Leukemia is cancer of the blood cells. It starts in the bone marrow, the soft tissue inside most bones. Bone marrow is where blood cells are made.
When you are healthy, your bone marrow makes:
When you have leukemia, the bone marrow starts to make a lot of abnormal white blood cells, called leukemia cells. They don't do the work of normal white blood cells, they grow faster than normal cells, and they don't stop growing when they should.
Over time, leukemia cells can crowd out the normal blood cells. This can lead to serious problems such as anemia, bleeding, and infections. Leukemia cells can also spread to the lymph nodes or other organs and cause swelling or pain.
There are several different types of leukemia. In general, leukemia is grouped by how fast it gets worse and what kind of white blood cell it affects.
The four main types of leukemia are:
In adults, chronic lymphocytic leukemia (CLL) and acute myelogenous leukemia (AML) are the most common leukemias. In children, the most common leukemia is acute lymphoblastic leukemia (ALL). Childhood leukemias also include acute myelogenous leukemia (AML) and other myeloid leukemias, such as chronic myelogenous leukemia (CML) and juvenile myelomonocytic leukemia (JMML).
Experts don't know what causes leukemia. But some things are known to increase the risk of some kinds of leukemia. These things are called risk factors. You are more likely to get leukemia if you:
But most people who have these risk factors don't get leukemia. And most people who get leukemia do not have any known risk factors.
Symptoms may depend on what type of leukemia you have, but common symptoms include:
To find out if you have leukemia, a doctor will:
If your blood tests are not normal, the doctor may want to do a bone marrow biopsy. This test lets the doctor look at cells from inside your bone. This can give key information about what type of leukemia it is so you can get the right treatment.
What type of treatment you need will depend on many things, including what kind of leukemia you have, how far along it is, and your age and overall health.
Treatments for leukemia include:
For some people, clinical trials are a treatment option. Clinical trials are research projects to test new medicines and other treatments. Often people with leukemia take part in these studies.
Some treatments for leukemia can cause side effects. Your doctor can tell you what problems are common and help you find ways to manage them.
Finding out that you or your child has leukemia can be a terrible shock. It may help to:
Learning about leukemia:
Living with leukemia:
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Experts do not yet know what causes leukemia.
A risk factor is anything that raises your chance of getting a disease. Risk factors for some types of leukemia include:
Most people who get leukemia do not have any risk factors.
Most types of leukemia do not seem to run in families. But in some cases chronic lymphocytic leukemia (CLL) does. There are also certain genetic conditions, like Down syndrome, that can make acute myelogenous leukemia (AML) more likely.
Symptoms of leukemia depend on how much the cancer has grown and may include:
The chronic forms of leukemia often cause no symptoms until much later in the disease.
Stem cells are made in the bone marrow. Stem cells become:
In most cases of leukemia, there are too many abnormal white blood cells. These leukemia cells crowd out the normal blood cells in your bone marrow and build up in your lymph nodes, liver, and spleen. This makes it hard for your body to fight infections.
When the leukemia cells crowd out your normal cells, your blood cannot do its job. You may bleed or bruise easily, have more infections, and feel very tired.
Survival rates are different for each kind of leukemia. A 5-year survival rate is the percentage of people who are still alive 5 years or more after being diagnosed. These numbers do not necessarily show what will happen in your case. The following are estimated 5-year survival rates:1
These numbers come from reports that were done at least 5 years ago, before newer treatments were available. So chances of survival today are likely to be higher than these numbers.
A risk factor is anything that makes you more likely to get a disease. Most people who have leukemia do not have any known risk factors. But things that increase your risk of having leukemia include:
Call your doctor to schedule an appointment if you have any symptoms, such as:
Watchful waiting is a period when your doctor is checking you regularly but not treating you. It is also called observation or surveillance. It means that you and your doctor will watch to see if you develop symptoms. It may be a treatment choice if you are an older adult, depending on the stage of the leukemia and your overall health.
Watchful waiting may give as good or better results than more aggressive treatment for early stage chronic lymphocytic leukemia (CLL). It is estimated that 1 out of 3 people who have CLL never need treatment.3 People who have chronic lymphocytic leukemia often live for a long time without treatment. Watchful waiting is not usually recommended for other types of leukemia.
During watchful waiting, you will:
Your family doctor or general practitioner can check symptoms of leukemia. For diagnosis of leukemia, you may be referred to a medical oncologist or hematologist. These specialists also treat leukemia.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
If your doctor suspects leukemia, he or she will ask about your medical history. Your doctor also will check for enlarged lymph nodes in your neck, underarm, or groin. He or she will also examine you to see if your liver or spleen is enlarged.
