Leukemia refers to a group of cancers that develop in the bone marrow, the soft inner part of some bones where new blood cells are made. Each type of leukemia has different characteristics — the kind of cells they start in, their growth rate, how they are treated and whether they are found mainly in adults, teens or children.
While 10 other cancers strike adults more frequently than leukemia does, the disease is the most common cancer in children and teens, accounting for one of three cases. But we are able to cure more and more patients, and research continues on additional, promising therapies.
Leukemia: Lymphoblastic vs. Myeloid and Chronic Vs. Acute
Leukemia develops from the two types of bone marrow stem cells:
- Lymphoid stem cells, which turn into lymphoblasts and then most infection-fighting white blood cells (lymphocytes)
- Myeloid stem cells, which turn into oxygen-carrying red blood cells, clot-forming platelets and another type of white blood cell
Cancer causes too many cells to form, and they don’t mature — meaning they not only fail to function properly but also crowd out other cells the body needs. The cancers also take one of two forms:
- Acute: The immature cells quickly build up and kill most patients within months if the disease is not treated.
- Chronic: The cancer progresses more slowly — giving most people longer to live, but usually proving harder to treat than acute cases. Chronic leukemia is rare in children and teens.
Combining the type of stem cell with the rate of growth gives the four main types of leukemia:
- Acute Lymphoblastic Leukemia (ALL):
- Most pediatric leukemia is ALL (thee out of four cases)
- Five-year survival rate for pediatric ALL now more than 85 percent
- Least common type among adults
- Can spread to central nervous system (brain and spinal cord)
- Acute Myeloid Leukemia (AML):
- Represents most of the remaining pediatric leukemia cases
- Five-year pediatric survival rate now 60 to 70 percent (varies depending on subtype)
- Relapses more frequently than ALL
- Chronic Lymphoblastic Leukemia (CLL)
- Mainly affects older adults: average age at diagnosis is around 72
- Rarely curable but most patients live with it for many years
- Might not need treatment right away, but usually need it eventually
- Chronic Myeloid Leukemia (CML):
- Mainly affects adults — average age at diagnosis is around 64
- Treatment doesn’t usually cure the disease, but keeps it in check
Each main type of leukemia also has subtypes that often play a role in disease progression and treatment recommendations.
We create individualized treatment plans, with our specialists working with patients and their families to come up with the best and most comprehensive plans.
Acute Leukemia Treatment
Acute leukemia treatment usually starts with a concentrated month or so of treatment to kill as many cancerous cells as possible and put the disease in remission. Up to two years of less intense treatment follows to make sure any remaining leukemia cells are destroyed — while the cells might not be active, they could eventually regrow and cause the disease to return (relapse).
Patients might spend much of the initial treatment period in the hospital, especially children and teens. Because of the risk for complications like infections, it’s important to get acute leukemia treatment at experienced centers like ours — centers that provide key additional support like specialized nursing care, nutritional help, antibiotics and blood transfusions.
Chronic Leukemia Treatment
We continue to make strides in treating chronic leukemia, but the disease is not usually curable. We provide top care to manage your symptoms and keep the cancer in check. We also understand that ongoing treatment can cause its own anxiety and stress and offer additional support.
Some patients diagnosed with chronic lymphocytic leukemia (CLL) can live for years without treatment — in that case, we provide careful monitoring (watchful waiting) and care for associated problems like infections.
Leukemia Treatment Considerations
Our recommendations for the best treatment approach (including therapy type and dose intensity) typically depend on:
- Leukemia type: ALL, AML, CLL or CML
- Type of cells the cancer began in and the leukemia subtype: Patients with different subtypes may have different prognoses and responses to treatment.
- Patient’s age and overall health
- The presence of certain genetic changes, including the Philadelphia chromosome (learn more about our blood targeted therapy)
- If the leukemia is newly diagnosed or has come back (a relapse): If a relapse occurs, then we account for how long it’s been since initial treatment and the location the cancer comes back — the bone marrow, or other parts of the body, including the brain, spinal cord and central nervous system.
