Clinical Trials

Many patients with leukemia take part in clinical trials (treatment studies). Clinical trials help doctors find out whether a new treatment is both safe and effective. They also help doctors answer questions about how the treatment works and what side effects it causes.

Patients who take part in studies may be among the first to receive treatments that have shown promise in research. In many studies, some of the patients receive the new treatment, while others receive standard treatment so that doctors can compare different treatments. Patients who take part in a trial make an important contribution to medical science. Although these patients take certain risks, they may have the first chance to benefit from improved treatment methods.

Doctors are studying new treatments for all types of leukemia. They are working on new drugs, new drug combinations, and new schedules of chemotherapy. They also are studying ways to improve bone marrow transplantation.

Many clinical trials involve various forms of biological therapy. Interleukins and colony-stimulating factors are forms of biological therapy being studied to treat leukemia. Doctors also are studying ways to use monoclonal antibodies in the treatment of leukemia. Often biological therapy is combined with chemotherapy or bone marrow transplantation.

Patients with leukemia (or their families) should talk with the doctor if they are interested in taking part in a clinical trial. They may want to read Taking Part in Clinical Trials: What Cancer Patients Need To Know, which explains some of the possible benefits and risks of treatment studies.

One way to learn about clinical trials is through PDQ, a computerized resource developed by the National Cancer Institute. PDQ contains information about cancer treatment and about clinical trials in progress throughout the country. The Cancer Information Service can provide PDQ information to doctors, patients, and the public.

Treatment

Treatment for leukemia is complex. It varies with the type of leukemia and is not the same for all patients. The doctor plans the treatment to fit each patient's needs. The treatment depends not only on the type of leukemia, but also on certain features of the leukemia cells, the extent of the disease, and whether the leukemia has been treated before. It also depends on the patient's age, symptoms, and general health.

Whenever possible, patients should be treated at a medical center that has doctors who have experience in treating leukemia. If this is not possible, the patient's doctor should discuss the treatment plan with a specialist at such a center. Also, patients and their doctors can call the Cancer Information Service to request up-to-date treatment information from the National Cancer Institute's PDQ database.

Acute leukemia needs to be treated right away. The goal of treatment is to bring about a remission. Then, when there is no evidence of the disease, more therapy may be given to prevent a relapse. Many people with acute leukemia can be cured.

Chronic leukemia patients who do not have symptoms may not require immediate treatment. However, they should have frequent checkups so the doctor can see whether the disease is progressing. When treatment is needed, it can often control the disease and its symptoms. However, chronic leukemia can seldom be cured.

Many patients and their families want to learn all they can about leukemia and the treatment choices so they can take an active part in decisions about medical care. The doctor is the best person to answer these questions. When discussing treatment, the patient (or, in the case of a child, the patient's family) may want to talk with the doctor about research studies of new treatment methods. Such studies, called clinical trials, are designed to improve cancer treatment. More information about clinical trials is in the Clinical Trials section.

When a person is diagnosed with leukemia, shock and stress are natural reactions. These feelings may make it difficult to think of every question to ask the doctor. Also, patients may find it hard to remember everything the doctor says.

Often, it helps to make a list of questions to ask the doctor. Taking notes or, if the doctor agrees, using a tape recorder can make it easier to remember the answers. Some people find that it also helps to have a family member or friend with them -- to take part in the discussion, to take notes, or just to listen. Patients do not need to ask all their questions or remember all the answers at one time. They will have other chances for the doctor to explain things that are not clear and to ask for more information.

Here are some questions patients and their families may want to ask the doctor before treatment begins:

• What type of leukemia is it?
• What are the treatment choices? Which do you recommend? Why?
• Would a clinical trial be appropriate?
• What are the expected benefits of each kind of treatment?
• What are the risks and possible side effects of each treatment?
• If I have pain, how will you help me?
• Will I have to change my normal activities?
• How long will treatment last?
• What is the treatment likely to cost? How can I find out what my insurance will cover?

Getting a Second Opinion

Sometimes it is helpful to have a second opinion about the diagnosis and treatment plan. (Many insurance companies provide coverage for a second opinion.) There are a number of ways to find a doctor who can give a second opinion:

• The patient's doctor may be able to suggest a doctor who specializes in adult or childhood leukemia. Doctors who treat adult leukemia are oncologists and hematologists. Pediatric oncologists and hematologists treat childhood leukemia.
• The Cancer Information Service, at 1-800-4-CANCER, can tell callers about cancer centers and other treatment facilities in their area, including programs that are supported by the National Cancer Institute.
• Patients can get the names of specialists from their local medical society, a nearby hospital, or a medical school.