Your doctor will order blood tests, such as a complete blood count (CBC) and a blood profile. These provide important information about the cells in your blood. They are used to look into symptoms such as fatigue, weakness, fever, bruising, or weight loss.
If your blood work points to possible leukemia, your doctor will want to find out what kind you might have. Your treatment plan will depend on the specific kind of leukemia that you have.
Tests that look closely at unusual cells, chromosomes, or proteins on cells can show what type or subtype of leukemia you have. These tests can help guide treatment. Sometimes they can help your doctor and you know whether your leukemia is likely to go into remission or come back. In some cases, the tests can predict survival rates.
These tests include:
Your doctor may also order other tests, including:
Also, a biopsy of a lymph node or other tissues may be done to look for cancer cells.
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.
Chemotherapy is the use of drugs to fight cancer. It is the usual treatment for acute leukemia. For most people, that means receiving drugs in stages:
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.
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.
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.
Treatment if acute leukemia gets worse
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:
Clinical trials. People who have leukemia may enter a research program when they first start treatment or if the leukemia is not getting better. These programs test new ways to treat the disease. For more information on clinical trials, see www.cancer.ca/Canada-wide/Cancer%20research/Clinical%20trials.aspx?sc_lang=en, www.cancer.gov/clinical_trials/, or http://clinicaltrials.gov.
You can find more information about acute leukemias online at the:
Chronic lymphocytic leukemia (CLL)
Chronic lymphocytic leukemia is not always treated right away. It usually gets worse more slowly than acute leukemia.
Treatment choices for CLL include:
When you have CLL, your body is not able to fight infections very well. You and your doctor need to watch for any signs of infections, such as pneumonia or yeast infections. Early treatment of these and other infections will help you live longer. You can sometimes prevent certain infections or keep from getting very sick by getting a flu shot or a pneumonia vaccine. Your doctor also may give you antibiotics to prevent infection while you are being treated for leukemia.
Chronic myelogenous leukemia (CML)
Chronic myelogenous leukemia is treated right away.
Treatment choices for CML include:
Clinical trials are used to find out whether a medicine or treatment is safe and effective. People who have chronic leukemia are often referred to clinical trials for their treatment. For more information, see www.cancer.ca/Canada-wide/Cancer%20research/Clinical%20trials.aspx?sc_lang=en, www.cancer.gov/clinical_trials/, or http://clinicaltrials.gov.
You can find more information about chronic leukemias online at the:
You can find more information about hairy cell leukemia online from the U.S. National Cancer Institute website at www.cancer.gov.
Leukemia in children
Treatments for children who have leukemia are not the same as treatments for adults who have leukemia. Children may respond and react to treatments in ways that are different from how adults respond. Also, after the leukemia has been treated, children may need to be monitored for treatment side effects that may appear months or years later.
Leukemia in children is usually treated by a medical team led by a pediatric hematologist-oncologist.
You can find more information about childhood leukemias online at the:
If you have leukemia, you may want to consider having hospice palliative care along with your treatments. Hospice palliative care is a kind of care for people who have serious illnesses. It can help you manage symptoms from your treatment. Hospice palliative care focuses on improving your quality of life—not just in your body but also in your mind and spirit.
Hospice palliative care may help you manage symptoms or side effects from treatment. It could also help you cope with your feelings about living with a serious illness, make future plans for your medical care, or help your family better understand your illness and how to support you.
If you are interested in hospice palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.
For more information, see the topic Hospice Palliative Care.
Even if your treatment is going well, it's a good idea to plan ahead. Talk to your family and your doctor about health care and other legal issues that arise near the end of life. Put your health care choices in writing with an advance care plan. This is important, if a time comes when you can't make and communicate these decisions. Think about your treatment options and which kind of treatment will be best for you. An advance care plan allows you to choose a substitute decision-maker to make and carry out decisions about your care if you become unable to speak for yourself.
A time may come when your goals may change from treating an illness to maintaining your comfort and dignity. Your doctor can address questions or concerns about maintaining your comfort when cure is no longer an option. Hospice palliative care professionals can provide care in the comfortable surroundings of your own home.
When leukemia has been in remission for a long time, the word "cure" is often used. Your doctor may use the term "remission" instead of "cure" when talking about the effectiveness of your treatment. Although many people who have leukemia are successfully treated, the term remission is used because cancer can return (recur). It is important to discuss the possibility of recurrence with your doctor.
