What is leukemia?
Leukemia is a cancer of the white blood cells that help fight infection. With leukemia, your bone marrow, the spongy tissue inside bones, produces abnormal white blood cells. These abnormal white blood cells grow rapidly, spread out into the bloodstream, and crowd out healthy white blood cells, red blood cells, and platelets.
The abnormal white blood cells are not able to fight infection as effectively as the normal white blood cells, resulting in increased infections. The abnormal white blood cells also accumulate in the organs of the body, such as the spleen, liver, lymph nodes, testes, and brain, and interfere with normal organ function.
Other types of cells can be affected as well. The reduced number of red blood cells leads to anemia. The lower number of platelets, special cells that are needed for normal clotting, leads to poor blood clotting.
Leukemia is a common cancer in adults. Among children and teenagers, it is also one of the most common cancers and the second-leading cause of cancer deaths (behind cancers of the brain and nervous system).
Leukemia can develop quickly, leading to life-threatening complications and possibly death, especially if it goes undetected and untreated. The good news is some types of leukemia can be cured or controlled. Chemotherapy is the main treatment for most types of leukemia. Other options include radiation therapy, biologic therapy, targeted therapies, and stem cell transplant.
Getting regular check-ups offers the best chances of detecting leukemia in its earliest, most curable stage. Seek prompt medical care if you have symptoms of leukemia, such as frequent infections, fatigue, fever, or night sweats. If you have leukemia, following your treatment plan may help reduce your risk of serious complications.
What are the different types of leukemia?
The name “leukemia” is a general term for many types of malignant diseases of the blood and bone marrow. The four primary types of leukemia are classified by how quickly the disease progresses and by the type of white blood cell affected.
Acute leukemia progresses rapidly. The disease affects immature blood cells called blasts that multiply at a high rate, so symptoms worsen quickly. Patients with acute leukemia receive prompt, aggressive treatment.
Chronic leukemia affects more mature blood cells, which multiply more slowly. They can also maintain their normal function for a longer time, slowing the progression of the disease. Some patients have no symptoms for years and, once diagnosed, may undergo “watchful waiting” before starting treatment. Chronic leukemia may affect the skin, central nervous system, digestive tract, kidneys, and testicles.
The types of white blood cells that can be affected by leukemia are:
- Lymphocytes, which make up the lymphatic tissue in your immune system
- Myeloid cells, a type of blood-forming cell in the bone marrow that generates red blood cells, white blood cells, and platelets
Rapidly progressing types of leukemia
- Acute lymphoblastic (lymphocytic) leukemia (ALL): ALL affects immature lymphocytes, causing them to multiply quickly. This can lead to rapid accumulation of leukemia cells in the blood, which can spread to elsewhere in the body. ALL is the most common leukemia in children and teens, but adults can also get ALL. Children are more likely than adults to have curable disease.
- Acute myeloid (myelogenous) leukemia (AML): AML starts in the bone marrow, developing from blood-forming cells. Most often it affects new white blood cells, but can also develop into red blood cells or platelets. The leukemia cells enter the bloodstream and can spread to other parts of the body. AML is more common in adults than in children. While it can be hard to treat, AML is curable in some cases.
Slowly progressing types of leukemia
- Chronic lymphocytic (lymphoblastic) leukemia (CLL): CLL is the most common leukemia in adults. It develops from more mature lymphocytes, and it can grow slowly or quickly. The slow-growing form is less severe than the fast-growing type. When it grows slowly, CLL may not require treatment for several years. Doctors may recommend watchful waiting instead.
- Chronic myeloid (myelogenous) leukemia (CML): CML occurs due to the formation of an abnormal gene—the BCR-ABL1 fusion gene. This gene forms as the result of replication errors, which shorten chromosome 22, dubbed the Philadelphia chromosome. The fusion gene product stimulates the bone marrow to produce too many white blood cells, which can crowd out healthy blood cells. CML starts and progresses slowly, and oral treatment is very effective for most people.
What are the symptoms of leukemia?
