Chronic Leukemia
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Chronic Lymphocytic Leukemia
Chronic Myelogenous Leukemia
Chronic Lymphocytic Leukemia
Chronic lymphocytic leukemia is a type of cancer in which the bone marrow
makes too many lymphocytes (a type of white blood cell).
Chronic lymphocytic leukemia (also called CLL)
is a blood and bone marrow disease that usually gets worse slowly. CLL is the
second most common type of leukemia in adults. It often occurs during or after
middle age; it rarely occurs in children.
Normally, the body produces bone marrow stem cells
(immature cells) that develop into mature blood cells. There are 3 types of
mature blood cells:
- Red blood cells that carry oxygen and other materials to all tissues
of the body.
- White blood cells that fight infection and disease.
- Platelets that help prevent bleeding by causing blood clots to form.
In CLL, too many stem cells develop into a type
of white blood cell called lymphocytes. There are 3 types of lymphocytes:
- B lymphocytes that make antibodies to help fight infection.
- T lymphocytes that help B lymphocytes make antibodies to fight infection.
- Natural killer cells that attack cells with cancer or a virus.
The lymphocytes in CLL are not able to fight infection
very well. Also, as the amount of lymphocytes increases in the blood and bone
marrow, there is less room for healthy white blood cells, red blood cells,
and platelets. This may result in infection, anemia, and easy bleeding.
Older age can affect the risk of developing chronic lymphocytic leukemia.
Risk factors for CLL include the
following:
- Being middle-aged or older, male, or white.
- A family history of CLL or cancer of the lymph system.
- Having relatives who are Russian Jews or Eastern European Jews.
Possible signs of chronic lymphocytic leukemia include swollen lymph nodes
and tiredness.
Usually CLL does not cause any symptoms and is found
during a routine blood test. Sometimes symptoms occur that may be caused by
CLL or by other conditions. A doctor should be consulted if any of the following
problems occur:
- Painless swelling of the lymph nodes in the neck, underarm, stomach,
or groin.
- Tiredness that does not go away.
- Pain or fullness below the ribs.
- Fever and infection.
- Weight loss (unexplained).
Tests that examine the blood, bone marrow, and lymph nodes are used to
detect (find) and diagnose chronic lymphocytic leukemia.
The following tests and procedures
may be used:
- Physical exam and history: An exam of the body to check general signs
of health, including checking for signs of disease, such as lumps or anything
else that seems unusual. A history of the patient’s health habits and past
illnesses and treatments will also be taken.
- Complete blood count: A procedure in which a sample of blood is drawn
and checked for the following:
- The number of red blood cells, white blood cells, and platelets.
- The amount of hemoglobin (the protein that carries oxygen) in the
red blood cells.
- The portion of the sample made up of red blood cells.
- Cytogenetic analysis: A test in which a sample of blood or bone marrow
is looked at under a microscope to find out if there are changes in the
structure or number of chromosomes in the lymphocytes.
- Immunophenotyping: A test in which the cells in a sample of blood or bone
marrow are looked at under a microscope to find out if malignant lymphocytes
(cancer) began from the B lymphocytes or the T lymphocytes.
- Bone marrow biopsy and aspiration: The removal of a small piece of bone
and bone marrow by inserting a needle into the hipbone or breastbone. A
pathologist views the sample under a microscope to look for abnormal cells.
Certain factors affect treatment options and prognosis (chance of recovery).
Treatment options depend on:
- The stage of the disease.
- Red blood cell, white blood cell, and platelet blood counts.
- Whether there are symptoms, such as fever, chills, or weight loss.
- Whether the liver, spleen, or lymph nodes are larger than normal.
- The response to initial treatment.
- Whether the CLL has recurred (come back).
The prognosis (chance of recovery)
depends on:
- Whether there is a change in the DNA and the type of change, if
there is one.
- Whether lymphocytes are spread throughout the bone marrow.
- The stage of the disease.
- Whether the CLL gets better with treatment or has recurred (come back).
- Whether the CLL progresses to lymphoma or prolymphocytic leukemia.
