Leukemia

Leukemia is a broad term for blood cancers that start in the blood and bone marrow, most often the white blood cells. It causes too many abnormal white blood cells, and interferes with your bone marrow’s ability to make red blood cells and platelets.

Five-year Leukemia survival rates

Acute Lymphocytic leukemia

Chart comparing all stages Acute Lymphocytic leukemia UCHealth 75.2% survival rate to Colorado state average of 74.8%

Number of Patients Diagnosed – UCHealth 78 – State of Colorado – 343
Number of Patients Surviving – UCHealth 59 – State of Colorado – 257
*n<30, 5 Year Survival – (Date of diagnosis 1/1/2010–12/31/2014)

Chronic Lymphocytic Leukemia

Chart comparing all stages Chronic Lymphocytic Leukemia UCHealth 80.0% survival rate to Colorado state average of 74.6%

Number of Patients Diagnosed – UCHealth 134 – State of Colorado – 1,012
Number of Patients Surviving – UCHealth 107 – State of Colorado – 755
*n<30, 5 Year Survival – (Date of diagnosis 1/1/2010–12/31/2014)

Chronic Myeloid Leukemia

Chart comparing all stages Chronic Myeloid Leukemia UCHealth 63.1% survival rate to Colorado state average of 61.3%

Number of Patients Diagnosed – UCHealth 73 – State of Colorado – 385
Number of Patients Surviving – UCHealth 46 – State of Colorado – 236
*n<30, 5 Year Survival – (Date of diagnosis 1/1/2010–12/31/2014)

Other Leukemia

Chart comparing all stages Other Leukemia UCHealth 60.6% survival rate to Colorado state average of 50.0%

Number of Patients Diagnosed – UCHealth 72 – State of Colorado – 327
Number of Patients Surviving – UCHealth 44 – State of Colorado – 164
*n<30, 5 Year Survival – (Date of diagnosis 1/1/2010–12/31/2014)

Overview and types

There are several types of leukemia, categorized based on whether it occurs in children or adults, if it is fast growing (acute) or slow growing (chronic), and if it starts in myeloid cells or lymphoid cells. The type determines the treatment options, so a proper diagnosis is critical.

Main leukemia types

Acute lymphocytic (or lymphoblastic) leukemia (ALL). Starts in the bone marrow where blood cells are made; more common in children.

Acute myeloid leukemia, acute myelocytic leukemia, acute myelogenous leukemia, acute granulocytic leukemia or acute non-lymphocytic leukemia (AML). Most common in older adults.

Chronic lymphocytic leukemia (CLL). Starts in lymphocytes in the bone marrow; mainly affects older adults and accounts for about one-third of all leukemias.

Chronic myeloid leukemia or chronic myelogenous leukemia (CML). Starts in blood-forming cells of bone marrow and invades the blood.

Chronic myelomonocytic leukemia (CMML). Starts in blood-forming cells of bone marrow and invades the blood; affects mainly older adults.

Hairy cell leukemia. Slow growing; some patients go years without symptoms or needing treatment.

Childhood leukemia. The most common cancer in children and teens, accounting for almost a third of all cancers. Most childhood leukemias are either ALL or AML; chronic leukemias are rare in children.

Causes of leukemia

DNA in normal bone marrow cells can cause them to become leukemia cells. DNA determines our genes, which are passed on from our parents. The genes that help cells grow, divide and stay alive are oncogenes. Genes that keep cell growth and division under control, or make cells die at the right time, are tumor suppressor genes. Any mutation in the chromosomes of these genes can lead to cancer.

The most common type of chromosome mutation that can lead to leukemia is a translocation, where DNA from one chromosome breaks off and attaches to a different chromosome. This affects nearby genes, like turning on oncogenes or turning off tumor suppressor genes.

Even though we inherit genes, the DNA mutations leading to leukemia can also be acquired during a lifetime. We know that exposure to radiation or cancer-causing chemicals can cause mutations.

However, in many cases, gene changes just happen inside a cell, without having an outside cause. These changes can build up as we age, which is why some forms of leukemia happen in older adults.

Symptoms and risk factors

Signs and symptoms

In general, all types of leukemia share some common signs and symptoms:

  • Frequent infections
  • Fever
  • Fatigue and weakness
  • Bone pain
  • Swollen lymph nodes
  • Paleness
  • Bruising or bleeding easily
  • Difficulty breathing
  • Headache
  • Weight loss
  • Night sweats

lady looking into the distance

Depending on the type of leukemia, other symptoms may occur. For example, chronic lymphocytic leukemia (CLL) can present with pain or a sense of fullness in the stomach because this type enlarges the spleen and/or liver. Your doctor can share a complete list of symptoms for your type of leukemia.