Methods of Treatment

Most patients with leukemia are treated with chemotherapy. Some also may have radiation therapy and/or bone marrow transplantation (BMT) or biological therapy. In some cases, surgery to remove the spleen (an operation called a splenectomy) may be part of the treatment plan.

Chemotherapy is the use of drugs to kill cancer cells. Depending on the type of leukemia, patients may receive a single drug or a combination of two or more drugs.

Some anticancer drugs can be taken by mouth. Most are given by IV injection (injected into a vein). Often, patients who need to have many IV treatments receive the drugs through a catheter.

One end of this thin, flexible tube is placed in a large vein, often in the upper chest. Drugs are injected into the catheter, rather than directly into a vein, to avoid the discomfort of repeated injections and injury to the skin.

Anticancer drugs given by IV injection or taken by mouth enter the bloodstream and affect leukemia cells in most parts of the body. However, the drugs often do not reach cells in the central nervous system because they are stopped by the blood-brain barrier. This protective barrier is formed by a network of blood vessels that filter blood going to the brain and spinal cord. To reach leukemia cells in the central nervous system, doctors use intrathecal chemotherapy. In this type of treatment, anticancer drugs are injected directly into the cerebrospinal fluid.

Intrathecal chemotherapy can be given in two ways. Some patients receive the drugs by injection into the lower part of the spinal column. Others, especially children, receive intrathecal chemotherapy through a special type of catheter called an Ommaya reservoir. This device is placed under the scalp, where it provides a pathway to the cerebrospinal fluid. Injecting anticancer drugs into the reservoir instead of into the spinal column can make intrathecal chemotherapy easier and more comfortable for the patient.

Chemotherapy is given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. In some cases, the patient has chemotherapy as an outpatient at the hospital, at the doctor's office, or at home. However, depending on which drugs are given and the patient's general health, a hospital stay may be necessary.

Here are some questions patients and their families may want to ask the doctor before starting chemotherapy:

• What drugs will be used?
• When will the treatments begin? How often will they be given? When will they end?
• Will I have to stay in the hospital?
• How will we know whether the drugs are working?
• What side effects occur during treatment? How long do the side effects last? What can be done to manage them?
• Can these drugs cause side effects later on?

Radiation therapy is used along with chemotherapy for some kinds of leukemia. Radiation therapy (also called Radiotherapy) uses high-energy rays to damage cancer cells and stop them from growing. The radiation comes from a large machine.

Radiation therapy for leukemia may be given in two ways. For some patients, the doctor may direct the radiation to one specific area of the body where there is a collection of leukemia cells, such as the spleen or testicles. Other patients may receive radiation that is directed to the whole body. This type of radiation therapy, called total-body irradiation, usually is given before a bone marrow transplant.

Here are some questions patients and their families may want to ask the doctor before having radiation therapy:

• When will the treatments begin? How often are they given? When will they end?
• Can normal activities be continued?
• How will we know if the treatment is working?
• What side effects can be expected? How long will they last? What can be done about them?
• Can radiation therapy cause side effects later on?

Bone marrow transplantation also may be used for some patients. The patient's leukemia-producing bone marrow is destroyed by high doses of drugs and radiation and is then replaced by healthy bone marrow. The healthy bone marrow may come from a donor, or it may be marrow that has been removed from the patient and stored before the high-dose treatment. If the patient's own bone marrow is used, it may first be treated outside the body to remove leukemia cells. Patients who have a bone marrow transplant usually stay in the hospital for several weeks. Until the transplanted bone marrow begins to produce enough white blood cells, patients have to be carefully protected from infection. Research Report: Bone Marrow Transplantation provides more information about this complex treatment.

Here are some questions patients and their families may want to ask the doctor about bone marrow transplantation:

• What are the benefits of this treatment?
• What are the risks and side effects? What can be done about them?
• How long will I be in the hospital? What care will be needed after I leave the hospital?
• What changes in normal activities will be necessary?
• How will we know if the treatment is working?

Biological therapy involves treatment with substances that affect the immune system's response to cancer. Interferon is a form of biological therapy that is used against some types of leukemia.

Here are some questions patients and their families may want to ask the doctor before starting biological therapy:

• What kind of treatment will be used?
• What side effects can be expected? How long do the side effects last? What can be done to manage them?
• How will we know whether the treatment is working?

Diagnosis

To find the cause of a person's symptoms, the doctor asks about the patient's medical history and does a physical exam. In addition to checking general signs of health, the doctor feels for swelling in the liver; the spleen; and the lymph nodes under the arms, in the groin, and in the neck.