- The patient's general health.
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After chronic lymphocytic leukemia has been diagnosed, tests are done
to find out how far the cancer has spread in the blood and bone marrow.
Staging is the process used to find out how far
the cancer has spread. It is important to know the stage of the disease in
order to plan the best treatment. The following tests may be used in the staging
process:
- Bone marrow biopsy and aspiration: The removal of a small piece of bone
and bone marrow by inserting a needle into the hipbone or breastbone. A
pathologist views the sample under a microscope to look for abnormal cells.
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray
is a type of energy beam that can go through the body and onto film, making
a picture of areas inside the body, such as the lymph nodes.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio
waves, and a computer to make a series of detailed pictures of areas inside
the body, such as the brain and spinal cord. This procedure is also called
nuclear magnetic resonance imaging (NMRI).
- CT scan (CAT scan): A procedure that makes a series of detailed pictures
of areas inside the body, taken from different angles. The pictures are
made by a computer linked to an x-ray machine. A dye may be injected into
a vein or swallowed to help the organs or tissues show up more clearly.
This procedure is also called computed tomography, computerized tomography,
or computerized axial tomography.
- Blood chemistry studies: A procedure in which a blood sample is checked
to measure the amounts of certain substances released into the blood by
organs and tissues in the body. An unusual (higher or lower than normal)
amount of a substance can be a sign of disease in the organ or tissue that
produces it.
- Antiglobulin test: A test in which a sample of blood is looked at under
a microscope to find out if there are any antibodies on the surface of red
blood cells or platelets. These antibodies may react with and destroy the
red blood cells and platelets. This test is also called a Coomb's test.
The following stages are used for chronic lymphocytic leukemia:
In stage 0 chronic lymphocytic leukemia, there are
too many lymphocytes in the blood, but there are no other symptoms of leukemia.
Stage 0 chronic lymphocytic leukemia is indolent (slow-growing).
In stage I chronic lymphocytic leukemia, there are
too many lymphocytes in the blood and the lymph nodes are larger than normal.
In stage II chronic lymphocytic leukemia, there
are too many lymphocytes in the blood, the liver or spleen is larger than normal,
and the lymph nodes may be larger than normal.
In stage III chronic lymphocytic leukemia, there
are too many lymphocytes in the blood and there are too few red blood cells.
The lymph nodes, liver, or spleen may be larger than normal.
In stage IV chronic lymphocytic leukemia, there
are too many lymphocytes in the blood and too few platelets. The lymph nodes,
liver, or spleen may be larger than normal and there may be too few red blood
cells.
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Refractory chronic lymphocytic leukemia is cancer
that does not get better with treatment.
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There are different types of treatment for patients with chronic lymphocytic
leukemia.
Different types of treatment are available for patients
with chronic lymphocytic leukemia. Some treatments are standard (the currently
used treatment), and some are being tested in clinical trials. Before starting
treatment, patients may want to think about taking part in a clinical trial.
A treatment clinical trial is a research study meant to help improve current
treatments or obtain information on new treatments for patients with cancer.
When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.
Clinical trials are taking place in many parts of
the country. Choosing the most appropriate cancer treatment is a decision that
ideally involves the patient, family, and health care team.
Watchful waiting
Watchful waiting is closely monitoring a patient’s
condition without giving any treatment until symptoms appear or change. This
is also called observation. During this time, problems caused by the disease,
such as infection, are treated.
Radiation therapy
Radiation therapy is a cancer treatment that uses
high-energy x-rays or other types of radiation to kill cancer cells. There
are two types of radiation therapy. External radiation therapy uses a machine
outside the body to send radiation toward the cancer. Internal radiation therapy
uses a radioactive substance sealed in needles, seeds, wires, or catheters
that are placed directly into or near the cancer. The way the radiation therapy
is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs
to stop the growth of cancer cells, either by killing the cells or by stopping
the cells from dividing. When chemotherapy is taken by mouth or injected into
a vein or muscle, the drugs enter the bloodstream and can reach cancer cells
throughout the body (systemic chemotherapy). When chemotherapy is placed directly
in the spinal column, a body cavity such as the abdomen, or an organ, the drugs
mainly affect cancer cells in those areas. The way the chemotherapy is given
depends on the type and stage of the cancer being treated.
