Leukemia is a cancer of blood-forming tissues, including bone marrow. Many types exist such as acute lymphoblastic leukemia, acute myeloid leukemia, and chronic lymphocytic leukaemia. Many patients with slow-growing types of leukaemia don't have symptoms. Rapidly growing types of leukaemia may cause symptoms that include fatigue, weight loss, frequent infections, and easy bleeding or bruising.Treatment is highly variable. For slow-growing leukemias, treatment may include monitoring. For aggressive leukemias, treatment includes chemotherapy that's sometimes followed by radiation and stem-cell transplant.

1. LEUKEMIA
PRESENTED BY
R.PRIYA

2. INTRODUCTION
CANCER STARTS WHEN CELLS IN THE BODY CHANGE (MUTATE) AND GROW OUT OF CONTROL. BODY IS
MADE UP OF TINY BUILDING BLOCKS CALLED CELLS. NORMAL CELLS GROW WHEN BODY NEEDS THEM.
THEY DIE WHEN BODY DOESN'T NEED THEM ANYMORE. CANCER IS MADE UP OF ABNORMAL CELLS THAT
GROW EVEN THOUGH BODY DOESN’T NEED THEM. IN MOST TYPES OF CANCERS, THE ABNORMAL CELLS
GROW TO FORM A LUMP OR MASS CALLED A TUMOR.
LEUKEMIA IS DIFFERENT FROM MOST OTHER CANCERS. LEUKEMIA CELLS DON'T ALWAYS FORM A TUMOR.
THIS CANCER STARTS IN THE BONE MARROW. THE BONE MARROW IS THE THICK, SPONGY LIQUID INSIDE
BONES. IT'S WHERE NEW BLOOD CELLS ARE MADE.
LEUKEMIA STARTS IN EARLY FORMS OF BLOOD CELLS, OFTEN WHITE BLOOD CELLS, WHICH HELP FIGHT
INFECTIONS. WHEN HAVE LEUKEMIA, BODY MAKES TOO MANY "BAD" BLOOD CELLS THAT DON’T WORK LIKE
THEY SHOULD. INSTEAD OF FORMING TUMORS, LEUKEMIA CELLS TRAVEL IN THE BLOOD AND GO ALL OVER
THE BODY. THIS MEANS THEY CAN REACH ALMOST ANY ORGAN. LEUKEMIA CAN CAUSE PROBLEMS AND BE
FOUND IN MANY DIFFERENT WAYS, DEPENDING ON WHICH ORGANS ARE AFFECTED.

3. DEFINITION
LEUKEMIA IS A CANCER OF THE BLOOD CELLS. THERE ARE SEVERAL BROAD
CATEGORIES OF BLOOD CELLS, INCLUDING RED BLOOD CELLS (RBCS), WHITE
BLOOD CELLS (WBCS), AND PLATELETS. GENERALLY, LEUKEMIA REFERS TO
CANCERS OF THE WBCS.
WBCs are a vital part of immune system. They protect body from invasion by
bacteria, viruses, and fungi, as well as from abnormal cells and other foreign
substances. In leukemia, the WBCs don’t function like normal WBCs. They can
also divide too quickly and eventually crowd out normal cells.
WBCs are mostly produced in the bone marrow, but certain types of WBCs are
also made in the lymph nodes, spleen, and thymus gland. Once formed, WBCs
circulate throughout body in blood and lymph (fluid that circulates through
the lymphatic system), concentrating in the lymph nodes and spleen.

4. KNOW ABOUT HEMATOPOIETIC STEM
CELL

5. BONE MARROW FUNCTION
The bones of the skeletal system serve many important functions for the body, from giving body support
to allowing to move. They also play an important role in blood cell production and fat storage.
Bone marrow is the spongy or viscous tissue that fills the inside of bones. There are actually two types
of bone marrow:
•Red bone marrow helps produce blood cells
•Yellow bone marrow helps store fat.
Read on to learn more about different functions of red and yellow bone marrow as well as the conditions
that affect bone marrow.
Red bone marrow is involved in hematopoiesis. This is another name for blood cell production.
Hematopoietic stem cells that are found in red bone marrow can develop into a variety of different blood
cells, including:
•Red blood cells. These are the cells that work to carry oxygen-rich blood to the cells of the body. Old red
blood cells can also be broken down in red bone marrow, but this task is mostly performed in
the liver and spleen.
•Platelets. Platelets help blood clot. This prevents uncontrolled bleeding.
•White blood cells. There are several types of white blood cells. They all work to help body fight off
infections.

