Need to Know
- Routine blood tests or symptoms like fatigue, bruising, or swollen lymph nodes often reveal leukemia, and a bone marrow biopsy confirms it.
- Doctors treat acute leukemia aggressively with hospital-based chemotherapy, transfusions, and sometimes stem cell transplants or CAR T-cell therapy to reach remission.
- Chronic leukemias (CLL and CML) progress more slowly, so doctors typically manage them with milder approaches like tyrosine kinase inhibitors (TKIs), which control but don't cure the disease.
This summary was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
How Do I Know If I Have Leukemia?
Because many types of leukemia show no obvious symptoms early in the disease, leukemia may be diagnosed incidentally during a physical exam or as a result of routine blood testing. If a person appears pale, has enlarged lymph nodes, swollen gums, an enlarged liver or spleen, significant bruising, bleeding, fever, persistent infections, fatigue, or a small pinpoint rash, the doctor should suspect leukemia. A blood test showing an abnormal white cell count may suggest the diagnosis. To confirm the diagnosis and identify the specific type of leukemia, a needle biopsy and aspiration of bone marrow from a pelvic bone will need to be done to test for leukemic cells, DNA markers, and chromosome changes in the bone marrow.
Important factors in leukemia include the age of the patient, the type of leukemia, and the chromosomal abnormalities found in leukemia cells and bone marrow.
What Are the Treatments for Leukemia?
With the aging of the American population, the incidence of certain leukemias has risen while others have fallen. But more people are surviving longer, thanks mainly to advances in chemotherapy, targeted therapy, and immunotherapy. Childhood leukemia (3 out of 4 cases in children is acute lymphocytic leukemia, or ALL), for example, represents one of the most dramatic success stories of cancer treatment. The five-year survival rate for children with ALL has risen to about 90% today.
For acute leukemia, the immediate goal of treatment is remission. The patient undergoes chemotherapy, sometimes with targeted therapy or immunotherapy, in a hospital and stays in a private room to reduce the chance of infection. Since acute leukemia patients have extremely low counts of healthy blood cells, they are given blood and platelet transfusions to help prevent or stop bleeding. They receive antibiotics to prevent or treat infection. Medications to control treatment-related side effects are given, as well.
People with acute leukemia are likely to attain remission when chemotherapy is used as the primary treatment. To keep the disease under control, they will then receive consolidation chemotherapy for 1-4 months to get rid of any remaining malignant cells.
Patients with ALL will receive intermittent treatment usually for up to two years.
After obtaining a complete remission, some patients with acute myeloid leukemia (AML) may require an allogeneic stem cell transplant. This requires a willing donor with compatible tissue type and genetic characteristics -- preferably a family member. Other donor sources could include a matched unrelated donor or umbilical blood.
The FDA recently approved a new oral treatment, called decitabine cedazuridine (Inqovi), for adult patients diagnosed with AML, taken in the form of a tablet once a month.
A stem cell transplant has three stages: induction, conditioning, and transplantation. First, the individual’s white blood cell count is brought under control by chemotherapy. Then a single dose of chemotherapy may be given followed by a conditioning regimen of high dose chemotherapy. This will destroy the individual’s bone marrow and any residual leukemia cells that may be present. Then the donor cells will be infused.
Until the donor marrow cells start producing new blood, the individual is left with virtually no blood cells -- white cells, red cells, or platelets. This makes death by infection or bleeding a strong possibility. Once the donor stem cells grow sufficiently into the marrow, usually in two to six weeks, long-term remission becomes a strong possibility. In addition to chemotherapy, the person will receive medication to prevent and treat graft versus host disease. With this disease, donor cells attack the person's normal tissue cells. Medication is also given to prevent rejection of the donor stem cells.
Allogeneic stem cell transplantation is both expensive and risky, but it offers the best chance for long-term remission for high risk AML and certain cases of ALL.
If these treatments don't work for kids or adults who have B-cell type ALL, or the cancer comes back, their doctor may want to tray a new kind of gene therapy. Using CAR T-cell therapy, certain immune cells can be "reprogrammed" to attack the cancer. Because there can be severe side effects, only certified hospitals and clinics can do this treatment.
Chronic lymphocytic leukemia (CLL), a form of leukemia that usually affects older persons, typically progresses slowly. Therefore, treatment may be conservative. Not all patients require immediate treatment. Patients experiencing symptoms requiring treatment include the so-called ‘B’ symptoms of fevers, night sweats for 14 consecutive days, or 10% unintentional body weight loss over 6 months. Other symptoms, such as painful swollen lymph glands, painful swollen liver or spleen, or evidence of bone marrow failure, also require treatment. Treatment of CLL may include chemotherapy, targeted therapy, immunotherapy, or a combination of all three.
Chronic myeloid leukemia (CML) typically affects older people and progresses slowly.
Targeted therapy is typically the first treatment given for CML. In the past, most cases of CML eventually advanced to an acute phase despite treatment, so doctors advised bone marrow transplantation during the chronic phase. Allogeneic stem cell transplantation for CML is still a treatment option for diseases resistant to treatment or for persons whose disease is in the acute phase.
Targeted therapy from tyrosine kinase inhibitors (TKIs) attack the genetic alterations that cause white blood cells to grow out of control. TKIs don't cure CML, but their use can result in long-term remission and survival of CML. There are several tyrosine kinase inhibitors available, including: Imatinib (Gleevec, Imkeldi), asciminib (Scemblix), bosutinib (Bosulif), dasatinib (Sprycel, Phyrago), nilotinib (Tasigna, Danziten, Cavhanza), and ponatinib (Iclusig).