Blood tests also help in the diagnosis. A sample of blood is examined under a microscope to see what the cells look like and to determine the number of mature cells and blasts. Although blood tests may reveal that a patient has leukemia, they may not show what type of leukemia it is.

To check further for leukemia cells or to tell what type of leukemia a patient has, a hematologist, oncologist, or pathologist examines a sample of bone marrow under a microscope. The doctor withdraws the sample by inserting a needle into a large bone (usually the hip) and removing a small amount of liquid bone marrow. This procedure is called bone marrow aspiration. A bone marrow biopsy is performed with a larger needle and removes a small piece of bone and bone marrow.

If leukemia cells are found in the bone marrow sample, the patient's doctor orders other tests to find out the extent of the disease. A spinal tap (lumbar puncture) checks for leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord (cerebrospinal fluid). Chest x-rays can reveal signs of disease in the chest.

Symptoms

Leukemia cells are abnormal cells that cannot do what normal blood cells do. They cannot help the body fight infections. For this reason, people with leukemia often get infections and have fevers.

Also, people with leukemia often have less than the normal amount of healthy red blood cells and platelets. As a result, there are not enough red blood cells to carry oxygen through the body. With this condition, called anemia, patients may look pale and feel weak and tired. When there are not enough platelets, patients bleed and bruise easily.

Like all blood cells, leukemia cells travel through the body. Depending on the number of abnormal cells and where these cells collect, patients with leukemia may have a number of symptoms.

In acute leukemia, symptoms appear and get worse quickly. People with this disease go to their doctor because they feel sick. In chronic leukemia, symptoms may not appear for a long time; when symptoms do appear, they generally are mild at first and get worse gradually. Doctors often find chronic leukemia during a routine checkup -- before there are any symptoms.

These are some of the common symptoms of leukemia:

• Fever, chills, and other flu-like symptoms
• Weakness and fatigue
• Frequent infections
• Loss of appetite and/or weight
• Swollen or tender lymph nodes, liver, or spleen
• Easy bleeding or bruising
• Tiny red spots (called petechiae) under the skin
• Swollen or bleeding gums
• Sweating, especially at night; and/or
• Bone or joint pain

In acute leukemia, the abnormal cells may collect in the brain or spinal cord (also called the central nervous system or CNS). The result may be headaches, vomiting, confusion, loss of muscle control, and seizures. Leukemia cells also can collect in the testicles and cause swelling. Also, some patients develop sores in the eyes or on the skin. Leukemia also can affect the digestive tract, kidneys, lungs, or other parts of the body.

In chronic leukemia, the abnormal blood cells may gradually collect in various parts of the body. Chronic leukemia may affect the skin, central nervous system, digestive tract, kidneys, and testicles.

Types of Leukemia

There are several types of leukemia. They are grouped in two ways. One way is by how quickly the disease develops and gets worse. The other way is by the type of blood cell that is affected.

Leukemia is either acute or chronic. In acute leukemia, the abnormal blood cells are blasts that remain very immature and cannot carry out their normal functions. The number of blasts increases rapidly, and the disease gets worse quickly. In chronic leukemia, some blast cells are present, but in general, these cells are more mature and can carry out some of their normal functions. Also, the number of blasts increases less rapidly than in acute leukemia. As a result, chronic leukemia gets worse gradually.

Leukemia can arise in either of the two main types of white blood cells -- lymphoid cells or myeloid cells. When leukemia affects lymphoid cells, it is called lymphocytic leukemia. When myeloid cells are affected, the disease is called myeloid or myelogenous leukemia.

These are the most common types of leukemia:

• Acute lymphocytic leukemia (ALL) is the most common type of leukemia in young children. This disease also affects adults, especially those age 65 and older.
• Acute myeloid leukemia (AML) occurs in both adults and children. This type of leukemia is sometimes called acute nonlymphocytic leukemia (ANLL).
• Chronic lymphocytic leukemia (CLL) most often affects adults over the age of 55. It sometimes occurs in younger adults, but it almost never affects children.
• Chronic myeloid leukemia (CML) occurs mainly in adults. A very small number of children also develop this disease.

Hairy cell leukemia is an uncommon type of chronic leukemia. This and other uncommon types of leukemia are not discussed in this booklet. The Cancer Information Service can supply information about them.

Normal Blood Cells

The blood is made up of fluid called plasma and three types of cells. Each type has special functions.

• White blood cells (also called WBCs or leukocytes) help the body fight infections and other diseases.
• Red blood cells (also called RBCs or erythrocytes) carry oxygen from the lungs to the body's tissues and take carbon dioxide from the tissues back to the lungs. The red blood cells give blood its color.
• Platelets (also called thrombocytes) help form blood clots that control bleeding.