6. BONE MARROW FUNCTION
YELLOW BONE MARROW IS INVOLVED IN THE STORAGE OF FATS. THE FATS IN
YELLOW BONE MARROW ARE STORED IN CELLS CALLED ADIPOCYTES. THIS FAT
CAN BE USED AS AN ENERGY SOURCE AS NEEDED.
YELLOW BONE MARROW ALSO CONTAINS MESENCHYMAL STEM CELLS. THESE
ARE CELLS THAT CAN DEVELOP INTO BONE, FAT, CARTILAGE, OR MUSCLE CELLS.
REMEMBER, OVER TIME, YELLOW BONE MARROW STARTS TO REPLACE RED
BONE MARROW. SO, MOST BONES IN AN ADULT BODY CONTAIN YELLOW BONE
MARROW.

7. LEUKEMIA TYPES IN FLOW CHART

8. TYPES
• GENERAL CLASSIFICATION
CLINICALLY AND PATHOLOGICALLY, LEUKEMIA IS SUBDIVIDED INTO A VARIETY OF LARGE GROUPS. THE
FIRST DIVISION IS BETWEEN ITS ACUTE AND CHRONIC FORMS:[CITATION NEEDED]
•ACUTE LEUKEMIA IS CHARACTERIZED BY A RAPID INCREASE IN THE NUMBER OF IMMATURE BLOOD
CELLS. THE CROWDING THAT RESULTS FROM SUCH CELLS MAKES THE BONE MARROW UNABLE TO
PRODUCE HEALTHY BLOOD CELLS RESULTING IN LOW HEMOGLOBIN AND LOW PLATELETS. IMMEDIATE
TREATMENT IS REQUIRED IN ACUTE LEUKEMIA BECAUSE OF THE RAPID PROGRESSION AND
ACCUMULATION OF THE MALIGNANT CELLS, WHICH THEN SPILL OVER INTO THE BLOODSTREAM AND
SPREAD TO OTHER ORGANS OF THE BODY. ACUTE FORMS OF LEUKEMIA ARE THE MOST COMMON
FORMS OF LEUKEMIA IN CHILDREN.
•CHRONIC LEUKEMIA IS CHARACTERIZED BY THE EXCESSIVE BUILDUP OF RELATIVELY MATURE, BUT
STILL ABNORMAL, WHITE BLOOD CELLS. TYPICALLY TAKING MONTHS OR YEARS TO PROGRESS, THE
CELLS ARE PRODUCED AT A MUCH HIGHER RATE THAN NORMAL, RESULTING IN MANY ABNORMAL WHITE
BLOOD CELLS. WHEREAS ACUTE LEUKEMIA MUST BE TREATED IMMEDIATELY, CHRONIC FORMS ARE
SOMETIMES MONITORED FOR SOME TIME BEFORE TREATMENT TO ENSURE MAXIMUM EFFECTIVENESS
OF THERAPY. CHRONIC LEUKEMIA MOSTLY OCCURS IN OLDER PEOPLE, BUT CAN OCCUR IN ANY AGE
GROUP.