Surgery
Splenectomy is surgery to remove the spleen.
Monoclonal antibody therapy
Monoclonal antibody therapy is a cancer treatment
that uses antibodies made in the laboratory, from a single type of immune system
cell. These antibodies can identify substances on cancer cells or normal substances
in the body that may help cancer cells grow. The antibodies attach to the substances
and kill the cancer cells or block their growth. Monoclonal antibodies are
given by infusion. They may be used alone or to deliver drugs, toxins, or radioactive
material directly to cancer cells.
Chemotherapy with stem cell transplantation
Stem cell transplantation is a method of giving
chemotherapy and replacing blood-forming cells destroyed by the cancer treatment.
Stem cells (immature blood cells) are removed from the blood or bone marrow
of the patient or a donor, frozen, and stored. After the chemotherapy is completed,
the stored stem cells are thawed and given back to the patient through an infusion.
Over time, these reinfused stem cells grow into (and restore) the body’s blood
cells.
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Treatment of stage 0 chronic lymphocytic leukemia
is usually watchful waiting.
Treatment of stage I chronic lymphocytic leukemia
may include the following:
- Watchful waiting when there are few or no symptoms.
- Chemotherapy with 1 or more drugs, with or without steroids.
- Low-dose external radiation therapy to areas of the body where cancer is found,
such as the spleen or lymph nodes.
- A clinical trial of monoclonal antibodies.
- A clinical trial of chemotherapy with stem cell transplantation.
Treatment of stage II chronic lymphocytic leukemia
may include the following:
- Watchful waiting when there are few or no symptoms.
- Chemotherapy with 1 or more drugs, with or without steroids.
- Low-dose external radiation therapy to areas of the body where cancer is found,
such as the spleen or lymph nodes.
- Radiation therapy to the spleen as palliative therapy to relieve symptoms and
improve quality of life.
- A clinical trial of monoclonal antibodies.
- A clinical trial of chemotherapy with stem cell transplantation.
Treatment of stage III chronic lymphocytic leukemia
may include the following:
- Watchful waiting when there are few or no symptoms.
- Chemotherapy with 1 or more drugs, with or without steroids.
- Splenectomy.
- Radiation therapy to the spleen as palliative therapy to relieve symptoms and
improve quality of life.
- A clinical trial of monoclonal antibodies.
- A clinical trial of chemotherapy with stem cell transplantation.
Treatment of stage IV chronic lymphocytic leukemia
may include the following:
- Watchful waiting.
- Chemotherapy with 1 or more drugs, with or without steroids.
- Splenectomy.
- Radiation therapy to the spleen as palliative therapy to relieve symptoms and
improve quality of life.
- A clinical trial of monoclonal antibodies.
- A clinical trial of chemotherapy with stem cell transplantation.
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Treatment of refractory chronic lymphocytic leukemia
may include the following:
- A clinical trial of chemotherapy with stem cell transplantation.
- A clinical trial of a new treatment.
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Chronic Myelogenous Leukemia
Chronic myelogenous leukemia is a disease in which the bone marrow makes
too many white blood cells.
Chronic myelogenous leukemia (also called CML or chronic
granulocytic leukemia) is a slowly progressing blood and bone marrow disease
that usually occurs during or after middle age, and rarely occurs in children.
Normally, the body produces bone marrow stem cells (immature cells) that develop
into mature blood cells.
There are 3 types of mature blood
cells:
- Red blood cells that carry oxygen and other materials to all tissues
of the body.
- White blood cells that fight infection and disease.
- Platelets that help prevent bleeding by causing blood clots to form.
In CML, the body tells too many bone marrow stem cells
to develop into a type of white blood cell called granulocytes. Some of these
bone marrow stem cells never become mature white blood cells. These are called
blasts. Over time, the granulocytes and blasts crowd out the red blood cells
and platelets in the bone marrow.
