Anemia facts

Anemia is a medical condition in which the red blood cell count

or hemoglobin is less than normal.

For men, anemia is typically defined as hemoglobin level of less than 13.5
gram/100 ml and in women as hemoglobin of less than 12.0 gram/100 ml.

Anemia is caused by either a decrease in production of red blood cells or

hemoglobin, or an increase in loss (usually due to bleeding) or destruction of
red blood cells.

Some patients with anemia have no symptoms. Those that do have

symptoms may
o feel tired,
o become easily fatigued,
o appear pale,
o have a feeling of a heart racing,
o feel short of breath, and/or
o have worsening heart problems.

Anemia can be detected by a simple blood test called a complete blood cell
count (CBC).

The treatment of the anemia varies greatly and very much depends on the
particular cause.

What is anemia?
Anemia is a medical condition in which the red blood cell count or hemoglobin is less
than normal. The normal level of hemoglobin is generally different in males and
females. For men, anemia is typically defined as hemoglobin level of less than 13.5
gram/100 ml and in women as hemoglobin of less than 12.0 gram/100 ml. These

definitions may vary slightly depending on the source and the laboratory reference
used

What are the symptoms of anemia?

Some patients with anemia have no symptoms. Others with anemia may feel:

Tired

Fatigue easily

Appear pale

Develop palpitations (feeling of heart racing)

Become short of breath

Additional symptoms may include:

Hair loss

Malaise (general sense of feeling unwell)

Worsening of heart problems

It is worth noting that if anemia is longstanding (chronic anemia), the body may
adjust to low oxygen levels and the individual may not feel different unless the
anemia becomes severe. On the other hand, if the anemia occurs rapidly (acute
anemia), the patient may experience significant symptoms relatively quickly, and
even with relative mild fluctuations of hemoglobin levels.

What causes anemia?

Any process that can disrupt the normal life span of a red blood cell may cause
anemia. Normal life span of a red blood cell is typically around 120 days. Red blood
cells are made in the bone marrow.
Anemia is caused essentially through two basic pathways. Anemia is caused by
either:

1. a decrease in production of red blood cells or hemoglobin, or

2. an increase in loss or destruction of red blood cells.
A more common classification of anemia (low hemoglobin) is based on the Mean
Corposcular Volume (MCV) which signifies the average volume of individual red
blood cells.
1. If the MCV is low (less than 80), the anemia is categorized as microcytic
anemia (low cell volume).
2. If the MCV is in the normal range (80-100), it is called a normocytic anemia
(normal cell volume).
3. If the MCV is high, then it is called a macrocytic anemia (large cell volume).
Looking at each of the components of a complete blood count (CBC), especially the
MCV, a physician can gather clues as to what could be the most common reason for
anemia in each patient.

Can inadequate iron cause anemia (iron deficiency anemia)?

Absolutely! As a matter of fact, iron deficiency is a very common cause of anemia.
This is because iron is major component of hemoglobin and essential for its proper
function. Chronic blood loss due to any reason is the main cause of low iron level in
the body as it depletes the body's iron stores to compensate for the ongoing loss of
iron. Anemia that is due to low iron levels is called iron deficiency anemia.
Young women are likely to have low grade iron deficiency anemia because of the
loss of blood each month through normal menstruation. This is generally without any
major symptoms as the blood loss is relatively small and temporary

Iron deficiency anemia (continued)

Another common reason for iron deficiency anemia can be due to recurring or small
ongoing bleeding, for instance from colon cancer or from stomach ulcers. Stomach
ulcerbleeding may be induced by medications, even very common over-thecounter drugs such as aspirin andibuprofen (Advil, Motrin). Slow and chronic oozing
from these ulcers can lead to loss of iron. Gradually, this could result in anemia. In

infants and young children, iron deficiency anemia is most often due to a diet lacking
iron.
Interpretation of CBC may lead to clues to suggest this type of anemia. For instance,
iron deficiency anemia usually presents with low mean corpuscular volume
(microcytic anemia) in addition to low hemoglobin.

What about sudden (acute) blood loss as a cause of anemia?

Acute blood loss from internal bleeding (as from a bleeding ulcer) or external
bleeding (as from trauma) can produce anemia in an amazingly short span of
time.This type of anemia results in severe symptoms and consequences if not
addressed promptly. Severe sudden blood loss anemia may cause

dizziness,

lightheadedness,

fatigue,

confusion,

shortness of breath, and

even loss of consciousness.