Blood cells are formed in the bone marrow, the soft, spongy center of bones. New(immature) blood cells are called blasts. Some blasts stay in the marrow to mature. Some travel to other parts of the body to mature.

Normally, blood cells are produced in an orderly, controlled way, as the body needs them. This process helps keep us healthy.

Leukemia Cells

When leukemia develops, the body produces large numbers of abnormal blood cells. In most types of leukemia, the abnormal cells are white blood cells. The leukemia cells usually look different from normal blood cells, and they do not function properly.

What Is Leukemia?

Leukemia is a type of cancer. Cancer is a group of more than 100 diseases that have two important things in common. One is that certain cells in the body become abnormal. Another is that the body keeps producing large numbers of these abnormal cells.

Leukemia is cancer of the blood cells. To understand leukemia, it is helpful to know about normal blood cells and what happens to them when leukemia develops.

What You Need to Know about Leukemia

By The National Cancer Institute WebMD Public Information from the National Cancer Institute

Each year, nearly 27,000 adults and more than 2,000 children in the United States learn that they have leukemia. This National Cancer Institute (NCI) booklet describes the symptoms of leukemia and explains how this disease is diagnosed and treated. It also has information to help you deal with leukemia if it affects you or someone you know.

Definitions of words that may be new to readers and other terms related to cancer can be found in the Glossary. For some words, a "sounds-like" spelling is also given.

Our materials cannot answer every question you may have about leukemia. They cannot take the place of talks with doctors, nurses, and other members of the health care team. We hope our information will help with those talks.

Our knowledge about leukemia and how to treat it keeps increasing. For up-to-date information or to order this publication, call the NCI-supported Cancer Information Service (CIS) toll free at 1-800-4-CANCER (1-800-422-6237).

www.webmd.com

Types of Leukemia

There are several types of Leukemia. They are grouped in two ways. One way is by how quickly the disease develops and gets worse. The other way is by the type of blood cell that is affected.

Leukemia is either acute or chronic. In acute leukemia, the abnormal blood cells are blasts that remain very immature and cannot carry out their normal functions. The number of blasts increases rapidly, and the disease gets worse quickly. In chronic leukemia, some blast cells are present, but in general, these cells are more mature and can carry out some of their normal functions. Also, the number of blasts increases less rapidly than in acute leukemia. As a result, chronic leukemia gets worse gradually.

Leukemia can arise in either of the two main types of white blood cells-lymphoid cells or myeloid cells. When Leukemia affects lymphoid cells, it is calls lymphocytic leukemia. When myeloid cells are affected, the disease is called myeloid or myelogenous leukemia.

These are the most common types of Leukemia:

• Acute Lymphocytic Leukemia (ALL) is the most common type of Leukemia in young children. This disease also affects adults, especially those age 65 and older.

• Acute Myeloid Leukemia (AML) occurs in both adults and children. This type of leukemia is sometimes called Acute NonLymphocytic Leukemia (ANLL).

• Chronic Lymphocytic Leukemia (CLL) most often affects adults over the age of 55. It sometimes occurs in younger adults, but it almost never affects children.

• Chronic Myeloid Leukemia (CML) occurs mainly in adults. A very small number of children also develop this disease.

The Cancer Information Service can supply you with information about Hairy Cell Leukemia and other uncommon types of Leukemia.

What is Leukemia?

Leukemia is a type of cancer. Cancer is a group of more than 100 diseases that have two important things in common. One is that certain cells in the body become abnormal. Another is that the body keeps producing large numbers of these abnormal cells.

Leukemia is cancer of the blood cells. To understand Leukemia, it is helpful to know about normal blood cells and what happens to them when leukemia develops.

Normal Blood Cells

The Blood is made up of fluid called plasma and three types of cells. Each type has special functions.

• White Blood Cells (also called WBCs or Leukocytes) help the body fight infections and other diseases.

• Red Blood Cells (also called RBCs or erythrocytes) carry oxygen from the lungs to the body's tissues and take carbon dioxide from the tissues back to the lungs. The red blood cells give blood its color.

• Platelets (also called thrombocytes) help form blood clots that control bleeding.

Blood cells are formed in the bone marrow, the soft, spongy center of bones. New (immature) blood cells are called blasts. Some Blasts stay in the marrow to mature. Some travel to other parts of the body to mature.

Normally, blood cells are produced in an orderly, controlled way, as the body needs them. This process helps keep us healthy.

Leukemia Cells

When Leukemia develops, the body produces large numbers of abnormal blood cells. In most types of Leukemia, the abnormal cells are white blood cells. The Leukemia cells usually look different from normal blood cells, and they do not function properly.