Possible signs of chronic myelogenous leukemia include tiredness, night
sweats, and fever.
These and other symptoms may be
caused by CML or by other conditions. A doctor should be consulted if any
of the following problems occur:
- Tiredness that does not go away.
- Lack of energy.
- Weight loss (unexplained).
- Night sweats.
- Fever.
- Pain or fullness below the ribs on the left side.
Sometimes CML does not cause any symptoms at all.
Most people with CML have a gene mutation (change) called the Philadelphia
chromosome.
Every cell in the body contains DNA (genetic material)
that determines how the cell looks and acts. DNA is contained inside chromosomes.
In CML, part of the DNA from one chromosome moves to another chromosome. This
change is called the “Philadelphia chromosome.” It results in the bone marrow
making an enzyme, called tyrosine kinase, that causes too many stem cells to
develop into white blood cells (granulocytes or blasts).
The Philadelphia chromosome is not passed from
parent to child.
Tests that examine the blood and bone marrow are used to detect (find)
and diagnose chronic myelogenous leukemia.
The following tests and procedures
may be used:
- Physical exam and history: An exam of the body to check general signs
of health, including checking for signs of disease such as an enlarged spleen.
A history of the patient’s health habits and past illnesses and treatments
will also be taken.
- Complete blood count: A procedure in which a sample of blood is drawn
and checked for the following:
- The number of red blood cells, white blood cells, and platelets.
- The amount of hemoglobin (the protein that carries oxygen) in the
red blood cells.
- The portion of the sample made up of red blood cells.
- Blood chemistry studies: A procedure in which a blood sample is checked
to measure the amounts of certain substances released into the blood by
organs and tissues in the body. An unusual (higher or lower than normal)
amount of a substance can be a sign of disease in the organ or tissue that
produces it.
- Cytogenetic analysis: A test in which cells in a sample of blood or bone
marrow are viewed under a microscope to look for certain changes in the
chromosomes, such as the Philadelphia chromosome.
- Bone marrow aspiration and biopsy: The removal of a small piece of bone
and bone marrow by inserting a needle into the hipbone or breastbone. A
pathologist views both the bone and bone marrow samples under a microscope
to look for abnormal cells.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery)
and treatment options depend on the following:
- The patient’s age.
- The phase of CML.
- The amount of blasts in the blood or bone marrow.
- The size of the spleen at diagnosis.
- The patient’s general health.
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After chronic myelogenous leukemia has been diagnosed, tests are done
to find out if the cancer has spread.
Staging is the process used to find out how far
the cancer has spread. There is no standard staging system for chronic myelogenous
leukemia (CML). Instead, the disease is classified by phase: chronic phase,
accelerated phase, or blastic phase. It is important to know the phase in order
to plan treatment. The following tests and procedures may be used to find out
the phase:
- Cytogenetic analysis: A test in which cells in a sample of blood or bone
marrow are viewed under a microscope to look for certain changes in the
chromosomes, such as the Philadelphia chromosome.
- Bone marrow aspiration and biopsy: The removal of a small piece of bone
and bone marrow by inserting a needle into the hipbone or breastbone. A
pathologist views both the bone and bone marrow samples under a microscope
to look for abnormal cells.
As the amount of blast cells increases in the
blood and bone marrow, there is less room for healthy white blood cells, red
blood cells, and platelets. This may result in infections, anemia, and easy
bleeding, as well as bone pain and pain or fullness below the ribs on the left
side. The amount of blast cells in the blood and bone marrow and the severity
of symptoms determine the phase of the disease.
Chronic phase
In chronic phase CML, there are 5% or fewer blast
cells in the blood and bone marrow.
Accelerated phase
In accelerated phase CML, there are 6% to 30% blast
cells in the blood and bone marrow.
Blastic phase
In blastic phase CML, there are 30% or more blast
cells in the blood or bone marrow. When tiredness, fever, and an enlarged spleen
occur during the blastic phase, it is called blast crisis.