Symptoms of leukemia can vary among individuals and differ depending on the specific type of leukemia. In some cases, there may not be any symptoms of chronic lymphocytic leukemia or chronic myelogenous leukemia.
Symptoms of leukemia are caused by the high numbers of abnormal white blood cells that crowd out normal white blood cells, red blood cells, and platelets.
The abnormal white blood cells of leukemia are not able to fight infection as effectively as the normal white blood cells, resulting in frequent infections. Lower numbers of red blood cells result in anemia and symptoms that include fatigue, shortness of breath, pale skin, and slow healing of wounds.
The abnormal white blood cells formed in leukemia eventually accumulate in the organs of the body, such as the spleen, liver, lymph nodes, testes, and brain, and interfere with normal organ function.
Symptoms of leukemia include:
- Achiness in the joints and bones
- Enlarged liver and glands, such as the spleen and lymph nodes
- Frequent infections
- Loss of appetite
- Night sweats
- Ongoing low-grade fever
- Pale skin or pallor
- Shortness of breath
- Slow healing of wounds
- Weight loss
What are the stages of leukemia?
Because the progression of leukemia varies based on the specific diagnosis, doctors classify stages differently for each of the four types.
Stages of acute lymphocytic (lymphoblastic) leukemia (ALL)
This aggressive form of leukemia affects immature white blood cells that multiply quickly, causing the disease to progress rapidly. Doctors classify ALL on the status of treatment, symptoms, and presence of cancer cells.
- Untreated: The patient is recently diagnosed and treatment has not been administered to destroy cancer cells, only to manage symptoms.
- In remission: Less than 5% of bone marrow cells are cancer cells, and the patient does not have symptoms.
- Recurrent: The cancer has returned following treatment.
For childhood ALL, doctors classify by risk group:
- Standard or low risk: Children between ages 1 and 9 whose white blood cell count is below 50,000
- High risk: Children 10 and older and children with a white blood cell count higher than 50,000
Stages of acute myeloid (myelogenous) leukemia (AML)
Instead of using traditional stages, doctors classify AML progression by the status of the disease:
- Untreated: The condition is newly diagnosed and the person is symptomatic. Only symptoms have been treated to date, and at least 20% of bone marrow cells are leukemia cells (blasts).
- In remission: Treatment has been successful, and complete blood count is normal. Less than 5% of bone marrow cells are blasts, and the patient does not have symptoms.
- Recurrent: The leukemia has come back in the blood or bone marrow.
In childhood AML, doctors use similar classifications:
- Newly diagnosed: More than 20% of the cells in the child’s bone marrow are blast cells, or less than 20% are blast cells, but there are also chromosomal changes known to cause or increase the risk of AML.
- In remission: The child’s complete blood count is normal, with blast cells at less than 5% of bone marrow cells. The child has no other symptoms of leukemia.
Stages of chronic lymphocytic (lymphoblastic) leukemia (CLL):
This form of leukemia progresses slowly, as more mature white blood cells accumulate in the bloodstream and throughout the body.
Doctors stage CLL similarly to other forms of cancer:
- Stage 0: The level of lymphocytes in the blood is too high.
- Stage I: The level of lymphocytes is too high and lymph nodes are swollen.
- Stage II: The level of lymphocytes is too high, lymph nodes are swollen, and the liver or spleen is enlarged.
- Stage III: The level of lymphocytes is too high and the level of red blood cells is too low. The lymph nodes, liver or spleen may be swollen.
- Stage IV: The level of lymphocytes is too high and the level of platelets is too low, preventing proper blood clotting. The lymph nodes, liver or spleen may be swollen, and the level of red blood cells may be too low.
Stages of chronic myeloid (myelogenous) leukemia (CML)
In this slow-growing type of leukemia, the bone marrow produces too many white blood cells (blasts), which crowd out healthy blood cells. Doctors classify CML into three phases:
- Chronic phase: Less than 10% of cells in the bone marrow and blood are blast cells
- Accelerated phase: Between 10 to 19% of cells in the bone marrow and blood are blast cells
- Blastic phase: 20% or more of cells in the bone marrow and blood are blast cells. If you have fever, fatigue, or swelling of the spleen, this is known as a “blast crisis.”