Clinical trials play a very important part in the treatment of leukemia. Clinical trials test the latest drugs and other new treatments. They have made it possible for many people with leukemia to live longer. People who are in clinical trials get all the recommended treatments for their cancer and are closely watched. Talk to your doctor about whether there is a clinical trial that might be good for you. For more information, see www.cancer.ca/Canada-wide/Cancer%20research/Clinical%20trials.aspx?sc_lang=en, www.cancer.gov/clinical_trials/, or http://clinicaltrials.gov.
There is no known way to prevent most types of leukemia. Most people with leukemia do not have known risk factors. A risk factor is anything that raises your chances of getting a disease.
Some types of leukemia may be prevented by avoiding high doses of radiation, exposure to the chemical benzene, smoking and other tobacco use, or certain types of chemotherapy used to treat other types of cancer.
During treatment for any stage of leukemia, there are things you can do at home to help manage the side effects of leukemia or its treatment. Home treatment may be all that is needed to manage the following common problems. If your doctor has given you instructions or medicines to treat these symptoms, be sure to use them. Eating a balanced diet and getting enough sleep and exercise may help you feel better.
Dealing with your emotions
If you have recently been diagnosed with leukemia, you may have many different emotions. There is no "normal" or "right" way to react. But if your reaction is interfering with your ability to make decisions about your health, it is important to talk with your doctor. Your cancer treatment centre may offer psychological or financial services.
You may also contact your local chapter of the Canadian Cancer Society or the Leukemia and Lymphoma Society of Canada to help you find a support group. Talking with other people who may have had similar feelings can be very helpful.
There are other emotional issues you may face:
If leukemia or its treatment causes pain, there are many ways to relieve it. If your doctor has given you instructions or medicines for pain, be sure to use them. And check with your doctor before trying any home treatment for pain. While some home treatments may be fine, others (such as a non-steroidal anti-inflammatory medication) may not be safe if you have leukemia.
Chemotherapy is the standard treatment for many types of leukemia. Even when a cure is not possible, chemotherapy may help you live longer and feel better.
Chemotherapy for leukemia is usually a combination of drugs. This is because different drugs attack leukemia cells in different ways. The combination also helps keep the leukemia cells from becoming resistant to any one drug. Other drugs used to treat leukemia help prevent infection and help your body grow new blood cells (such as epoetin and hematopoietic stimulants).
Nausea and vomiting are the most common side effects of chemotherapy for leukemia. But having chemotherapy does not mean that you have to suffer with nausea and vomiting. Your doctor may prescribe medicines to control nausea and vomiting. There are also things you can do at home. For more information on these side effects, see:
Your treatment plan will include the kind of medicine that works best for the specific type or subtype of leukemia that you have.
Medicines used for treatments for chronic lymphocytic leukemia (CLL) are taken orally (by mouth) or given intravenously for limited periods of time. If there is relapse, medicines are given again. For chronic myelogenous leukemia (CML), medicine is usually taken by mouth for as long as needed. Treatment choices may include:
Nausea and vomiting are common side effects of chemotherapy. These side effects usually are temporary and go away when treatment is stopped. Your doctor will prescribe medicines to help relieve nausea. These medicines include aprepitant, dimenhydrinate, phenothiazines, or serotonin antagonists.
There are a lot of clinical trials of new medicines for leukemia. These trials have made it possible for many people with leukemia to live longer. Ask your doctor whether you are a candidate for participation in a clinical trial. For more information, see www.cancer.ca/Canada-wide/Cancer%20research/Clinical%20trials.aspx?sc_lang=en., www.cancer.gov/clinical_trials, or http://clinicaltrials.gov.
Often a swollen lymph node will be removed to confirm the diagnosis of leukemia. This operation is called a lymphadenectomy.
Surgery is sometimes needed to place a central venous catheter into a large vein in the chest. The catheter is a small tube that is used to give you chemotherapy and other drugs. The tube can also be used to take samples of blood or for giving blood transfusions when needed. It prevents the need for many needle sticks during treatment.
The following other treatments may be used to treat leukemia:
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:
Mind-body treatments like the ones listed above may help you feel better. They can make it easier to cope with cancer treatments. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, it is very important to talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. Complementary therapies are not meant to take the place of standard medical treatment, but they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.
