Leukemia

The UofL Brown Cancer Center has a team of highly experienced physicians dedicated to the treatment of leukemia.

Overview

UofL Brown Cancer Center has a team of highly experienced physicians dedicated to the treatment of leukemia. Using a comprehensive team approach, we work together to give you customized care that includes the most advanced diagnostic methods and treatments.

As a regional leader in the treatment of leukemia, we offer access to numerous innovative new therapies and investigational agents that may help increase your chances for successful treatment. Many of these are not found in other centers. We have the full range of services needed to ensure comprehensive, yet specialized care.

Successful leukemia treatment begins with accurate and precise diagnosis. We have the expertise and our specialized pathologists are highly experienced in diagnosing leukemia.

Our approach to leukemia is customized especially for you; we do not take a one-size-fits-all approach. Our first step is to carefully evaluate your risk factors to determine if treatment is necessary. If it is, we recommend the most advanced therapy with the least impact on your body.

Our Multidisciplinary Blood and Marrow Transplant Clinic offers all the services needed to care for leukemia and its impact on your body, such as infections and bleeding issues. We strive to accomplish as much care as possible on an outpatient basis.

We are constantly striving to find new and better ways to fight leukemia and are able to offer a wide range of clinical trials for treatment. Many of the doctors who treat leukemia at UofL Brown Cancer Center are also dedicated researchers.

If you are diagnosed with leukemia, your doctor will discuss the best options to treat it. This depends on several factors, including the type of leukemia, your age and your general health.

According to the American Cancer Society, some 43,000 people in the United States are diagnosed with leukemia each year. This includes about:

  • 15,000 cases of chronic lymphocytic leukemia (CLL), most in older adults
  • 13,500 cases of acute myeloid leukemia (AML), most in adults
  • 6,000 cases of acute lymphocytic leukemia (ALL), about one in three in adults
  • 5,000 cases of chronic myeloid leukemia (CML), most in older adults

Leukemia is cancer of blood-forming tissue such as the bone marrow, the sponge-like material inside some bones. In healthy bone marrow, blood cells form and mature, then move into the bloodstream. To understand what happens to your blood when you have leukemia, it helps to know what makes up normal blood and bone marrow.

Red Blood Cells

Red Blood Cells (RBCs), the major part of your blood, carry oxygen and carbon dioxide throughout your body. The percentage of RBCs in the blood is called hematocrit. The part of the RBC that carries oxygen is a protein called hemoglobin. All body tissues need oxygen to work properly. When the bone marrow is working normally, the RBC count remains stable. Anemia occurs when there are too few RBCs in the body. Leukemia, or the chemotherapy used to treat it, can cause anemia. Symptoms of anemia include shortness of breath, headache, weakness and fatigue.

White Blood Cells

White Blood Cells (WBCs) include several different types. Each has its own role in protecting the body from germs. The three major types are neutrophils, monocytes and lymphocytes:

  • Neutrophils (also known as granulocytes or polys) destroy most bacteria.
  • Monocytes destroy germs such as tuberculosis.
  • Lymphocytes are responsible for destroying viruses and for overall management of the immune system. When lymphocytes see foreign material, they increase the body’s resistance to infection.

WBCs play a major role in fighting infection. Infections are more likely to occur when there are too few normal WBCs in the body.

Absolute Neutrophil Count

Absolute Neutrophil Count (ANC) is a measure of the number of WBCs you have to fight infections. You can figure out your ANC by multiplying the total number of WBCs by the percentage of neutrophils (“neuts”). For example:

  • WBC = 1000 = 1.0K
  • Neuts = 50% (0.5)
  • 1000 X 0.5 = 500 neutrophils

While anyone can catch a cold or other infections, this is more likely to occur if your ANC falls below 500. Your WBC count generally will fall within the first week you start chemotherapy, but it should be back to normal between 21 and 28 days after starting chemotherapy.

Platelets are the cells that help control bleeding. When you cut yourself, the platelets collect at the site of the injury and form a plug to stop the bleeding.

Bone marrow is the soft tissue within the bones where blood cells are made. All blood cells begin in the bone marrow as stem cells.

The bone marrow is made up of blood cells at different stages of maturity. As each cell fully matures, it is released from the bone marrow to circulate in the bloodstream. The blood circulating outside of the bone marrow in the heart, veins and arteries is called peripheral blood.

Stem cells are very immature cells. When there is a need, the stem cells are signaled to develop into mature RBCs, WBCs or platelets. This signaling is done with “growth factors.”

In leukemia, the normal production of blood cells changes. The bone marrow starts making too many abnormal, immature cells, called blasts or lymphoblasts, which crowd out other blood cells in the blood marrow, blood stream and lymph system. They can travel to other places in the body, including lymph glands and the spleen.

Leukemia types

Types of leukemia are grouped by the type of cell affected and by the rate of cell growth. Leukemia can be either acute or chronic.

Acute leukemia involves an overgrowth of very immature blood cells. This condition is life threatening because there are not enough mature blood cells to prevent anemia, infection and bleeding. A diagnosis of acute leukemia is made when there are 20% or more blasts or immature cells in the bone marrow.

There are two main types of acute leukemia:

  • Acute lymphocyte leukemia (ALL) is most prevalent during childhood and early adulthood, but it also is found in adults.
  • Acute myeloid (or myelogenous) leukemia (AML) occurs more often in adults.

Myelodysplastic Syndrome (MDS) is a condition in which the bone marrow does not produce enough normal blood cells. Some cases of MDS may, over time, progress to acute leukemia.