What are other causes of anemia?

Some of the most common causes include:

Vitamin B12 deficiency may cause pernicious anemia. This type of anemia
could happen in people who are unable to absorb vitamin B12 from
theirintestines due to a number of reasons.
o Strict vegetarians are at risk if they do not take adequate
vitamin supplements.
o Long-term alcoholics.

o People who have abnormal structure or function of the stomach or

intestines leading to impaired B12 absorption despite adequate intake.
o This typically causes macrocytic (large blood cell volume) anemia.
Vitamin B12, along with folate, is involved in making the heme
molecule that is an integral part of hemoglobin. Folate deficiency can
be the culprit of anemia as well. This may also be caused by
inadequate absorption, under-consumption of green, leafy vegetables,
and also long-term heavy alcohol use.

There can be rupture or destruction of red blood cells (hemolytic anemia) due
to antibodies clinging to the surface of the red cells. Examples of hemolytic
anemia include hemolytic disease of the newborn, medication induced
hemolytic anemia, transfusion related hemolysis, and autoimmune hemolytic
anemia.

A wide assortment of bone marrow diseases can cause anemia.

o For example, cancers that spread (metastasize) to the bone marrow, or
cancers of the bone marrow (such as leukemia or multiple myeloma)
can cause the bone marrow to inadequately produce red blood cells,
resulting in anemia.
o Certain chemotherapy for cancers can also cause damage to the bone
marrow and decrease red blood cell production, resulting in anemia.
o Certain infections may involve the bone marrow and result in bone
marrow impairment and anemia.
o Finally, patients with kidney failure may lack the hormone necessary to
stimulate normal red blood cell production by the bone marrow.
o Chronic alcohol consumption may lead to anemia via different
pathways and thus, anemia is commonly seen in alcoholics.

Another common cause of anemia is called anemia of chronic disease. This

could typically occur in individuals with longstanding chronic diseases.

Some medications can cause anemia in a variety of ways.

Human immunodeficiency virus (HIV) and acquired immune deficiency

syndrome (AIDS) can cause anemia.

Can anemia be hereditary?

Yes, anemia may be genetic. Hereditary disorders can shorten the life span of the
red blood cell and lead to anemia (for example, sickle cell anemia). Hereditary
disorders can also cause anemia by impairing the production of hemoglobin (for
example, alpha thalassemiaand beta thalassemia).
Depending on the degree of the genetic abnormality, hereditary anemias may cause
mild, moderate, or severe anemia. In fact, some may be too severe to be compatible
with life and may result in death of the fetus (unborn infant). On the other hand,
some of these anemias are so mild that they are not noticeable and are incidentally
revealed during routine blood work.

How is anemia diagnosed?

Anemia is usually detected, or at least confirmed, by a complete blood cell (CBC)
count. A CBC test may be ordered by a physician as a part of routine general
checkup and screening or based on clinical signs and symptoms that may suggest
anemia or other blood abnormalities.

What is a complete blood cell (CBC) count?

Traditionally, CBC analysis was performed by a physician or a laboratory technician
by viewing a glass slide prepared from a blood sample under a microscope. Today,
much of this work is often automated and done by machines. Six component
measurements make up a CBC test:
1. Red blood cell (RBC) count
2. Hematocrit
3. Hemoglobin
4. White blood cell (WBC) count
5. Differential blood count

6. Platelet count
Only the first three of these tests -- the red blood cell (RBC) count, the hematocrit,
and the hemoglobin -- are relevant to the diagnosis of anemia.
Additionally, mean corpuscular volume (MCV) is also often reported in a CBC, which
basically measures the average volume of red blood cells in a blood sample. This is
important in distinguishing the causes of anemia. Units of MCV are reported in
femtoliters, a fraction of one millionth of a liter.
Other useful clues to causes of anemia that are reported in a CBC are the size,
shape, and color of red blood cells.

How is blood collected for a CBC?

