack
cancer cells. Many medicines are
available to fight leukemia and help
you live longer.
• Biological therapy - This is the use
of special medicines that improve
your body's natural defenses
against cancer.

34. Treatment
Chronic lymphocytic leukemia is
not always treated right away. It
usually gets worse more slowly
than acute leukemia.
 Treatment of Chronic Leukemia
 Chronic Myelogenous Leukemia
• High-dose chemotherapy with stem cell
transplant - After chemotherapy is
completed, stem cells that were previously
donated and frozen are thawed and
infused.
• Donor lymphocyte infusion (DLI) - This is a
treatment that may be used after a stem
cell transplant. With DLI, a person is given
more of their donor's white blood cells
(lymphocytes).
• Surgery - If the spleen starts destroying red
blood cells and platelets, it may need to be
removed. This operation is called a
splenectomy.
Overview: http://www.cancer.ca/Canada-wide/About cancer/Types of cancer/Treatment for leukemia.aspx

35. Leukemia: References
The incidence of leukemia is highest among whites, and lowest among
American Indians, and the Asian and Pacific Islander population.

36. References
• “New leukemia therapy destroys cancer by turning blood cells into assassins“, Ryan Jaslow, CBS News
http://www.cbsnews.com/8301-504763_162-20091135-10391704.html
• “Mechanism behind acute leukemia identified by VUMC researchers”, Mary Beth Gardner, Vanderbilt
University Medical Center http://www.mc.vanderbilt.edu/reporter/index.html?ID=2190
• “Understanding Leukemia - Diagnosis and Treatment, WebMD
http://www.webmd.com/cancer/understanding-leukemia-treatment
• “Leukemia: Causes and Risk Factors”, CancerCompass http://www.cancercompass.com/leukemia-
information/causes-and-risk-factors.htm
• Ontario Task Force on the Primary Prevention of Cancer.: Recommendations for the Primary
Prevention of Cancer. Toronto, Canada: Queen's Printer for Ontario, 1995.
• “Cigarette Smoking: Health Risks and How to Quit”, National Cancer Institute
http://www.cancer.gov/cancertopics/pdq/prevention/control-of-tobacco-
use/HealthProfessional/page2
• Leukemia - Treatment Overview, WebMD http://www.webmd.com/cancer/tc/leukemia-treatment-
overview