9. SPECIFIC TYPES
• SPECIFIC TYPES
ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) IS THE MOST COMMON TYPE OF LEUKEMIA IN NG CHILDREN. IT ALSO AFFECTS
ADULTS, ESPECIALLY THOSE 65 AND OLDER. STANDARD TREATMENTS INVOLVE CHEMOTHERAPY AND RADIOTHERAPY.
SUBTYPES INCLUDE PRECURSOR B ACUTE LYMPHOBLASTIC LEUKEMIA, PRECURSOR T ACUTE LYMPHOBLASTIC
LEUKEMIA, BURKITT'S LEUKEMIA, AND ACUTE BIPHENOTYPIC LEUKEMIA. WHILE MOST CASES OF ALL OCCUR IN CHILDREN, 80%
OF DEATHS FROM ALL OCCUR IN ADULTS.[15]
•CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) MOST OFTEN AFFECTS ADULTS OVER THE AGE OF 55. IT SOMETIMES OCCURS IN
NGER ADULTS, BUT IT ALMOST NEVER AFFECTS CHILDREN. TWO-THIRDS OF AFFECTED PEOPLE ARE MEN. THE FIVE-YEAR
SURVIVAL RATE IS 85%. IT IS INCURABLE, BUT THERE ARE MANY EFFECTIVE TREATMENTS. ONE SUBTYPE IS B-CELL
PROLYMPHOCYTIC LEUKEMIA, A MORE AGGRESSIVE DISEASE.
•ACUTE MYELOGENOUS LEUKEMIA (AML) OCCURS FAR MORE COMMONLY IN ADULTS THAN IN CHILDREN, AND MORE
COMMONLY IN MEN THAN WOMEN. IT IS TREATED WITH CHEMOTHERAPY. THE FIVE-YEAR SURVIVAL RATE IS 20%. SUBTYPES OF
AML INCLUDE ACUTE PROMYELOCYTIC LEUKEMIA, ACUTE MYELOBLASTIC LEUKEMIA, AND ACUTE MEGAKARYOBLASTIC
LEUKEMIA.
•CHRONIC MYELOGENOUS LEUKEMIA (CML) OCCURS MAINLY IN ADULTS; A VERY SMALL NUMBER OF CHILDREN ALSO DEVELOP
THIS DISEASE. IT IS TREATED WITH IMATINIB (GLEEVEC IN UNITED STATES, GLIVEC IN EUROPE) OR OTHER DRUGS. THE FIVE-
YEAR SURVIVAL RATE IS 90%. ONE SUBTYPE IS CHRONIC MYELOMONOCYTIC LEUKEMIA.
•HAIRY CELL LEUKEMIA (HCL) IS SOMETIMES CONSIDERED A SUBSET OF CHRONIC LYMPHOCYTIC LEUKEMIA, BUT DOES NOT FIT
NEATLY INTO THIS CATEGORY. ABOUT 80% OF AFFECTED PEOPLE ARE ADULT MEN. NO CASES IN CHILDREN HAVE BEEN
REPORTED. HCL IS INCURABLE BUT EASILY TREATABLE. SURVIVAL IS 96% TO 100% AT TEN YEARS.