Blood is collected by venipuncture (using a needle to draw blood from a vein) in a
lab, hospital, or physician's office. Typically, blood is collected in a special sterile tube
from an arm vein. The tube has some preservatives to prevent clotting of the blood.
Results may be available in an hour or longer depending on the setting.
In some instances, a quick in office test called hemoglobin rapid test may be
performed using a few drops of blood from a finger prick. The advantage of this quick
test is that results may be obtained in a few minutes and only a few drops of blood
may be required.

What is the red blood cell (RBC) count?

The red blood cells (RBCs or erythrocytes) are the most common type of cells in the
blood. We each have millions and millions of these little disc-shaped cells. The RBC
count is done to determine if the number of red blood cells is low (anemia) or high
(polycythemia).
In an RBC count, the number and size of the RBCs are determined. This is usually
reported as number of RBCs per a specified volume, typically in millions of RBCs in
microliters (one one-thousandth of an ml) of whole blood. The shape of the RBCs is
also evaluated under a microscope. All of this information, the number, size and
shape of the RBCs, is useful in the diagnosis of anemia. Further, the specific type of
anemia may be determined by this information

What is hemoglobin?
Hemoglobin is a red pigment that imparts the familiar red color to red blood cells and
to blood. Functionally, hemoglobin is the key chemical compound that combines with
oxygen from the lungs and carries the oxygen from the lungs to cells throughout the
body. Oxygen is essential for all cells in the body to produce energy.
The blood also transports carbon dioxide, which is the waste product of this energy
production process, back to the lungs from which it is exhaled into the air. The
transport of the carbon dioxide back to the lung is also achieved by hemoglobin. The
carbon dioxide bound to hemoglobin is unloaded in the lungs in exchange for oxygen
to be transported to the tissues of the body.

What does a low hemoglobin level mean?

Low hemoglobin is called anemia. When there is a low hemoglobin level, there is
often a low red blood cell count and a low hematocrit, too. Reference ranges are
slightly different from one source to another, but typically hemoglobin of less than
13.5 gram/100 ml is abnormal in men and less than 12.0 gram/100 ml in women.

What is the hematocrit?

The hematocrit is specifically a measure of how much of the blood is made of red
cells. The hematocrit is a very convenient way to determine whether the red blood
cell count is too high, too low, or normal. The hematocrit is a measure of the
proportion of blood that is composed of the red blood cells.

How is hematocrit determined?

The red blood cells in the sample of blood are packed down by spinning the tube in a
centrifuge under prescribed conditions. The proportion of the tube that consists of
red blood cells is then measured. Let's say that it is 45%. The hematocrit is 45%

How is anemia treated?

The treatment of the anemia varies greatly. First, the underlying cause of the anemia
needs to be identified and corrected. For example, anemia as a result of blood loss
from a stomach ulcer should begin with medications to heal the ulcer. Likewise,

surgery is often necessary to remove a colon cancer that is causing chronic blood
loss and anemia.
Sometimes iron supplements will also be needed to correct iron deficiency. In severe
anemia, blood transfusions may be necessary. Vitamin B12 injections will be
necessary for patients suffering from pernicious anemia or other causes of B12
deficiency.
In certain patients with bone marrow disease (or bone marrow damage from
chemotherapy) or patients with kidney failure, epoetin alfa (Procrit, Epogen) may be
used to stimulate bone marrow red blood cell production.
If a medication is thought to be the culprit, then it should be discontinued under the
direction of the prescribing doctor.

What are the complications of anemia?

As mentioned earlier, hemoglobin has the important role of delivering oxygen to all
parts of the body for consumption and carries back carbon dioxide back to the lung
to exhale it out of the body. If the hemoglobin level is too low, this process may be
impaired, resulting in low levels of oxygen in the body (hypoxia).

What is the outlook (prognosis) for anemia?

Anemia generally has a very good prognosis and it may be curable in many
instances. The overall prognosis depends on the underlying cause of anemia, its
severity, and the overall health of the patient.

Leukemia facts

Leukemia is a cancer of blood cells (and therefore sometimes referred to as

blood cancer).

While the exact cause(s) of leukemia is not known, risk factors have been
identified, including radiation exposure and exposure to benzene.

Common symptoms of chronic or acute leukemia may include

o pain in the bones or joints,
o swollen lymph nodes that usually don't hurt,
o fevers or night sweats,
o feeling weak or tired,
o bleeding and bruising easily,
o frequent infections,
o discomfort or swelling in the abdomen,
o weight loss or loss of appetite.

