Leukemia is cancer of the blood cells. Cells not working correctly begin to crowd out healthy blood cells in the bone marrow. Leukemia mostly occurs in adults over age 55, but it is also the most common childhood cancer. Every day in the United States, 148 people are diagnosed with leukemia. More than 327,520 Americans are living with leukemia.
There are several kinds of leukemia:
- Acute lymphoblastic leukemia (ALL) is a type of blood cancer that occurs when the bone marrow produces too many immature white blood cells called lymphoblasts. These abnormal cells crowd out healthy blood cells, leading to symptoms like fatigue, infections, easy bruising or bleeding, and bone pain. Treatment for ALL typically involves chemotherapy, radiation therapy, CAR-T therapy and sometimes a stem cell transplant to replace diseased cells with healthy ones.
- Acute myeloid or myeloblastic leukemia (AML) is another type of blood cancer. It is the most common acute leukemia in adults. It occurs when the bone marrow produces too many abnormal myeloid cells, a type of white blood cell. These abnormal cells prevent the production of healthy blood cells, leading to symptoms such as fatigue, frequent infections, easy bruising or bleeding, and shortness of breath. Treatment for AML usually involves chemotherapy, sometimes combined with targeted therapy. Some patients also need a stem cell transplant, with the goal of eliminating the abnormal cells and restoring normal blood cell production.
- Chronic myeloid leukemia (CML) is a type of blood cancer that is characterized by the overproduction of abnormal white blood cells called myeloid cells in the bone marrow. Unlike acute leukemias, CML progresses more slowly, which is why it is called chronic. If untreated, it can be deadly. Common symptoms include fatigue, weight loss, night sweats, and an increased susceptibility to infections. Fortunately, excellent targeted treatments can help control the disease and improve the quality of life for patients.
- Chronic myelomonocytic leukemia (CMML) is a disease that is characterized by the presence of too many immature white blood cells called myelocytes and monocytes in the bone marrow and blood. This leads to a disruption in normal blood cell production, similar to the other disorders above. Treatment for CMML aims to manage symptoms and improve quality of life. It may include supportive care measures, blood transfusions, targeted therapies, or, in some cases, a bone marrow transplant.
- Hairy cell leukemia (HCL) is slow growing and can happen if your bone marrow makes too many B cells (lymphocytes). Lymphocytes fight infection. The excess B cells look hairy when viewed under a microscope. If diagnosed with HLL, your care will be managed by a lymphoma specialist.
- Large granular lymphocytic leukemia (LGL) is a rare form of leukemia, also managed by a lymphoma specialist, is chronic and slow growing.
- Myelodysplastic syndrome (MDS), also known as Myelodysplastic Neoplasms, refers to a group of disorders in which the bone marrow does not produce enough healthy blood cells. MDS primarily affects older adults. Due to the shortage of red blood cells, white blood cells, and platelets, MDS patients may experience symptoms like fatigue, shortness of breath, frequent infections, easy bruising or bleeding, and anemia. Treatment for MDS depends on the specific subtype and severity of the condition. It may include supportive care, blood transfusions, growth factors, chemotherapy, or a stem cell transplant in some cases. The goal of treatment is to alleviate symptoms and improve blood cell production.
Myeloproliferative neoplasms (MPNs) are a group of disorders characterized by the overproduction of mature blood cells in the bone marrow. These conditions arise from genetic mutations in the hematopoietic stem cells, which are responsible for producing blood cells.
There are several types of myeloproliferative neoplasms, including:
- Polycythemia vera (PV): In PV, there is an excessive production of red blood cells. This leads to an increase in blood viscosity and a higher risk of blood clotting.
- Essential thrombocythemia (ET): ET involves the overproduction of platelets, which are important for blood clotting. Increased platelet counts can result in abnormal clotting or bleeding.
- Primary myelofibrosis (PMF): PMF is characterized by the progressive replacement of the bone marrow with fibrous scar tissue. This disrupts normal blood cell production and can lead to anemia, an enlarged spleen, and other complications.
Tests
Following a medical history and physical examination, procedures for diagnosing leukemia may include:
Complete Blood Count (CBC)
A blood sample is taken to check for the number and percentage of red blood cells, white blood cells, and platelets. We will also check the amount of hemoglobin, a protein that carries oxygen.