10. SPECIFIC TYPES
•T-CELL PROLYMPHOCYTIC LEUKEMIA (T-PLL) IS A VERY RARE AND AGGRESSIVE LEUKEMIA AFFECTING ADULTS;
SOMEWHAT MORE MEN THAN WOMEN ARE DIAGNOSED WITH THIS DISEASE.[22] DESPITE ITS OVERALL RARITY, IT IS
THE MOST COMMON TYPE OF MATURE T CELL LEUKEMIA;[23] NEARLY ALL OTHER LEUKEMIAS INVOLVE B CELLS. IT IS
DIFFICULT TO TREAT, AND THE MEDIAN SURVIVAL IS MEASURED IN MONTHS.
•LARGE GRANULAR LYMPHOCYTIC LEUKEMIA MAY INVOLVE EITHER T-CELLS OR NK CELLS; LIKE HAIRY CELL
LEUKEMIA, WHICH INVOLVES SOLELY B CELLS, IT IS A RARE AND INDOLENT (NOT AGGRESSIVE) LEUKEMIA.[24]
•ADULT T-CELL LEUKEMIA IS CAUSED BY HUMAN T-LYMPHOTROPIC VIRUS (HTLV), A VIRUS SIMILAR TO HIV. LIKE HIV,
HTLV INFECTS CD4+ T-CELLS AND REPLICATES WITHIN THEM; HOWEVER, UNLIKE HIV, IT DOES NOT DESTROY THEM.
INSTEAD, HTLV "IMMORTALIZES" THE INFECTED T-CELLS, GIVING THEM THE ABILITY TO PROLIFERATE ABNORMALLY.
HUMAN T-CELL LYMPHOTROPIC VIRUS TYPES I AND II (HTLV-I/II) ARE ENDEMIC IN CERTAIN AREAS OF THE
WORLD.[CITATION NEEDED]
•CLONAL EOSINOPHILIAS (ALSO CALLED CLONAL HYPEREOSINOPHILIAS) ARE A GROUP OF BLOOD DISORDERS
CHARACTERIZED BY THE GROWTH OF EOSINOPHILS IN THE BONE MARROW, BLOOD, AND/OR OTHER TISSUES.
THEY MAY BE PRE-CANCEROUS OR CANCEROUS. CLONAL EOSINOPHILIAS INVOLVE A "CLONE" OF EOSINOPHILS,
I.E., A GROUP OF GENETICALLY IDENTICAL EOSINOPHILS THAT ALL GREW FROM THE SAME MUTATED ANCESTOR
CELL.[25] THESE DISORDERS MAY EVOLVE INTO CHRONIC EOSINOPHILIC LEUKEMIA OR MAY BE ASSOCIATED WITH
VARIOUS FORMS OF MYELOID NEOPLASMS, LYMPHOID NEOPLASMS, MYELOFIBROSIS, OR THE MYELODYSPLASTIC
SYNDROME

11. RISK FACTOR
THE CAUSES OF LEUKEMIA AREN’T KNOWN. HOWEVER, SEVERAL FACTORS HAVE BEEN
IDENTIFIED WHICH MAY INCREASE RISK. THESE INCLUDE:
•A FAMILY HISTORY OF LEUKEMIA
•SMOKING, WHICH INCREASES RISK OF DEVELOPING ACUTE MYELOID LEUKEMIA (AML)
•GENETIC DISORDERS SUCH AS DOWN SYNDROME
•BLOOD DISORDERS, SUCH AS MYELODYSPLASTIC SYNDROME, WHICH IS SOMETIMES
CALLED “PRELEUKEMIA”
•PREVIOUS TREATMENT FOR CANCER WITH CHEMOTHERAPY OR RADIATION
•EXPOSURE TO HIGH LEVELS OF RADIATION
•EXPOSURE TO CHEMICALS SUCH AS BENZENE

12. PATHOPHYSIOGY

13. SIGNS AND SYMPTOMS
•FATIGUE
•A GENERAL FEELING OF DISCOMFORT OR ILLNESS (CALLED MALAISE)
•LOSS OF APPETITE
•WEIGHT LOSS
•FEVER
•SHORTNESS OF BREATH
•PALENESS
•RAPID HEARTBEAT (CALLED PALPITATIONS)
•WEAKNESS
•DIZZINESS
•EASY BRUISING
•FREQUENT OR SEVERE NOSE BLEEDS
•BLEEDING GUMS
•BLEEDING IN THE MIDDLE OF A MENSTRUAL CYCLE OR HEAVY MENSTRUAL FLOW
•TINY, FLAT, RED SPOTS CAUSED BY BLEEDING JUST UNDER THE SURFACE OF THE SKIN (CALLED PETECHIAE)
•FREQUENT INFECTIONS IN THE LUNGS, URINARY TRACT OR GUMS OR AROUND THE ANUS
•FREQUENT COLD SORES

