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How Do I Know If I Have Leukemia?

Because many types of leukemia show no obvious symptoms early on, the disease may be diagnosed incidentally during a physical examination or as a result of routine blood tests. If a patient has enlarged lymph nodes, swollen gums, an enlarged liver or spleen, significant bruising, 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, the patient will have a needle biopsy of bone marrow from a pelvic bone and a test for cancer cells. In the case of CML, DNA tests will check for the Philadelphia Chromosome.

Important prognostic factors in leukemia, the age of the patient and the chromosomal abnormalities found in leukemia cells.

What Are the Treatments?

While the reported incidence of leukemia has not changed much since the 1950s, more people are surviving longer, thanks mainly to advances in chemotherapy. Childhood leukemia (ALL), for example, represents one of the most dramatic success stories of cancer treatment: Some 90% of children diagnosed with the disease attain remission, and more than half are cured completely. The five-year survival rate for all patients with ALL has risen from 4% in the 1960s to more than 50% in the 1990s.

Conventional Medicine

For acute leukemia, the immediate goal of treatment is remission. The patient undergoes aggressive chemotherapy in a hospital for several weeks and is kept in sterile isolation and cleansed constantly to reduce the chance of infection. Since acute leukemia patients have extremely low counts of healthy blood cells, they are usually given blood and platelet transfusions to boost their natural immune function and to help stop bleeding. They may also receive drugs to combat infection and to reduce nausea and vomiting that may occur as side effects of the chemotherapy.

People with ALL are likely to attain satisfactory remission after several weeks of aggressive chemotherapy in a hospital. To keep the disease under control, they will continue receiving low-dose chemotherapy and possibly radiation therapy for a month or more to eliminate residual cancer traces. At home they will receive an on-and-off maintenance protocol for months or even years. Since AML does not respond as well to chemotherapy, the best chance of lasting remission or cure depends on successful bone marrow transplantation, which requires a willing donor with compatible tissue type and genetic characteristics — usually a family member.

A bone marrow transplant has three stages: preparation, operation, and recovery. First, the patient's cancerous white blood cell count is brought under control — usually by chemotherapy but possibly by leukopheresis, a mechanical process that separates cancer cells from the blood. During the operation stage, the patient's bone marrow is destroyed by intensive chemotherapy to avoid rejection of new marrow. After the patient's disease bone marrow has been destroyed by chemotherapy, the patient is given marrow from a health donor to reinstitute the marrow.

Recovery is the most dangerous stage: Until the donor marrow cells start producing new blood, the patient is left with virtually no white blood cells, making death by infection a strong possibility. Once the donor marrow multiplies sufficiently — usually in two to six weeks — the outlook for long-term remission and sometimes a complete cure is better. Bone marrow transplantation is still both expensive and risky, but it may offer the best chance of remission and cure for AML and recurring cases of ALL.

Since CLL generally affects older people and progresses slowly, conventional treatment tends to be conservative. As long as symptoms are absent, the disease requires no treatment. If swelling appears in lymph nodes and other organs, CLL can usually be controlled for years with oral chemotherapy. Many people with CLL lead basically normal lives and die of unrelated causes.

Oral chemotherapy can effectively control symptoms of CML for several years before the disease becomes acute. CML sufferers may survive longer if they receive interferon, a naturally occurring protein that can kill or slow the growth of cancerous cells. Because most cases of CML eventually advance to an acute phase despite treatment, some doctors advise bone marrow transplantation during the chronic phase.

The drug Gleevec has radically changed treatment for CML. Known as a molecular targeting drug, it attacks the enzymes which cause cancerous white blood cells to grow out of control. Gleevec doesn't cure CML, but a new study shows it can prevent the white blood cell changes that signal worsening disease and death. And it does much better than what used to be the best treatment, interferon alpha plus low-dose cytarabine chemotherapy.