Leukemias are grouped by how quickly the disease develops (acute or

chronic) as well as by the type of blood cell that is affected (lymphocytes or
myelocytes). The four main types of leukemia include acute lymphocytic
leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myelocytic
leukemia (AML), and chronic myelocytic leukemia (CML).

People with leukemia are at significantly increased risk for developing

infections, anemia, and bleeding. Other symptoms and signs include easy
bruising, weight loss, night sweats, and unexplained fevers.

The diagnosis of leukemia is supported by findings of the medical history and

examination, and examining blood and bone marrow samples under a
microscope.

Treatment of leukemia depends on the type of leukemia, certain features of

the leukemia cells, the extent of the disease, and prior history of treatment, as
well as the age and health of the patient.

Most patients with leukemia are treated with chemotherapy. Some patients
also may haveradiation therapy and/or bone marrow transplantation.

There is no known way to prevent leukemia.

The prognosis of leukemia depends upon several factors, including the

patient's age, the type of leukemia, and the extent to which the cancer has
spread.

What is leukemia? What are the different types of leukemia?

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Leukemia is a malignancy (cancer) of blood cells. In leukemia, abnormal blood cells

are produced in the bone marrow. Usually, leukemia involves the production of
abnormal white blood cells -- the cells responsible for fighting infection. However, the
abnormal cells in leukemia do not function in the same way as normal white blood
cells. The leukemia cells continue to grow and divide, eventually crowding out the
normal blood cells. The end result is that it becomes difficult for the body to fight
infections, control bleeding, and transport oxygen.
There are different types of leukemia, based upon how quickly the disease develops
and the type of abnormal cells produced. Leukemia is called an acute leukemia if it
develops rapidly. Large numbers of leukemia cells accumulate very quickly in the
blood and bone marrow, leading to symptoms such as tiredness, easy bruising, and
susceptibility to infections. Acute leukemia requires fast and aggressive treatment.
There are around 54,000 new cases of leukemia each year in the U.S. and about
24,000 deaths due to leukemia. Leukemia makes up about 3% of all new cancer
cases.
Chronic leukemias develop slowly over time. These leukemias may not cause
specific symptoms at the beginning of their course. If left untreated, the cells may
eventually grow to high numbers, as in acute leukemias causing similar symptoms.
Leukemias are further classified as myeloid or lymphoid, depending upon the type of
white blood cell that makes up the leukemia cells. A basic understanding of the

normal development of blood cells is needed to understand the different types of

leukemia. Normal blood cells develop from stem cells that have the potential to
become many cell types. Myeloid stem cells mature in the bone marrow and become
immature white cells called myeloid blasts. These myeloid blasts further mature to
become either red blood cells, platelets, or certain kinds of white blood cells.
Lymphoid stem cells mature in the bone marrow to become lymphoid blasts. The
lymphoid blasts develop further into T or B lymphocytes, special types of white blood
cells. Myeloid leukemias are made up of cells that arise from myeloid cells, while
lymphoid leukemias arise from lymphoid cells. Knowing the type of cell involved in
leukemia is important in choosing the appropriate treatment.
Common types of leukemia

The four most common types of leukemia are acute lymphocytic leukemia, chronic
lymphocytic leukemia, acute myeloid leukemia, and chronic myeloid leukemia.

Acute lymphocytic leukemia (ALL, also known as acute lymphoblastic leukemia) is

the most common type of leukemia in children, but it can also affect adults. In this
type of leukemia, immature lymphoid cells grow rapidly in the blood. It affects over
6,000 people per year in the U.S.

Acute myeloid leukemia (AML, also called acute myelogenous leukemia) involves the
rapid growth of myeloid cells. It occurs in both adults and children and affects about
18,000 people each year in the U.S.

Chronic lymphocytic leukemia (CLL) is a slow-growing cancer of lymphoid cells that

usually affects people over 55 years of age. It is estimated to affect about 16,000
people in the U.S. every year. It almost never occurs in children or adolescents.

Chronic myeloid leukemia (CML, also known as chronic myelogenous leukemia)

primarily affects adults and occurs in about 6,000 people every year in the U.S.

Less common types of leukemia account for about 6,000 cases of leukemia each
year in the U.S.

Hairy cell leukemia is an uncommon type of chronic leukemia.