End stage leukemia

End stage leukemia has signs and symptoms that show the person is in the final days of life:

  • Slow breathing with long pauses; noisy breathing with congestion.
  • Cool skin that may turn a bluish, dusky color, especially in the hands and feet.
  • Dryness of mouth and lips
  • Decreased amount of urine
  • Loss of bladder and bowel control
  • Restlessness or repetitive, involuntary movements
  • Confusion about time, place, and identity of people, including family members and close friends.
  • Hallucinations and dream-like experiences
  • Drifting in and out of consciousness, and becoming less responsive to touch or voice

Risk factors

Research has identified some common factors that may increase your risk of developing some type of leukemia:

  • Previous cancer treatment. Chemotherapy and radiation therapy for other cancers increase the risk of developing certain types of leukemia.
  • Genetic disorders. Certain genetic disorders like Down syndrome.
  • Exposure to certain chemicals. Benzene, found in gasoline and the chemical industry, is linked to an increased risk of some kinds of leukemia.
  • Smoking. Increases the risk of acute myelogenous leukemia.
  • Family history of leukemia.

Diagnosis and staging

Diagnosis

UCHealth specialists use a series of leading-edge tests on your blood and bone marrow to properly diagnose leukemia. We may also take samples of other tissue and cells to help guide your treatment.

  • Blood tests. We perform a complete blood count and blood cell exam (peripheral blood smear). We may also perform other tests.
  • Flow cytometry. A machine that looks for certain markers on or in cells that help identify what types of cells they are. This test is important in diagnosing chronic lymphocytic leukemia (CLL).
  • Bone marrow aspiration and biopsy. Usually taken from the back of the pelvic bone, but sometimes we may take them from other bones.
  • Cytogenetics. We grow bone marrow cells or other cells in a lab, and examine the chromosomes.
  • Fluorescent in situ hybridization (FISH). Used to look at chromosomes and DNA without having to grow the cells in the lab.
  • cDNA sequencing. Looks at the genes in immunoglobulins, the antibodies that help your body fight infections. Especially important in staging CLL.
  • Lymph node biopsy. Usually done for lymphomas, and may be done for types of leukemia.
  • Lumbar puncture or spinal tap. Done if your doctor suspects leukemia cells may have spread to the area around the brain or spinal cord, or if there might be an infection in those areas.
  • CT scan. Shows if any lymph nodes or organs in your body are enlarged.
  • PET/CT scan. Uses a radioactive atom injected into the blood to show cancer cells.
  • Magnetic resonance imaging (MRI) scan. Most useful in looking at the brain and spinal cord.
  • Ultrasound. Looks at lymph nodes and enlarged organs inside your abdomen.

Staging

Staging is the process of determining the extent of a cancer based on the size of the main tumor and how far it has spread. Leukemia has a slightly different staging process as the different types don’t form tumors. Each type does have a standard system for staging, which your doctor can share with you and explain what it means, and how it affects your personalized treatment plan.

Treatment and recovery

Our leading-edge, personalized treatment for leukemia can include chemotherapy, targeted therapy, biological therapy, radiation, surgery and stem cell transplants.

Available treatments

The first line of treatment depends on the type and stage of leukemia, plus other conditions. Our multidisciplinary team will put together the right plan for you, which may include these common treatments:

Chemotherapy. A regimen of several drugs used together. Each medication destroys tumor cells in different ways, so a combination of drugs is often more effective.

Targeted therapy. Additional drugs used in combination with chemotherapy and other leukemia treatments. Chemotherapy can affect all cells, but targeted therapy directly attacks leukemia cells, helping to reduce damage to healthy cells and reduce side effects.

Biological therapy. In some cases of chronic myelogenous leukemia (CML), we might use biological therapy—natural or artificial substances that change the way cells behave. We would consider this if you cannot cope with the side effects of, or the CML is resistant to, targeted therapies.

Radiation or surgery. We may use radiation to destroy leukemia cells, to relieve discomfort caused by an enlarged liver or spleen or swollen lymph nodes, or to help treat pain from damage in the bone marrow. If an enlarged spleen doesn’t respond to treatment, we may perform surgery to remove the spleen (splenectomy).

Stem cell transplant. We may use this early in treatment. We infuse healthy blood-forming stem cells into the body, which may come from the patient or from a matched donor.

Questions and answers (FAQs)

Yes, the acute types of leukemia like ALL and AML can occur suddenly. Other forms of leukemia like hairy cell leukemia occur slowly.

Research shows that childhood leukemias may occur due to a combination of certain gene changes early in life, and exposure to certain viruses later than normal (after the first year).

Anywhere on the body. When leukemia progresses to a certain point, it can cause capillaries to burst underneath the skin and leak. This leakage can cause tiny red, purple, or brown spots called petechiae to appear on the skin, which grouped together can look similar to a rash but is not actually one.

Yes, some types of leukemia can be cured. Leukemia is a broad term for several types of blood cancer, so the treatment and prognosis depends on the specific type.