Advances in treatment options have turned some forms of these once-deadly blood cancers into manageable chronic conditions. Here’s what you need to know about leukemia.
There are four types of leukemia, all of which affect the bone marrow or blood.Bakhtiar Zein/Getty Images
Leukemia is the umbrella term for four different types of cancer of the bone marrow and blood cells. In 2015, an estimated 54,270 people in the United States will be diagnosed with the disease, according to the American Cancer Society. And more than 327,000 live with or are in remission from it, according to statistics from the Leukemia & Lymphoma Society.
We spoke to Hagop M. Kantarjian, MD, professor and chair of the department of leukemia at the University of Texas MD Anderson Cancer Center in Houston; and to Frederick Lansigan, MD, a hematologist-oncologist and inpatient medical director of cancer services at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. Both facilities are National Cancer Institute-Designated Cancer Centers. Here are 10 essential facts about leukemia that you should know.
1. There are four main types of leukemia. They are:
- Acute Myeloid Leukemia (AML): In 2015, about 20,830 people will develop AML (also known as acute myelogenous leukemia), a type of cancer in which the bone marrow makes unhealthy red blood cells, myeloblasts (a type of white blood cell), or platelets.
- Chronic Myeloid Leukemia (CML): This type of leukemia (which is also known as chronic myelogenous leukemia) will affect an estimated 6,660 Americans this year. In CML, the bone marrow makes too many unhealthy white blood cells.
- Acute Lymphocytic Leukemia (ALL): A type of blood cancer in which the bone marrow produces too many unhealthy white blood cells. (The condition is also known as acute lymphoblastic leukemia.) There will be about 6,250 cases of ALL this year.
- Chronic Lymphocytic Leukemia (CLL): About 14,620 Americans will be diagnosed in 2015 with CLL, a type of cancer in which the bone marrow produces too many unhealthy white blood cells.
2. Leukemia starts in the bone marrow.
Our bodies make most of our blood cells — from the infection-fighting white blood cells, to the oxygen-transporting red blood cells, to the clot-preventing platelets — in the bone marrow. All blood cells start out as unspecified, or “immature,” cells, and eventually develop into the “mature” kinds that help us stay healthy. But in people with acute leukemia, the blood cells don’t normally progress past the “immature” phase. And in people with chronic leukemia, those cells do progress past the “immature” phase, but can be overwhelmed by other, abnormal, mature cells. In both cancers, the abnormal blood cells then crowd out the healthy kinds, not only in the bone marrow itself, but in the bloodstream and other parts of the immune system, too.
3. The specific kind of leukemia depends on which type of blood cell has become cancerous.
In ALL, for example, the lymphoblasts, which are “immature” white blood cells, are affected. In CML, types of blood cells called granulocytes are affected.
blasts, which are “immature” white blood cells, are affected. In CML, types of blood cells called granulocytes are affected.
4. Some forms of leukemia progress faster than others.
Acute leukemias (AML and ALL) are rapid-growing cancers in which the bone marrow cannot produce enough healthy blood cells. But chronic forms of the disease (CML and CLL) progress more slowly — oftentimes, people with these conditions have enough mature blood cells to partly maintain their immune system’s health.
5. The five-year survival rate for leukemia is improving.
In fact, the number of people who’ve lived with the cancer for at least five years has quadrupled since 1960, from 14 percent in the early 1960s to about 60 percent during the 2004 to 2010 time period, according to the Leukemia & Lymphoma Society.
6. Age can be a risk factor for leukemia.
Although leukemia tends to target adults over age 55, it’s also the most common cancer in children under 15. According to the American Society for Hematology, other risk factors for leukemia include :
- Exposure to high levels of radiation
- Repeated exposure to certain chemicals (for example, benzene)
- Down syndrome
- A strong family history of leukemia
7. The symptoms of leukemia depend on its type and stage.
Symptoms can include :
- Fever, chills, night sweats, and flu-like symptoms
- Weakness and fatigue
- Swollen or bleeding gums
- Enlarged liver and spleen
- Swollen tonsils
- Bone pain
- Weight loss
8. Most people with CML are now considered to have a chronic (rather than potentially fatal) illness.
“In fact, most people with chronic myeloid leukemia can now live a normal life by taking tyrosine kinase inhibitors,” says Dr. Kantarjian. These drugs, called TKIs, help inhibit a gene called BCR-ABL, which causes the cancerous CML cells to multiply. These drugs include Gleevec (imatinib), Sprycel (dasatinib), Tasigna (nilotinib), Bosulif (bosutinib), and Iclusig (ponatinib).
“Taking these drugs, which need to be taken indefinitely, can put CML into remission,” says Dr. Lansigan. “People are now living 15, to more than 20, years with CML.”
9. Promising treatments are on the horizon.
“We have many, many promising advances against these diseases,” says Kantarjian. These include monoclonal antibodies and CAR T Cells, which are forms of immunotherapy that are in use against ALL and CLL. Targeted therapies called FLT3 inhibitors are being studied for AML, and B cell receptor inhibitors are being studied for CLL, says Kantarjian.
10. If you are diagnosed with leukemia, see a hematologist, oncologist, or both to get the facts.
“Acute forms of leukemia need to be treated urgently. And an oral medication for CML is highly effective and must be started as soon as you’re diagnosed. As for early-stage CLL, you can live for many, many years without needing treatment,” says Lansigan. To make sure you’re getting the best treatment for your condition, consider seeking a second opinion at a National Cancer Institute-Designated Cancer Center, which is at the forefront of cancer research.