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Leukemia is a cancer that affects white blood cells. There are many types of leukemia. Each one is named for the kind of white blood cell it affects. These include myelocytes, lymphocytes, plasma cells, and other types of white blood cells. Leukemia can be acute or chronic.

The acute leukemias are very aggressive and worsen over a brief period. Two examples of acute leukemia are as follows:

• acute lymphocytic leukemia, or ALL
• acute myelogenous leukemia, or AML

• chronic lymphocytic leukemia, or CLL
• chronic myelogenous leukemia, or CML

Both CLL and CML may eventually enter a stage that behaves like acute leukemia.

What is going on in the body?

When the cancerous cells grow in the bone marrow, normal bloods cells are often destroyed or crowded out. Having fewer normal white cells can cause the person to become infected easily. The infections may be serious and life-threatening. Having fewer platelets means that the person may bruise or bleed easily. Anemia, or low numbers of red blood cells, can make the person weak and easily tired.

What are the signs and symptoms of the disease?

• anemia, or a low red blood cell count
• bleeding problems due to poorly working blood clotting cells, called platelets
• loss of normal white blood cell function, which increases the risk of infection
• a need for red blood cell transfusions

What are the causes and risks of the disease?

• certain genetic defects
• cigarette smoking
• exposure to certain chemicals, such as benzene and toluene
• exposure to large doses of radiation
• in rare cases, certain types of chemotherapy, which can lead to acute leukemia
• some unusual viruses, which can lead to rare types of leukemia

What can be done to prevent the disease?

Dosages of chemotherapy drugs and radiation should be limited to the minimum necessary to achieve the treatment goal for which they are given. Persons should avoid using tobacco and minimize exposure to organic chemicals such as benzene and toluene.

How is the disease diagnosed?

Diagnosis of leukemia begins with a medical history and physical exam. A blood sample will be examined to see if it contains cancerous white cells. Special studies are done on these cells to determine the specific type of leukemia. A bone marrow biopsy, in which a small piece of the bone marrow is removed for examination by a pathologist, can confirm that a person has leukemia.

What are the long-term effects of the disease?

Acute leukemia of any type can quickly lead to death if it is not treated. Chronic leukemia will eventually be fatal if not treated. However, the course of chronic leukemia may be many months or years. If the treatment is effective, the person may recover and live a normal life.

What are the risks to others?

There are no risks to others. No one can acquire leukemia from contact with a person who has the disease.

What are the treatments for the disease?

The treatment of acute leukemia involves intensive chemotherapy. A combination of powerful medicines is given to the person through the veins to kill the leukemia cells.These medicines are usually given over several months. They kill the leukemia cells. They can also severely damage the normal cells produced in the bone marrow.

The first course of therapy is called induction therapy. It is designed to induce a remission or complete destruction of the leukemia. The next treatments are called maintenance therapy. These are designed to make the remission last by destroying any remaining disease.

Some people are given bone marrow, either one's own marrow that has been banked during a remission, or from a genetically matched donor, to help recovery. This is called a bone marrow transplant. It is generally used only when ordinary chemotherapy has failed.

Chronic leukemia is generally treated with less intense treatments. Chemotherapy is used for most types of chronic leukemia. Biological response modifiers, or BRMs, may be used for some types of chronic leukemia. BRMs are elements of the body's immune system that are combined with medicines to fight cancer.

What are the side effects of the treatments?

• allergic reactions to medicines
• bleeding problems that may require transfusions
• common or unusual infections
• diarrhea or poor food absorption
• irritation of the gastrointestinal tract
• mouth sores
• nausea and vomiting
• numbness or burning pain in the extremities
• weakness and fatigue
• weight loss

The person will have other side effects related to the type of medicine used. Biological response modifiers cause flu-like symptoms. Nausea is common. Hair loss, or alopecia, is another side effect of chemotherapy. Medicines will be given to control these symptoms.

What happens after treatment for the disease?

After therapy has been completed, the person will usually regain normal bone marrow function over several weeks. Treatment followed by recovery may be repeated several times until all signs of leukemia are gone.

How is the disease monitored?

Frequent blood tests will be taken to monitor treatment and recovery. Additional samples will be taken to confirm that the leukemia has been successfully treated. After all therapy has been completed, blood tests will be done regularly to make sure the person is still in remission. A bone marrow sample may also be needed periodically. Any new or worsening symptoms should be reported to the healthcare provider.