Peripheral Blood Smear
A blood sample is checked for cells that appear "hairy." We will also review the number and kinds of white blood cells, and changes in the shape of blood cells.
Blood Chemistry Studies
These tests are used for screening a blood sample for the amounts of substances released into the blood by organs and tissues.
Bone Marrow Biopsy
During this test, a specialist removes a small amount of bone marrow, blood, and bone (from the hip or breastbone). We will look for microscopic signs of cancer.
Immunophenotyping
This is used to examine the antigens or markers on the surface of blood or bone marrow cells. It helps us to diagnose the specific type of leukemia by comparing the cancer cells to normal cells of the immune system.
Flow Cytometry
Flow cytometry measures the number and percentage of live cells and certain cell characteristics in a blood sample. These include size, shape, and the presence of markers on the cell surface related to cancers.
Cytogenetic Analysis
This lab test is used to look at cells under a microscope for chromosome changes in blood or bone marrow. Fluorescent in situ hybridization (FISH) is one type of cytogenetic test. It uses a fluorescent dye that only attaches to certain parts of chromosomes.
Multigene Tests
Because no tumor has a single mutation, genomic profiling allows the pathologist to identify groups of mutations in your blood sample and create a tumor profile for you. That profile can be used to determine what type of treatment would be the most effective and how long you should have treatments like chemotherapy. Your profile may also help predict whether the leukemia is likely to recur and guide treatment accordingly.
Treatments
Chemotherapy (Medical Therapy)
This is the main way to treat leukemia. The treatment uses medicines to kill cancer cells, with the goal of putting cancer into remission. Chemotherapy drugs may be injected into your cerebrospinal fluid (CSF). This is called intrathecal chemotherapy, or central nervous system prophylaxis. It helps to prevent cancer growth. It can reach cancer cells around the brain and nervous system.
We offer intravenous (infusion) chemotherapy at the Comprehensive Treatment Unit (CTU) at Sylvester's Miami location. This 12,000-square-foot unit includes 33 recliners and 11 private rooms. If you prefer, you may have your infusion treatments at the Kendall, Plantation, Hollywood, Coral Springs, Coral Gables, and Deerfield Beach locations.
Targeted Therapy
This is a type of cancer treatment that focuses on specific molecular targets or pathways involved in the growth and survival of cancer cells. It works by using drugs or other substances that interfere with the specific molecules involved in the cancer's development. By targeting these specific molecules, targeted therapy aims to block the signals that promote cancer growth, leading to the inhibition or destruction of cancer cells while minimizing damage to healthy cells.
Immunotherapy
Also called biologic therapy, this type of therapy available in clinical trials makes cancer more visible to your immune system. Your Sylvester oncologist will advise you if a clinical trial or immunotherapy may be appropriate for your leukemia.
- Checkpoint blockade therapy: This immune-based cancer treatment takes advantage of immune T cells. Immune T cells are present in many tumors but have been shut off by cancer cells. The checkpoint system prevents immune cells from attacking cancer cells. Checkpoint blockade drugs disable that safety mechanism, allowing your immune T cells to use their destructive capabilities on the tumors.
- Adoptive cell transfer (ACT): This therapy has been compared to giving a living drug. ACT uses immune cells called T cells collected from your blood. The T cells are genetically engineered to recognize a specific protein (antigen) on tumor cells. Billions of the new cells are then grown in the laboratory and infused back into you. The T cells then multiply in your body, recognize and kill cancer cells.
Stem Cell Transplant with High-Dose Chemotherapy
If the usual doses of chemotherapy do not fight your cancer, your doctor may recommend very high doses of chemotherapy and a stem cell transplant. High-dose chemotherapy can remove the damaged cells from your system and bone marrow. Healthy "starter" cells for new blood cells are then injected back into your body to restore your body's lost blood cells. Stem cells may be drawn from you or a donor.
Supportive Care
Psychologists and palliative care specialists are available to help you fit cancer treatment into your life and to ease the burden and stress of treatment. Complementary therapies such as acupuncture and massage are also available.
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