Chronic myelomonocytic leukemia (CMML) is another type of chronic leukemia that

develops from myeloid cells.

Juvenile myelomonocytic leukemia (JMML) is a type of myeloid leukemia that usually

occurs in children under 6 years of age.

Large granular lymphocytic leukemia (LGL leukemia) is a type of chronic leukemia

that develops from lymphoid cells. It can be slow- or fast-growing.

Acute promeylocytic leukemia (APL) is a subtype of AML.

What causes leukemia? Is leukemia hereditary?

The exact cause of leukemia is not known, but it is thought to involve a combination
of genetic and environmental factors. Leukemia cells have acquired mutations in
their DNA that cause them to grow abnormally and lose functions of typical white
blood cells. It is not clear what causes these mutations to occur. One type of change
in the cells' DNA that is common in leukemias is known as a chromosome
translocation. In this process, a portion of one chromosome breaks off and attaches
to a different chromosome. One translocation seen in almost all cases of CML and in
sometimes in other types of leukemia is an exchange of DNA between chromosomes
9 and 22, which leads to what is known as the Philadelphia chromosome. This
creates an oncogene (cancer-promoting gene) known as BCR-ABL. This change in
DNA is not inherited but occurs sometime in the life of the affected individual.
Most cases of leukemia are not believed to be hereditary, but certain genetic
mutations and conditions can be passed along to offspring that increase the chances
of developing leukemia. A condition known as Li-Fraumeni syndrome is
characterized by an inherited mutation in a tumor suppressor gene known as TP53,
and individuals with this condition have an increased risk of leukemia and other
cancers. Other hereditary conditions that can increase the risk of developing
leukemia includeDown syndrome, neurofibromatosis type 1, ataxia telangiectasia,
and Noonan syndrome.
What are leukemia risk factors?

Exposure to radiation is known to increase the risk of developing AML, CML, or ALL.
Increases in leukemia were observed in people surviving atomic bombs. Radiation
therapy for cancer can also increase the risk of leukemia. Exposure to benzene,
used commonly in the chemical industry, increases the risk of
leukemia. Cigarettesmoking is known to increase the risk of developing AML.

Down syndrome, Li-Fraumeni syndrome, and other medical conditions can increase
the risk of developing leukemia. Blood disorders known as myelodysplastic
syndromes confer an increased risk of developing AML. Human T-cell leukemia virus
type 1 (HTLV-1) is a virus that causes a rare type of leukemia. Certain
chemotherapy drugs for cancer can increase the risk for AML or ALL.
Having risk factors does not mean that a person will definitely get leukemia, and
most people with risk factors will not develop the disease. Likewise, not everyone
who develops leukemia has an identifiable risk factor.

What are leukemia symptoms and signs?

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The symptoms and signs of leukemia depend upon the type of leukemia. As stated
earlier, slow-growing or chronic leukemia may not cause any symptoms at the
outset, while aggressive or rapidly growing leukemia may lead to severe symptoms.
The symptoms of leukemia arise from a loss of function of the normal blood cells or
from accumulation of the abnormal cells in the body.
Signs and symptoms of leukemia typically include the following:

Fevers

Night sweats

Swollen lymph nodes that are usually painless

Feelings of fatigue, tiredness

Easy bleeding or bruising, causing bluish or purplish patches on the skin or

tinyred spots on the skin, or recurring nosebleeds

Frequent infections

Bone or joint pain

Weight loss that is otherwise unexplained, or loss of appetite

Enlargement of the spleen or liver, which can lead to abdominal pain or

swelling

Red spots on the skin (petechiae)

If leukemia cells have infiltrated the brain, symptoms such

as headaches, seizures, confusion, loss of muscle control, and vomiting can occur.

How do physicians diagnose leukemia?