14. SIGNS AND SYMPTOMS
•VOMITING
•HEADACHE
•SORE THROAT
•NIGHT SWEATS
•BONE OR JOINT PAIN
•ENLARGED LYMPH NODES IN THE NECK, UNDERARM, GROIN OR ABOVE THE COLLARBONE
•ABDOMINAL DISCOMFORT OR FEELING OF FULLNESS
•VISION PROBLEMS
•SORES IN THE EYES
•SWELLING OF THE TESTICLES
•CHLOROMA – A COLLECTION OF LEUKEMIA CELLS, OR BLASTS, UNDER THE SKIN OR IN OTHER PARTS OF THE BODY
•LEUKEMIA CUTIS – APPEARS AS SORES OR AS PATCHES OF ANY SIZE THAT ARE USUALLY PINK OR TAN IN COLOUR
•LEUKOCYTOCLASTIC VASCULITIS – A CONDITION THAT LOOKS LIKE AN ALLERGIC REACTION ON THE SKIN AND USUALLY CAUSES SORES ON THE HANDS
AND FEET
•SWEET’S SYNDROME, OR ACUTE FEBRILE NEUTROPHILIC DERMATOSIS – CAUSES FEVER AND PAINFUL SORES THAT MAY APPEAR ANYWHERE ON THE
BODY

15. DIAGNOSTIC EVALUATION
PHYSICAL EXAM. DOCTOR WILL LOOK FOR PHYSICAL SIGNS OF LEUKEMIA, SUCH AS PALE SKIN FROM
ANEMIA, SWELLING OF LYMPH NODES, AND ENLARGEMENT OF LIVER AND SPLEEN
LABORATORY TESTS
BLOOD FILM – LIKELY TO SHOW THE PRESENCE OF BLAST CELLS
IMAGING OR INVASIVE TESTS
ALL CHILDREN SUSPECTED TO HAVE A NEW DIAGNOSIS OF LEUKEMIA SHOULD ALSO UNDERGO CHEST X
RAY TO EXCLUDE MEDIASTINAL MASS
LUMBAR PUNCTURE IS REQUIRED TO CHECK FOR CNS INVOLVEMENT
•.CT, MRI,UTRASOUND
•BLOOD TESTS. BY LOOKING AT A SAMPLE OF BLOOD, DOCTOR CAN DETERMINE IF HAVE ABNORMAL
LEVELS OF RED OR WHITE BLOOD CELLS OR PLATELETS — WHICH MAY SUGGEST LEUKEMIA. A BLOOD TEST
MAY ALSO SHOW THE PRESENCE OF LEUKEMIA CELLS, THOUGH NOT ALL TYPES OF LEUKEMIA CAUSE THE
LEUKEMIA CELLS TO CIRCULATE IN THE BLOOD. SOMETIMES THE LEUKEMIA CELLS STAY IN THE BONE
MARROW.
•BONE MARROW TEST. DOCTOR MAY RECOMMEND A PROCEDURE TO REMOVE A SAMPLE OF BONE
MARROW FROM HIPBONE. THE BONE MARROW IS REMOVED USING A LONG, THIN NEEDLE. THE SAMPLE IS
SENT TO A LABORATORY TO LOOK FOR LEUKEMIA CELLS. SPECIALIZED TESTS OF LEUKEMIA CELLS MAY
REVEAL CERTAIN CHARACTERISTICS THAT ARE USED TO DETERMINE TREATMENT OPTIONS. BONE
MARROW ASPIRATE/TREPHINE IS REQUIRED TO CONFIRM THE DIAGNOSIS