Leukemia 101: What You Need to Know About

Cancer in any form is a deadly disease. But when it affects the most vital components of the body then their fatality increases manifold. One such type of cancer is cancer of the blood, technically known as leukemia. Blood is the most important tissue of the body. It is the connective tissue which carries and supplies oxygen and other vital elements to the remotest parts of the body. The importance of blood can be understood by the fact that it is the most important of all the connective tissues which provide the nutrients and other vital elements to the body.

The most dangerous feature of leukemia is that it is related to the blood which has access to almost all body organs including the all important brain and heart. The incidence of cancerous cells being carried to the different parts of the body increases drastically due to this fact. Another striking aspect of the blood cancer is that it affects the leukocytes or the “white blood corpuscles” of the blood. These are the ones that protect the body from external infections. Thus the immunity of the body is seen to decrease drastically due to leukemia. The main effect of the disease is that the body starts producing infected and abnormal cells that hinder the function of blood i.e. carrying of oxygen.

A patient suffering from leukemia is seen to loose weight due to anemia. This happens because the cancerous cells are unable to carry the hemoglobin properly which is the chief source of iron to the body. And due to that the body looses all vitality. The situation of the patient becomes vulnerable because the brain also starts to dysfunction due to infected blood. Headache, night sweats etc. can be commonly seen to occur as an attachment to this deadly disease.

The people living in areas prone to radioactive waste disposal and activity are most common targets of leukemia. Overexposure to radioactivity causes the cells to mutate and function abnormally. The children who are diagnosed with Down syndrome have a high probability to develop leukemia. Over exposure to Benzene, the industrially important hydrocarbon is also a known cause of blood cancer. The abnormal cells are easily detected under the microscope. Thus the doctor suspicious of such a disease advises the patient for a bone marrow examination. The onset can be detected by the swollen lymph nodes of the body which are commonly found in armpits, around the neck and at the thigh.

Chemotherapy is the most effective but a very painful way of killing the cancerous cells. The patient is subjected to drugs orally. The patient undergoes tremendous pressure as he is injected with lot many chemicals at a time. Another treatment is through the radiation. It is also very treacherous way of getting treated. The patients are seen to loose hair and texture of skin.

Leukemia though very dangerous is still curable and the research in the field is also being done on an extensive basis. Proper treatment at the right time can prevent the reflux of this disease. Methods like bone marrow transplant, which may be required at a later stage, are also effective in treating the patient. Above all to over come with the disease a person needs to be loved and supported by all. Leukemia is fatal disease but life is mightier then it.

How Is Leukemia Treated?

Leukemia is a type of cancer that affects the blood and bone marrow. There are two types of leukemia, chronic and acute, which are treated differently and have different symptoms. Acute leukemia rapidly progresses and needs immediate, aggressive treatment. Chronic leukemia can take months or years to show symptoms and may not need immediate treatment but will require ongoing monitoring.

Chemotherapy utilizes chemicals to treat the cancer. It causes many side effects such as hair loss, nausea and decline of the immune system. The complete course of therapy can be from two to five years including maintenance. This is the most common form of treatment for leukemia with the desired result being total remission. Even without symptoms, ongoing monitoring must occur to guard against relapse.

Radiation therapy is another form of treatment. It is painless and in low doses causes very few side effects. Where the radiation is concentrated and the exposure levels will determine the side effects, if any, and the severity of them. Damage to the skin, swelling and infertility are among the possible side effects.

A bone marrow transplant is an effective way to prolong the life of cancer patients. It is, however, a risky surgery and requires a donor which can be difficult in attaining. These surgeries should be performed at state of the art hospitals specializing in cancer treatment. This surgery has a high mortality rate and is therefore used only in life threatening cases.

Immunotherapy is a means to stimulate the immune system so the body can attack the cancer cells. This type of treatment is still in its early stages and continually under development. It is believed that this type of treatment may prove less harmful than chemotherapy or radiation therapy and may someday supplant these treatments as a method for treating cancer.

Long term effects of leukemia treatments may cause anemia. This side effect can be treated by blood transfusions or platelet transfusions. There are risks with transfusions but it is believed transfusions will help reduce the threat of additional complications such as heart attacks. Doses of antibiotics are also generally prescribed to leukemia patients to help counteract the danger of infection cause by declined immune system or treatment side effects.

There are currently almost 200,000 people in the United States diagnosed with leukemia and an estimated 35,000 new cases will be diagnosed this year. It is the leading cause of death for people under the age of 20. There are many treatment facilities throughout the United States specializing in cancer treatment. Early diagnosis, aggressive treatment, and monitoring will help prolong life and increase chances of a person going into remission.