In addition to a medical history (asking about symptoms and risk factors) and a
physical exam to look for signs of leukemia (lymph node enlargement, enlargement
of spleen), the diagnosis of leukemia typically involves laboratory studies of a blood
sample. Abnormal numbers of blood cells may suggest a diagnosis of leukemia, and
the blood sample may also be examined under the microscope to see if the cells
appear abnormal. A sample of the bone marrow may also be obtained to establish
the diagnosis. For a bone marrow aspirate, a long, thin needle is used to withdraw a
sample of bone marrow from the hip bone, under local anesthesia. A bone marrow
biopsy involves insertion of a thick, hollow needle into the hip bone to remove a
sample of the bone marrow, using local anesthesia.
Cells from the blood and bone marrow are further tested if leukemia cells are
present. These additional tests look for genetic alterations and expression of certain
cell surface markers by the cancer cells (immunophenotyping). The results of these
tests are used to help determine the precise classification of the leukemia and to
decide on optimal treatment.
Other tests that may be useful include a chest X-ray to determine if there are
enlarged lymph nodes or other signs of disease and a lumbar puncture to remove a
sample of cerebrospinal fluid to determine if the leukemia cells have infiltrated the
membranes and space surrounding the brain and spinal cord.
Imaging tests such as MRI and CT scanning can also be useful for some patients to
determine the extent of disease.
What is the treatment for leukemia?

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There are a number of different medical approaches to the treatment of leukemia.

Treatment will typically depend upon the type of leukemia, the patient's age and
health status, as well as whether or not the leukemia cells have spread to the
cerebrospinal fluid. The genetic changes or specific characteristics of the leukemia
cells as determined in the laboratory can also determine the type of treatment that
may be most appropriate.
Watchful waiting may be an option for some people with a chronic leukemia who do
not have symptoms. This involves close monitoring of the disease so that treatment
can begin when symptoms develop. Watchful waiting allows the patient to avoid or
postpone the side effects of treatment. The risk of waiting is that it may eliminate the
possibility of controlling the leukemia before it worsens.
Treatments for leukemia include chemotherapy (major treatment modality for
leukemia), radiation therapy,biological therapy, targeted therapy, and stem cell
transplant. Combinations of these treatments may be used. Surgical removal of the
spleen can be a part of treatment if the spleen is enlarged.
Acute leukemia needs to be treated when it is diagnosed, with the goal of inducing a
remission (absence of leukemia cells in the body). After remission is achieved,
therapy may be given to prevent a relapse of the leukemia. This is called
consolidation or maintenance therapy. Acute leukemias can often be cured with
treatment.
Chronic leukemias are unlikely to be cured with treatment, but treatments are often
able to control the cancer and manage symptoms. Some people with chronic
leukemia may be candidates for stem cell transplantation, which does offer a chance
for cure.
Many patients opt to receive a second opinion before beginning treatment for
leukemia. In most cases, there is time to receive a second opinion and consider
treatment options without making the treatment less effective. However, in rare
cases of very aggressive leukemias, treatment must begin immediately. Someone
should discuss with a doctor the possibility of obtaining a second opinion and any

potential delays in treatment. Most doctors welcome the possibility of a second

opinion and will not be offended by a patient's wish to obtain one.
Chemotherapy

Chemotherapy is the administration of drugs that kill rapidly dividing cells such as
leukemia or other cancer cells. Chemotherapy may be taken orally in pill or tablet
form, or it may be delivered via a catheter or intravenous line directly into the
bloodstream. Combination chemotherapy is usually given, which involves a
combination of more than one drug. The drugs are given in cycles with rest periods
in between.
Sometimes, chemotherapy drugs for leukemia are delivered directly to the
cerebrospinal fluid (known as intrathecal chemotherapy). Intrathecal chemotherapy
is given in addition to other types of chemotherapy and can be used to treat
leukemia in the brain or spinal cord or, in some cases, to prevent spread of leukemia
to the brain and spinal cord. An Ommaya reservoir is a special catheter placed under
the scalp for the delivery of chemotherapy medications. This is used for children and
some adult patients as a way to avoid injections into the cerebrospinal fluid.
Side effects of chemotherapy depend on the particular drugs taken and the dosage
or regimen. Some side effects from chemotherapy drugs include hair loss,
nausea, vomiting, mouth sores, loss of appetite, tiredness, easy bruising or bleeding,
and an increased chance of infection due to the destruction of white blood cells.
There are medications available to help manage the side effects of chemotherapy.
Some adult men and women who receive chemotherapy sustain damage to the
ovaries or testes, resulting ininfertility. Most children who receive chemotherapy for
leukemia will have normal fertility as adults, but depending on the drugs and
dosages used, some may have infertility as adults.
Biological therapy