Many cancer patients looking for a cure are willing to try alternative treatments. Check with your doctor before using any special diets, over-the-counter drugs, herbal products, or unusual treatment methods that you may hear about. Some of them can make your side effects worse or reduce the benefits of chemotherapy.
|Leukemia and Lymphoma Society|
|1311 Mamaroneck Avenue|
|White Plains, NY 10605|
The Leukemia and Lymphoma Society is the world's largest voluntary health organization dedicated to funding blood cancer research, education, and patient services. The Society's mission is to cure leukemia, lymphoma, Hodgkin's lymphoma, and myeloma and to improve the quality of life for patients and their families.
|American Cancer Society (ACS)|
The American Cancer Society (ACS) conducts educational programs and offers many services to people with cancer and to their families. Staff at the toll-free number have information about services and activities in local areas and can provide referrals to local ACS divisions.
|Canadian Cancer Society|
|55 St. Clair Avenue West|
|Toronto, ON M4V 2Y7|
The Canadian Cancer Society (CCS) is a national, community-based organization that provides information about cancer prevention, care, and treatment. The CCS also provides funding for cancer research.
|Leukemia and Lymphoma Society of Canada|
|2 Lansing Square, Suite 804|
|Toronto, ON M2J 4P8|
The Leukemia and Lymphoma Society of Canada funds research and provides an online support network to individuals and their families affected by leukemia or lymphoma.
|National Cancer Institute (NCI)|
|6116 Executive Boulevard|
|Bethesda, MD 20892-8322|
|Web Address:||www.cancer.gov (or https://livehelp.cancer.gov/app/chat/chat_launch for live help online)|
The National Cancer Institute (NCI) is a U.S. government agency that provides up-to-date information about the prevention, detection, and treatment of cancer. NCI also offers supportive care to people who have cancer and to their families. NCI information is also available to doctors, nurses, and other health professionals. NCI provides the latest information about clinical trials. The Cancer Information Service, a service of NCI, has trained staff members available to answer questions and send free publications. Spanish-speaking staff members are also available.
- American Cancer Society (2010). Cancer Facts and Figures 2010. Atlanta: American Cancer Society. Available online: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-026238.pdf.
- Liesveld JL, Lichtman MA (2006). Acute myelogenous leukemia. In MA Lichtman et al., eds., Williams Hematology, 7th ed., pp. 1183–1236. New York: McGraw-Hill.
- Johnston JB, et al. (2009). Chronic lymphocytic leukemia. In JP Greer et al., eds., Wintrobe's Clinical Hematology, 12th ed., vol. 2, pp. 2214–2255. Philadelphia: Lippincott Williams and Wilkins.
Other Works Consulted
- Leung LLK (2010). Disseminated intravascular coagulation section of Coagulation disorders. In EG Nabel, ed., ACP Medicine, section 15, chap. 5. Hamilton, ON: BC Decker.
- Levi M, Seligsohn U (2010). Disseminated intravascular coagulation. In K Kaushanksy et al., eds., Williams Hematology, 8th ed., pp. 2101–2120. New York: McGraw-Hill.
- National Cancer Institute (2010). Adult Acute Lymphoblastic Leukemia Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/adultALL/healthprofessional.
- National Cancer Institute (2010). Adult Acute Myeloid Leukemia Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/adultAML/healthprofessional.
- National Cancer Institute (2010). Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/childAML/healthprofessional.
- National Cancer Institute (2010). Childhood Acute Lymphoblastic Leukemia Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/childALL/healthprofessional.
- National Cancer Institute (2010). Chronic Lymphocytic Leukemia Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/CLL/healthprofessional.
- National Cancer Institute (2010). Chronic Myelogenous Leukemia Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/CML/healthprofessional.
- National Cancer Institute (2010). Hairy Cell Leukemia Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/hairy-cell-leukemia/healthprofessional.
- National Comprehensive Cancer Network (2010). Acute myeloid leukemia, version 1.2011. Available online: http://www.nccn.org/professionals/physician_gls/PDF/aml.pdf.
- National Comprehensive Cancer Network (2010). Chronic myelogenous leukemia. Clinical Practice Guidelines in Oncology, version 1.2011. Available online: http://www.nccn.org/professionals/physician_gls/PDF/cml.pdf.
- National Comprehensive Cancer Network (2010). Non-Hodgkin's lymphomas. Clinical Practice Guidelines in Oncology, version 1.2010. Available online: http://www.nccn.org/professionals/physician_gls/PDF/nhl.pdf.
- Rodgers GM (2009). Disseminated intravascular coagulation section of Acquired coagulation disorders. In JP Greer et al., eds., Wintrobe's Clinical Hematology, 12th ed., vol. 2, pp. 1430–1440. Philadelphia: Lippincott Williams and Wilkins.
|Primary Medical Reviewer||Kathleen Romito, MD - Family Medicine|
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Brian Leber, MDCM, FRCPC - Hematology|
|Last Revised||November 13, 2012|
Last Revised: November 13, 2012
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