16. MANAGEMENT
•CHEMOTHERAPY. CHEMOTHERAPY IS THE MAJOR FORM OF TREATMENT FOR LEUKEMIA. THIS DRUG
TREATMENT USES CHEMICALS TO KILL LEUKEMIA CELLS. STANDARD INDUCTION PLANS
INCLUDE PREDNISONE, VINCRISTINE, AND AN ANTHRACYCLINE DRUG; OTHER DRUG PLANS MAY
INCLUDE L-ASPARAGINASE OR CYCLOPHOSPHAMIDE
•DEPENDING ON THE TYPE OF LEUKEMIA HAVE, MAY RECEIVE A SINGLE DRUG OR A COMBINATION OF
DRUGS. THESE DRUGS MAY COME IN A PILL FORM, OR THEY MAY BE INJECTED DIRECTLY INTO A VEIN.
•TARGETED THERAPY. TARGETED DRUG TREATMENTS FOCUS ON SPECIFIC ABNORMALITIES
PRESENT WITHIN CANCER CELLS. BY BLOCKING THESE ABNORMALITIES, TARGETED DRUG
TREATMENTS CAN CAUSE CANCER CELLS TO DIE.EG.IMATINUB
•RADIATION THERAPY. RADIATION THERAPY USES X-RAYS OR OTHER HIGH-ENERGY BEAMS TO
DAMAGE LEUKEMIA CELLS AND STOP THEIR GROWTH. DURING RADIATION THERAPY, LIE ON A TABLE
WHILE A LARGE MACHINE MOVES AROUND . MAY RECEIVE RADIATION IN ONE SPECIFIC AREA OF
BODY WHERE THERE IS A COLLECTION OF LEUKEMIA CELLS, OR MAY RECEIVE RADIATION OVER
WHOLE BODY. RADIATION THERAPY MAY BE USED TO PREPARE FOR A BONE MARROW TRANSPLANT.
• MAY RECEIVE STEM CELLS FROM A DONOR OR MAY BE ABLE TO USE OWN STEM CELLS.

17. MANAGEMENT
•BONE MARROW TRANSPLANT. A BONE MARROW TRANSPLANT, ALSO
CALLED A STEM CELL TRANSPLANT, HELPS REESTABLISH HEALTHY STEM
CELLS BY REPLACING UNHEALTHY BONE MARROW WITH LEUKEMIA-FREE
STEM CELLS THAT WILL REGENERATE HEALTHY BONE MARROW.
•PRIOR TO A BONE MARROW TRANSPLANT, RECEIVE VERY HIGH DOSES OF
CHEMOTHERAPY OR RADIATION THERAPY TO DESTROY LEUKEMIA-
PRODUCING BONE MARROW. THEN RECEIVE AN INFUSION OF BLOOD-
FORMING STEM CELLS THAT HELP REBUILD BONE MARROW.

18. MANAGEMENT
• MANY DIFFERENT TREATMENTS HAVE BEEN ATTEMPTED, WITH LIMITED
SUCCESS IN CERTAIN PEOPLE: PURINE ANALOGUES (PENTOSTATIN,
FLUDARABINE, CLADRIBINE), CHLORAMBUCIL, AND VARIOUS FORMS OF
COMBINATION CHEMOTHERAPY (CYCLOPHOSPHAMIDE, DOXORUBICIN,
VINCRISTINE, PREDNISONE CHOP, CYCLOPHOSPHAMIDE, VINCRISTINE,
PREDNISONE [COP], VINCRISTINE, DOXORUBICIN, PREDNISONE, ETOPOSIDE,
CYCLOPHOSPHAMIDE, BLEOMYCIN VAPEC-B). ALEMTUZUMAB (CAMPATH),
A MONOCLONAL ANTIBODY THAT ATTACKS WHITE BLOOD CELLS, HAS BEEN
USED IN TREATMENT WITH GREATER SUCCESS THAN PREVIOUS OPTIONS.
•Engineering immune cells to fight leukemia. A specialized treatment called chimeric
antigen receptor (CAR)-T cell therapy takes body's germ-fighting T cells, engineers them to
fight cancer and infuses them back into body. CAR-T cell therapy might be an option for
certain types of leu Immunotherapy. Immunotherapy uses immune system to fight cancer.
body's disease-fighting immune system may not attack cancer because the cancer cells
produce proteins that help them hide from the immune system cells. Immunotherapy works
by interfering with that process..

19. PREVENTION
•BE A NON-SMOKER. NOT SMOKING IS THE BEST WAY TO LOWER RISK
OF LEUKEMIA. ...
•MAINTAIN A HEALTHY BODY WEIGHT. ...
•AVOID BREATHING IN BENZENE AND FORMALDEHYDE. ...
•MORE INFORMATION ABOUT PREVENTING CANCER.