Biological therapy is any treatment that uses living organisms, substances that come
from living organisms, or synthetic versions of these substances to treat cancer.
These treatments help the immune system recognize abnormal cells and then attack
them. Biological therapies for various types of cancer can include antibodies, tumor
vaccines, or cytokines (substances that are produced within the body to control the
immune system). Monoclonal antibodies are antibodies that react against a specific

target that are used in the treatment of many kinds of cancer. An example of a
monoclonal antibody used in the treatment of leukemia is alemtuzumab, which
targets the CD52 antigen, a protein found on B-cell chronic lymphocytic leukemia
(CLL) cells. Interferons are cell signaling chemicals that have been used in the
treatment of leukemia.
Side effects of biological therapies tend to be less severe than those of
chemotherapy and can include rash or swelling at the injection site for IV infusions of
the therapeutic agents. Other side effects can includeheadache, muscle aches,
fever, or tiredness.
Targeted therapy

Targeted therapies are drugs that interfere with one specific property or function of a
cancer cell, rather than acting to kill all rapidly growing cells indiscriminately. This
means there is less damage to normal cells with targeted therapy than with
chemotherapy. Targeted therapies may cause the target cell to cease growing rather
than to die, and they interfere with specific molecules that promote growth or spread
of cancers. Targeted cancer therapies are also referred to as molecularly targeted
drugs, molecularly targeted therapies, or precision medicines.
Monoclonal antibodies (described above in the section on biologic therapy) are also
considered to be targeted therapies since they specifically interfere and interact with
a specific target protein on the surface of cancer cells. Imatinib (Gleevec)
and dasatinib (Sprycel) are examples of targeted therapies that are used to treat
CML, some cases of ALL, and some other cancers. These drugs target the cancerpromoting protein that is formed by the BCR-ABL gene translocation.
Targeted therapies are given in pill form or by injection. Side effects can include
swelling, bloating, and suddenweight gain. Other side effects can include nausea,
vomiting, diarrhea, muscle cramps, or rash.
Radiation therapy

Radiation therapy uses high energy radiation to target cancer cells. Radiation
therapy may be used in the treatment of leukemia that has spread to the brain, or it
may be used to target the spleen or other areas where leukemia cells have
accumulated.

Radiation therapy also causes side effects, but they are not likely to be permanent.
Side effects depend on the location of the body that is irradiated. For example,
radiation to the abdomen can cause nausea, vomiting, anddiarrhea. With any
radiation therapy, the skin in the area being treated may become red, dry, and
tender. Generalized tiredness is also common while undergoing radiation therapy.
Stem cell transplant

In stem cell transplantation, high doses of chemotherapy and/or radiation are given
to destroy leukemia cells along with normal bone marrow. Then, transplant stem
cells are delivered by an intravenous infusion. The stem cells travel to the bone
marrow and begin producing new blood cells. Stem cells may come from the patient
or from a donor.
Autologous stem cell transplantation refers to the situation in which the patient's own
stem cells are removed and treated to destroy leukemia cells. They are then
returned to the body after the bone marrow and leukemia cells have been destroyed.
An allogeneic stem cells transplant refers to stem cells transplanted from a donor.
These may be from a relative or an unrelated donor. A syngeneic stem cell transplant
uses stem cells taken from a healthy identical twin of the patient.
Stem cells may be removed (harvested) in different ways. Typically, they are taken
from the blood. They can also be harvested from the bone marrow or from umbilical
cord blood.
Stem cell transplantation is done in a hospital, and it is necessary to remain in the
hospital for several weeks. Risks of the procedure include infections and bleeding
due to the depletion of normal blood cells. A risk of stem cell transplant with donor
cells is known as graft-versus-host disease (GVHD). In GVHD, the donor white blood
cells react against the patient's normal tissues. GVHD can be mild or very severe,
and often affects the liver, skin, or digestive tract. GVHD can occur at any time after
the transplant, even years later. Steroids or medications that suppress the immune
response may be used to treat this complication.
Supportive treatments

Because many of the treatments for leukemia deplete normal blood cells, increasing
the risk for bleeding and infection, supportive treatments may be needed to help

prevent these complications of treatment. Supportive treatments may also be

needed to help minimize and manage unpleasant side effects of medical or radiation
therapy.
Types of supportive and preventive treatments that can be used for patients
undergoing treatment for leukemia include the following:

Vaccines against the flu or pneumonia

Blood or platelet transfusions

Anti-nausea medications

Antibiotics or antiviral medications to treat or prevent infections

White blood cell growth factors to stimulate white blood cell production (such as
granulocyte-colony stimulating factor [G-CSF], made up of filgrastim [Neupogen]
and pegfilgrastim [Neulasta] and granulocyte macrophage-colony stimulating growth
factor [GM-CSF], made up of sargramostim[Leukine])

Red cell growth factors to stimulate red blood cell production (darbepoetin
alfa [Aranesp] orepoetin alfa [Procrit])

Intravenous injections of immunoglobulins to help fight infection

What are complications of leukemia?

Many of the challenges of leukemia relate to the depletion of normal blood cells as
well as the side effects of treatments as described in the previous section, such as
frequent infections, bleeding, and GVHD in recipients of stem cell transplants.
Weight loss and anemia are further complications of leukemia and its treatment.
Complications of any leukemia also include a relapse or a progression of the disease
after a remission has been achieved with treatment.
Other complications of leukemia relate to the specific type of leukemia. For example,
in 3% to 5% of cases of CLL, the cells change characteristics and transform into an
aggressive lymphoma. This is known as a Richter transformation. Autoimmune
hemolytic anemic, in the body attacks and destroys red blood cells, is another

potential complication of CLL. People with CLL are also more likely to develop
second cancers and other blood disorders and blood cancers.
Tumor lysis syndrome is a condition caused by the rapid death of cancer cells when
treated. It can occur in almost any type of cancer, and it is seen with some cases of
leukemia, particularly when large numbers of leukemia cells are present such as with
AML or ALL. The rapid destruction of the leukemia cells leads to the release of large
amounts of phosphate, which further causes metabolic abnormalities and can lead
to kidney failure.
Children who receive therapy for ALL may experience late adverse effects including
central nervous system (CNS) impairment, slowing of growth, infertility, cataracts,
and an increased risk for other cancers. The incidence of these late effects varies
depending upon the age at treatment and the type and strength of therapies.
What is the prognosis of leukemia?

The prognosis of leukemia depends upon the type of leukemia that is present and
the age and health status of the patient. Mortality (death) rates for leukemia are
higher in the elderly than in younger adults and children. In many cases, leukemia
can be managed or cured with treatments available today. In particular, childhood
ALL has a very high 5-year survival rate.
Modern treatments have led to a greater than fourfold increase since 1960 in 5-year
survival rates for leukemia. For the time period from 2004 to 2010, 5-year survival
rates for different types of leukemia were approximately:
CML: 60%
CLL: 84%
AML: 25% overall, 66% for children and teens younger than 15
ALL: 70% overall, 92% for children and teens younger than 15, and 93% for children
younger than 5
Is it possible to prevent leukemia?

Most people who develop leukemia do not have a known risk factor, and it is
generally not possible to prevent leukemia. Certain risk factors, such as exposure to
radiation or benzene, may be minimized, but this does not guarantee prevention of
leukemia.
What support groups are available for people with leukemia?

Support groups for people with leukemia and their families offer a variety of
resources.
The Leukemia and Lymphoma Society (http://www.lls.org/#/diseaseinformation/
getinformationsupport/) offers information for patients and families, discussion
boards, online chats, support groups, and 1:1 support from information specialists.
They also offer family support groups.
Information specialists at 1-800-4-CANCER and at LiveHelp
(http://www.cancer.gov/help) can help someone locate programs, services, and
publications.
Throughout the U.S., hospitals and health systems offer support groups and
resources for people living with leukemia. A doctor or other members of a patient's
treatment team can provide information about support groups in the area. The
National Cancer Institute has publications for patients on coping with leukemia and
other cancers (http://www.cancer.gov/publications/patient-education#coping-andsupport).
What research is being done on leukemia?

Leukemia is an active area of biomedical research. Ongoing studies are examining

the risk factors and causes of leukemia, as well as examining new and improved
treatment options.
Clinical trials are studies that examine new drugs or new combinations of drugs and
existing treatments. Trials are under way to test new targeted therapy, biological
therapy, and chemotherapy regimens. Patients should discuss their situation and
care with their doctor if they are interested in being part of a clinical trial. The NCI's
web site includes a section on clinical trials at https://clinicaltrials.gov