What causes leukemia?
The cause of every type of leukemia is not known, but researchers believe it may develop from a combination of genetic and environmental factors.
The disease itself develops when blood cells do not behave normally. Typically, blood cells grow at a specific rate and die within a specific amount of time, allowing the blood to maintain steady levels of cells. With leukemia, certain types of blood cells continue to grow and multiply, which crowds out healthy blood cells. As healthy white blood cells, red blood cells, and platelets decrease, the body is not able to function normally, leading to the symptoms and complications, such as frequent infections, anemia, bleeding, fever, weight loss, and fatigue.
What are the risk factors for leukemia?
A number of factors are thought to increase your chances of developing leukemia. Not all people with risk factors will develop the disease.
Risk factors for leukemia include:
- Certain blood disorders, such as myelodysplastic syndrome
- Certain types of chemotherapy
- Chemotherapy and cancer therapy at a young age
- Exposure to certain chemicals such as benzene
- Exposure to large amounts of radiation
- Human T-cell leukemia virus (HTLV-I) infection
- Immunodeficiency from any cause
Reducing your risk of leukemia
You may be able to lower your risk of leukemia by:
- Avoiding exposure to benzene
- Avoiding exposure to ionizing radiation
- Not smoking
What are the diet and nutrition tips for leukemia?
There are no specific foods that will help you treat leukemia, but by eating nourishing foods and staying hydrated, you can help your body stay stronger and better able to tolerate the side effects of leukemia treatment. Maintaining a healthy, nutritious diet also builds your immune system and reduces your risk of other conditions like heart disease or diabetes.
A balanced diet should include:
- Fat-free or low-fat dairy, such as skim milk or low-fat plain yogurt
- Fresh fruits and vegetables, avoiding canned produce, which can contain added sugar and salt
- Healthy oils, such as olive oil
- Lean, low-fat proteins, focusing on poultry or fish over red meat
- Limited alcohol, recommended at one drink per day for women and two drinks per day for men
- Water or other non-sugar drinks to maintain hydration. Drink caffeine in moderation and avoid high-sugar drinks like soda or even some sports drinks.
- Whole grains instead of refined carbs like white bread, white rice or white pasta
A healthy lifestyle also includes regular exercise, not smoking, and getting enough sleep. Ask your healthcare provider for guidance before making significant changes to your diet or fitness routine.
Talk to your doctor if your leukemia symptoms are making it difficult to eat well or maintain a healthy weight. You may be able to work with a dietician to build a nutrition plan that best serves your needs.
How do doctors diagnose leukemia?
When diagnosing leukemia, a doctor performs a complete medical history, a physical examination, blood tests, and X-rays. Other diagnostic procedures that may be used include the following:
- Bone marrow aspiration and/or biopsy, a procedure that involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size and maturity of blood cells and/or abnormal cells
- Complete blood count (CBC), a measurement of size, number and maturity of different blood cells in a specific volume of blood
- Computed tomography scan (also called a CT or CAT scan), a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images (often called slices) of the body
- Magnetic resonance imaging (MRI), a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body
- Ultrasound (also called sonography), a diagnostic imaging technique that uses high-frequency sound waves and a computer to view internal organs as they function and to assess blood flow through various vessels
- Lymph node biopsy, a procedure performed to remove lymph node tissue or cells from the body for examination under a microscope
- Spinal tap/lumbar puncture, a procedure in which a special needle is placed into the lower back, into the spinal canal (the area around the spinal cord), to remove cerebrospinal fluid. This allows doctors to determine if the leukemia involves the central nervous system and to exclude the possibility of an infection or other problems.
What are the treatments for leukemia?
Treatment of leukemia begins with seeking regular medical care throughout your life. Regular medical care allows a healthcare professional to best evaluate your risks of developing leukemia and promptly order diagnostic testing for such symptoms as fatigue, enlarged spleen, shortness of breath, and easy bruising. These measures greatly increase the chances of detecting leukemia in its earliest, most curable stage.
The goal of treatment of leukemia is to bring about a complete remission of the disease. Remission means there is no longer any sign of the disease in the body, although it may recur or relapse later.