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In relapsed CML, the number of blast cells increases
after a remission.
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There are different types of treatment for patients with chronic myelogenous
leukemia.
Different types of treatment are available for patients
with CML. Some treatments are standard (the currently used treatment), and
some are being tested in clinical trials. Before starting treatment, patients
may want to think about taking part in a clinical trial. A treatment clinical
trial is a research study meant to help improve current treatments or obtain
information on new treatments for patients with cancer. When clinical trials
show that a new treatment is better than the standard treatment, the new treatment
may become the standard treatment.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs
to stop the growth of cancer cells, either by killing the cells or by stopping
the cells from dividing. When chemotherapy is taken by mouth or injected into
a vein or muscle, the drugs enter the bloodstream and can reach cancer cells
throughout the body (systemic chemotherapy). When chemotherapy is placed directly
into the spinal column, an organ, or a body cavity such as the abdomen, the
drugs mainly affect cancer cells in those areas (regional chemotherapy). The
way the chemotherapy is given depends on the type and stage of the cancer being
treated.
Other drug therapy
Imatinib (Gleevec) is a new type of cancer drug,
called a tyrosine kinase inhibitor. It blocks the enzyme, tyrosine kinase,
that causes stem cells to develop into more white blood cells (granulocytes
or blasts) than the body needs.
Biologic therapy
Biologic therapy is a treatment that uses the
patient’s immune system to fight cancer. Substances made by the body or made
in a laboratory are used to boost, direct, or restore the body’s natural defenses
against cancer. This type of cancer treatment is also called biotherapy or
immunotherapy.
High-dose chemotherapy with stem cell transplantation
High-dose chemotherapy with stem cell transplantation
is a method of giving high doses of chemotherapy and replacing blood-forming
cells destroyed by the cancer treatment. Stem cells (immature blood cells)
are removed from the blood or bone marrow of the patient or a donor and are
frozen and stored. After the chemotherapy is completed, the stored stem cells
are thawed and given back to the patient through an infusion. These reinfused
stem cells grow into (and restore) the body’s blood cells.
Donor lymphocyte infusion (DLI)
Donor lymphocyte infusion (DLI) is a cancer treatment
that may be used after stem cell transplantation. Lymphocytes (a type of white
blood cell) from the stem cell transplant donor are removed from the donor’s
blood and may be frozen for storage. The donor’s lymphocytes are thawed if
they were frozen and then given to the patient through one or more infusions.
The lymphocytes see the patient’s cancer cells as not belonging to the body
and attack them.
Surgery
Splenectomy is surgery to remove the spleen.
Other types of treatment are being tested in clinical trials.
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Treatment of chronic phase chronic myelogenous leukemia
may include the following:
- High-dose chemotherapy with donor stem cell transplantation.
- Biologic therapy (interferon) with or without chemotherapy.
- Other drug therapy (Gleevec).
- Chemotherapy.
- Splenectomy.
- A clinical trial of a new treatment.
Treatment of accelerated phase chronic myelogenous
leukemia may include the following:
- Stem cell transplantation.
- Other drug therapy (Gleevec).
- Biologic therapy (interferon) with or without chemotherapy.
- High-dose chemotherapy.
- Chemotherapy.
- Transfusion therapy to replace red blood cells, platelets, and sometimes white
blood cells, to relieve symptoms and improve quality of life.
- A clinical trial of a new treatment.
Treatment of blastic phase chronic myelogenous leukemia
may include the following:
- Other drug therapy (Gleevec).
- Chemotherapy using one or more drugs.
- High-dose chemotherapy.
- Donor stem cell transplantation.
- Chemotherapy as palliative therapy to relieve symptoms and improve quality of
life.
- A clinical trial of a new treatment.
Treatment of relapsed chronic myelogenous leukemia
may include the following:
- Donor stem cell transplantation.
- Donor lymphocyte infusion.
- Biologic therapy (interferon).
- A clinical trial of biologic therapy, combination chemotherapy, or other drug
therapy (Gleevec).
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