Myeloproliferative Disease (MPD), also known as myeloproliferative neoplasia (MPN), is a condition in which the bone marrow makes too many blood cells. Sometimes the disease progresses slowly and requires little treatment; other times it develops into acute myeloid leukemia (AML).

Chronic leukemia involves an overgrowth of mature blood cells. Usually, people with chronic leukemia have enough mature blood cells to prevent serious bleeding and infection. Chronic leukemia is found more often in people between ages 40 and 70. The main types of chronic leukemia are:

  • Chronic lymphoblastic leukemia (CLL)
  • Chronic myeloid (or myelogenous) leukemia (CML) 

To look for specific types of leukemia, your doctor will examine features on the bone marrow cell surface and the appearance of the bone marrow cells under a microscope, as well as analyze chromosome number and appearance.

Many times, leukemia does not have symptoms in the early stages. When it does have signs, they vary from person to person and according to the type of leukemia. If you do have symptoms, they may include:

  • Unexplained fever
  • Persistent fatigue or feeling of weakness
  • Unintentional weight loss, loss of appetite
  • Easy bruising or bleeding, unexplained nose bleeds
  • Shortness of breath
  • Petechiae (tiny red spots under the skin caused by bleeding)
  • Swollen lymph glands
  • Anemia (low red blood cell counts)
  • Night sweats
  • Bone or joint pain
  • Recurring infections

Symptoms of acute lymphoblastic leukemia may also include painless lumps under the skin in the groin, underarm or neck, and/or pain under the ribs.

These symptoms do not always mean you have leukemia. However, it is important to discuss any symptoms with your doctor, since they may signal other health problems.

Blood tests, imaging exams and even surgical procedures are used to check for cancer.

Accurate and precise diagnosis of leukemia is essential for effective treatment. 

Diagnosis of leukemia is based on the results of blood and bone marrow tests, including bone marrow aspiration and bone marrow biopsy.

Common cancer treatments include chemotherapy, radiation treatment and surgery. Doctors select a treatment plan based on your diagnosis and disease stage

We bring together internationally renowned physicians with a specialized support team to customize your care. These highly experienced experts communicate and collaborate often, ensuring you receive comprehensive care.

If you are diagnosed with leukemia, your doctor will discuss the best options to treat it. This depends on several factors, including the type of leukemia, your age and your general health.

Your treatment for leukemia will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Chemotherapy

Your treatment may consist of more than one chemotherapy drug or biological therapy. The short-term goal is a complete remission, which means the bone marrow has less than 5 percent blasts, the absolute neutrophil count is more than 1,000 and the platelet count is more than 100,000. The long-term goal is for an extended disease-free state and cure.

A course or cycle is the period of time from the start of chemotherapy until the blood and bone marrow cell counts are back to normal or you are able to receive further treatment. In some cases, leukemia cells are destroyed only in the blood and not in the bone marrow during the first course of chemotherapy. In these cases, a second course may be needed. If the leukemia does not respond to one or two courses of treatment, or if a relapse occurs, a different drug program may be used to attempt to bring about a remission.

A specific treatment plan is called a protocol. Each protocol is usually named by letters with each letter standing for a particular drug. A protocol may be considered standard or experimental therapy. Your doctor will discuss with you the advantages and disadvantages of a particular type of therapy.

Radiation therapy

Radiation therapy is used with chemotherapy for some kinds of leukemia. Radiation therapy for leukemia patients may be directed to:

  • A specific area of the body where there is a collection of leukemia cells, such as the spleen or testicles
  • The entire body. This is called total-body irradiation and usually is given before a stem cell transplant

Biological therapy

Biological therapies help the immune system fight cancer, infections and other diseases. They include growth factors, interleukins and monoclonal antibodies. Biological therapies may be given alone or with chemotherapy.

Targeted therapies

We offer innovative targeted therapies. These agents are specially designed to treat each cancer's specific genetic/molecular profile to help your body fight the disease.

Surgery

Sometimes a splenectomy, or surgical removal of the spleen, is needed. The spleen is located on the left side of in the abdomen and acts as a filtration system for blood cells. In chronic leukemia, the spleen tends to collect leukemia cells, transfused platelets and red blood cells. Frequently, the spleen enlarges from storing these cells, making it difficult for chemotherapy to reduce diseased cells. If the spleen is not removed, it sometimes grows so large that it causes breathing difficulty and compresses other organs.

Stem cell transplantation

Stem cell transplantation (SCT), which used to be called bone marrow transplant, destroys leukemic bone marrow cells using high doses of chemotherapy and in some cases, radiation therapy. Because high-dose chemotherapy severely damages the bone marrow's ability to produce cells, healthy stem cells then are given intravenously to stimulate new bone marrow growth.

Like other leukemia treatments, SCT is highly individualized. Your care will be planned specifically for you, considering such factors as type of leukemia, past response to chemotherapy, availability of stem cells for replacement, your age and the status of the leukemia.

Our doctors at UofL Brown Cancer Center are proudly part of UofL Physicians and the UofL School of Medicine.

We believe knowledge comes from questioning the status quo, discovering more about disease and using that knowledge to improve the health of our community. Our physicians are the teachers and researchers at the UofL School of Medicine, involved in the research and development of new treatments and cures for cancer. This means you receive the most advanced and appropriate treatment, even for complex or rare conditions.

To learn more about the physicians who make the academic difference in leukemia treatment, visit the UofL Physicians website here.