- Number of immature cells versus healthy red blood cells, white blood cells and/or platelets
- Whether the patient received chemotherapy in the past for a different cancer
- Whether there is a history of a blood disorder like myelodysplastic syndrome (learn more about our myelodysplastic syndrome care)
- How quickly and how well the leukemia responds to initial treatment
- Whether the patient is designated high risk or standard risk (child ALL only)
- Size of the spleen (CLL and CML only)
- Size of the liver or lymph nodes (CML only)
- Whether the leukemia was likely caused by previous cancer treatment (AML only)
- Whether the child has Down syndrome, which means a cure is more likely (child AML only)
Leukemia Risk Factors
While we don’t know what causes most cases of leukemia, there are risk factors that can increase your chances of developing the disease.
Risk Factors for Acute Lymphoblastic Leukemia (ALL)
Risk factors for ALL include:
- Age: Children have the highest risk for developing ALL, usually before age 5. (Two-thirds of cases are in children and teens.) The risk then declines slowly until the mid-20s, levels off and slowly rises again after 50.
- Race/Ethnicity: In adults, ALL is more common in whites than African Americans.
- Previous Treatments: Past treatment with chemotherapy or radiation can increase your risk.
- Inherited Syndromes: While ALL itself does not seem to run in families, there are certain inherited genetic syndromes that can raise the risk of developing the disease:
- Down syndrome
- Klinefelter syndrome
- Fanconi anemia
- Bloom syndrome
Risk Factors for Acute Myeloid Leukemia (AML)
Risk factors for AML include:
- Age: AML rarely strikes before 45, with 66 the average patient age.
- Smoking: Smoking can increase your risk, as can exposure to smoke.
- Previous Treatments: Past treatment with chemotherapy or radiation can increase your risk, as can previous treatment for childhood ALL.
- Chemicals: Benzene exposure can increase your risk.
- Blood Disorders: You may face a greater risk if you have a history of blood disorders such as aplastic anemia or myelodysplastic syndrome.
- Genetic Disorders: Certain genetic disorders can increase your risk, including:
- Down syndrome
- Fanconi anemia
- Neurofibromatosis type 1 (NF1)
- Noonan syndrome
- Shwachman-Diamond syndrome
Risk Factors for Chronic Lymphoblastic Leukemia (CLL)
There are very known risk factors for CLL:
- Age: CLL is rarely seen before 40, with 72 the average age of diagnosis.
- Family History: A family history of CLL or lymph system cancer increases your risk.
- Ethnicity: You may have a higher risk if you are Jewish and your family came from Russia or Eastern Europe.
Risk Factors for Chronic Myeloid Leukemia (CML)
The only know risk factor for CML is age: the disease mainly affects adults, with 64 the average age at diagnosis.
Leukemia can cause a number of symptoms:
- Fever or night sweats
- Easy bruising or bleeding
- Petechiae (flat, pinpoint, dark-red spots under the skin caused by bleeding)
- Weakness, fatigue or pale appearance
- Unexplained weight loss or loss of appetite
- Shortness of breath (adults)
- Bone or joint pain (ALL)
- Painless lumps in the neck, underarm, stomach or groin (ALL)
- Pain or feeling of fullness below the ribs (ALL)
- Getting many infections (ALL)
Other conditions can cause similar symptoms, too, so it’s important to see a doctor.
Successful treatment depends on a complete and accurate diagnosis. Each of our patients receives a thorough evaluation so we can create an individualized plan. We diagnose leukemia with:
- History and Physical Examination: We complete a thorough examination and take a full personal and family medical history.
- Blood Work: We may take a blood sample to test your complete blood count (CBC), blood chemistry and other factors.
- Biopsy: We use a hollow needle to remove a small sample of bone marrow, blood and bone from the hipbone or breastbone. The samples are studied under a microscope and may get other testing, including analysis for genetic changes.
We may also do additional testing, to confirm the type of leukemia and determine whether the cancer has spread:
- Chest X-ray: Low-dose radiation is used to take pictures of the chest.
- CT (CAT) Scan: Computed tomography takes a series of X-rays from different angles, then stitches them together into 3D images.
- MRI: Magnetic resonance imaging uses a powerful magnetic field and radio waves to create detailed 3D images at higher contrast than CT scans — useful for clarifying other test results.
- Lumbar Puncture (LP, or Spinal Tap): A needle is inserted into the spinal column to take a sample of cerebrospinal fluid.
- Biopsy of Testicles, Ovaries, or Skin: A needle is used to remove cells or tissues if the cancer has caused changes to the testicles, ovaries or skin, and the samples are checked under a microscope.