Leukemia treatment plans use a multifaceted approach that is individualized to the type of leukemia and stage of advancement; your age, medical history, and coexisting diseases or conditions; and other factors. Treatment is best delivered by a team of specialists in leukemia care. These specialists include hematology oncologists, hematologists, and registered nurses who specialize in cancer and leukemia care.
Leukemia treatment may include an individualized combination of:
- Bone marrow transplant to replace unhealthy bone marrow in order for the body to produce healthy blood cells
- Dietary counseling to help people with cancer maintain their strength and nutritional status
- Palliative care to improve the overall quality of life for families and patients with serious diseases
- Participation in a clinical trial to test promising new therapies and treatments for leukemia
- Physical therapy to help strengthen the body, increase alertness, reduce fatigue, and improve functional ability during and after cancer treatment
- Stem cell transplant to provide healthy new stem cells, which divide to make healthy new blood cells
- Transfusions of red blood cells and platelets
Some complementary treatments may help some people better deal with leukemia and its treatments. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.
Complementary treatments may include:
- Massage therapy
- Nutritional dietary supplements, herbal remedies, tea beverages, and similar products
In cases in which leukemia has progressed to an advanced stage and has become unresponsive to treatment, the goal of treatment shifts away from curing the disease and focuses on treating the person. In advanced leukemia the goal of hospice care is to help people in their last phases of an incurable disease to live as fully and comfortably as possible. Hospice care involves medically controlling pain and other symptoms while providing psychological and spiritual support as well as services to support the patient’s family.
How does leukemia affect quality of life?
Even when the prognosis is good, a cancer diagnosis is a life-changing event. If you have chronic, slow-growing disease, you may not start treatment and instead practice “watchful waiting,” which can create stress as you consider what might or might not happen in the future. Those with fast-growing, acute disease may undergo aggressive treatment that produces its own physical and emotional side effects.
As with any cancer, having a strong network of healthcare providers, family, and friends is essential to managing the physical challenges of leukemia as well as the mental and spiritual experience of the disease. Finding support groups online or in person can help you connect with other people living with leukemia, allowing you to share experiences, advice and encouragement.
What are the potential complications of leukemia?
Complications of leukemia are serious and can become life-threatening. Complications are caused by the rapid growth of abnormal white blood cells. This crowds out red blood cells, healthy white blood cells, and platelets. Together this can reduce your red blood cell count, weaken your ability to fight infections, and reduce your blood’s ability to clot. Abnormal white blood cells also accumulate in the body’s organs and interfere with normal organ function.
Complications of leukemia include:
- Adverse effects of treatment
- Easy bleeding
- Easy bruising
- Frequent infections
- Graft versus host disease (bone marrow transplant recipients)
- Organ dysfunction
You can best treat leukemia and lower your risk of complications by following the treatment plan that you and your healthcare team design specifically for you.
What is the survival rate and prognosis for leukemia?
Treatment advances have greatly improved the prognosis and survival rate for leukemia. Many people today with leukemia are able to treat or manage the disease effectively and live long, healthy lives.
A survival rate is an estimate of what percentage of people with leukemia will be alive five years after their diagnosis. When evaluating childhood leukemias, the 5-year survival rate refers to the percentage of children who live at least 5 years after diagnosis. It is important to remember that each patient is unique, and that survival rates may continue to improve with the development of new treatments.
The 5-year relative survival rate for leukemia overall has improved greatly in the last few decades, reaching 65.8% across all patients from 2009 to 2015. In that same time frame, the survival rates by leukemia type break down as follows.
Acute lymphocytic leukemia (ALL) 5-year relative survival rate
- 71.7% overall
- 91.9% for children and teens under 15
- 94.1 % for children under 5
Acute myeloid leukemia (AML) 5-year relative survival rate
- 29.4% overall
- 68.7% for children and teens under 15
Chronic lymphocytic leukemia (CLL) 5-year relative survival rate
- 88.2% overall
Chronic myeloid leukemia (CML) 5-year relative survival rate
- 69.7% overall