Acute Leukemia

Cancer is a disease of cells that look and act differently from normal cells. Cancer cells are constantly dividing, growing and spreading to other places in the body. Leukemia is a cancer of the cells in the bone marrow and blood cells. Acute leukemia usually progresses rapidly and has very few mature or normal cells.

Leukemic cells are “immature” cells or “blasts” that cannot perform their normal functions. Changes in the DNA (genetic material of the cell) can lead to leukemia. Leukemic cells block the production of normal cells such as white and red blood cells and platelets. The number of normal, mature cells is lower, but the number of “blasts” or immature cells is very high.

The two major types of acute leukemia are based on the type of cell that is cancerous:

Acute Myeloid Leukemia (AML)

Cancerous change involves red blood cells, white blood cells and platelets.
Patients diagnosed with AML have one of eight subtypes: Mo, M1, M2, M3, M4, M5, M6 or M7. The various subtypes are based on the different physical characteristics and type of blood cell that is immature. Knowing the subtype of AML is important because the treatment is based on the subtype.

Acute Lymphoblastic Leukemia (ALL)

Cancerous change involves a specific type of white blood cell called a lymphocyte.
ALL is divided into two major subtypes based on the physical characteristics and type of lymphocyte involved. These include: B-cell lymphoblastic leukemia and T-cell lymphoblastic leukemia.

What are the signs and symptoms of acute leukemia?

Fatigue
Pale complexion (due to low red blood cells)
Bruises or black-and-blue marks occurring for little or no reason
Prolonged bleeding from minor cuts
Small red spots on the skin (due to low platelet count) called petechiae
Mild fever
Infection (due to white blood cells being immature)
Swollen gums
Weight loss
Bone or joint pain
Enlarged liver or spleen

How is leukemia diagnosed?

Leukemia is diagnosed by performing a bone marrow biopsy. A change in the appearance and number of blood cells in the bone marrow help make the diagnosis. Cytogenetic analysis (which looks at characteristics of the cells) determines the specific type and subtype of acute leukemia.

How is leukemia treated?

A number of factors determine the treatment for acute leukemia, including:

The type and subtype of leukemia
A patient’s age and general health
Whether a person is getting treatment for the first time or undergoing subsequent treatment
If the leukemia has come back or relapsed
If it is in the central nervous system

Chemotherapy is the foundation of treatment for all subtypes of AML. In addition to chemotherapy, the M3 subtype called Acute Promyelocytic Leukemia (APL) is treated with all-trans retinoic acid with or without arsenic. Chemotherapy regimens for the treatment of acute leukemia are very intensive often requiring hospitalization for weeks to months.

Patients may be offered participation in a clinical trial. Many clinical trials are available at Parkview Comprehensive Cancer Center to treat leukemia and other cancers.

The initial treatment phase is called “induction.” The goal of induction therapy is to rid the blood and bone marrow of leukemic blast cells. Remission occurs when blasts are not detected in the bone marrow. If remission is not achieved, additional intensive chemotherapy will be given. If remission is achieved, consolidation therapy is started. The goal of consolidation therapy is to prevent the blast cells from coming back or to relapse.

Stem or bone marrow transplant offers the best opportunity for long-term cure.

What are the side effects of treatment?

Leukemia and the treatment regimens can lead to:

Infection
Bleeding
Nausea
Vomiting
Hair loss

Patients require antibiotics and frequent transfusions of blood and platelets.

Because of the complex care that is involved, it is essential that a person diagnosed with acute leukemia receive treatment at a comprehensive cancer center such as Parkview. The staff members have extensive experience and expertise in caring for acute leukemia patients.

What is the outlook?

Many factors, including the type, subtype, cytogenetics, age and complications of the disease and treatment, contribute to remission and cure rates. Advances in the treatment of AML have improved remission and cure rates over the years.

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