Types of Leukemia

ALL APL CML AML CLL Other Leukemia’s- MDS

Leukemia is not staged numerically (I, II, III, IV), the way many other cancers are staged. Rather, it is classified as acute or chronic. Acute leukemia grows more rapidly than chronic leukemia. Acute leukemia is a potentially life-threatening condition and requires urgent and intensive treatments. Chronic leukemia has a slower onset and is not usually life-threatening at the time of diagnosis. Leukemia is also classified by the type of white blood cells in which it arises; lymphoid cells or myeloid cells.

Acute Lymphocytic Leukemia (ALL)

Acute lymphocytic leukemia is a cancer that begins in the white blood cells called lymphocytes in the bone marrow (the soft inner part of the bones, where new blood cells are made). These immune cells can consist of T Cells or B-Cells.

ALL is a most common leukemia found in children, but also occurs found in adults.

Treatment Approach

Chemotherapy is the primary treatment for ALL and has there several phases to chemotherapy:

Induction: This phase of chemotherapy is administered in the hospital and lasts for approximately three weeks. This will typically requires you to stay inpatient until your counts to recover. A bone marrow biopsy test is performed at the end of the induction treatment to see if the leukemia is in remission (meaning the bone marrow biopsy shows no evidence of leukemia).

Consolidation/Intensification: Even if bone marrow tests do not show leukemia cells (indicating you are in remission) it is possible that some cells have still survived. At this point additional chemotherapy drugs are given to destroy any of these remaining leukemia cells that may have survived the induction phase of treatment. Chemotherapy can often be given in the outpatient setting.

Central Nervous System (CNS): ALL sometimes develops in the brain and spinal cord. Doctors try to prevent this by giving chemotherapy directly into the spinal fluid. Occasionally, radiation therapy (targeted X-rays to destroy tumors) to the brain is also necessary.

Maintenance: This phase of chemotherapy treatment lasts for up to 2 1/2 years from diagnosis and involves taking tablets at home and having intermittent, intravenous chemotherapy (treatment with anticancer drugs). During maintenance treatment you can possibly be able to take part in some normal daily activities. But this decision is decided by your physician.

Bone Marrow/Stem Cell Transplantation (BMT): After completing induction and/or consolidation chemotherapy treatment for your leukemia, your physician may recommend you undergo a bone marrow/stem cell transplant in order to give you the best chances of curing your leukemia. BMT Process

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Acute Myelogenous Leukemia (AML)

Acute Myelogenous Leukemia is the most common type of acute leukemia (cancer of the blood) in adults. It occurs in myeloid cells, which are a class of blood cells that develop into red and white blood cells and platelets.

Treatment Approach

Chemotherapy is the primary treatment for AML and has there several phases to chemotherapy:

Induction:This phase of chemotherapy is administered and lasts for approximately four to six weeks. This will typically require you to stay inpatient until your counts recover. . A bone marrow biopsy test is performed at the end of the induction treatment to see if the leukemia is in remission.(meaning the bone marrow biopsy shows no evidence of leukemia).

Consolidation Therapy:Even if bone marrow tests do not show leukemia cells (indicating you are in remission) it is possible that some cells have still survived. At this point additional chemotherapy drugs are given to destroy any of these remaining leukemia cells that may have survived the induction phase of treatment. Chemotherapy can often be given in the outpatient setting.

Bone Marrow/Stem Cell Transplantation (BMT): After completing induction and/or consolidation chemotherapy treatment for your leukemia, your physician may recommend you undergo a bone marrow/stem cell transplant in order to give you the best chances of curing your leukemia. BMT Process

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Acute Promyelocytic Leukemia (APL)

Acute Promyelocytic Leukemia is a FAB subtype (M3) of AML that differs from the other subtypes of AML. APL is associated with bleeding and will respond better when specific drugs (all-trans-retinoic acid – ATRA or arsenic trioxide) are used in combination with standard chemotherapy.

Treatment Approach

Chemotherapy is the main treatment for APL and has several phases:

Induction: Patients with APL are commonly treated with all-trans-retinoic acid (ATRA) therapy, either alone or in combination with other chemotherapy medications.

Consolidation: If your disease does not respond to induction therapy, Arsenic Trioxide may be added. Arsenic Trioxide may be used alone or in combination with ATRA or other chemotherapy medications

Maintenance: Patients continue to take ATRA every 3 months for a 2 year period. Blood tests will be performed every three months in addition to bone marrow biopsies every six months to monitor for disease recurrence.

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Chronic Lymphocytic Leukemia (CLL)

CLL is a type of leukemia that leads to overproduction of certain white blood cells. It generally occurs in older adults and progresses slowly, although the disease can become more aggressive over time.

Treatment Approach

Treatment in the early stages may include observation. Chemotherapy is usually given when symptoms occur, and most patients will respond well to therapy. Eventually, CLL will not respond well to chemotherapy and bone marrow/stem cell transplantation will be offered.

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Chronic Myelogenous Leukemia (CML)

CML is a slow growing leukemia where your bone marrow produces a large amount of white blood cells.

  • It is common for CML patients to have a genetic mutation known as the “Philadelphia Chromosome”
  • The “Philadelphia Chromosome” .is formed when DNA (genetic instructions) from chromosome 9 gets translocated or “misplaced” onto chromosome 22.
  • This change causes the overproduction of an enzyme called tyrosine kinase, which tells the bone marrow to make too many white blood cells.
  • Specific drugs (e.g. Gleevec (Imatimab) or Sprycel (Dastainib) were developed to block this enzyme and have become a standard therapy for the disease.

CML is also characterized by a chronic phase that can last for months, or years. The disease may have few or no symptoms during the chronic phase. Eventually, however, patients progress from the chronic phase to an accelerated phase to an acute leukemia phase during which time the leukemia cells grow more quickly.

Treatment Approach

The chronic phase can be controlled with an abl tryrosine kinase blocking agent like Gleevac. If a patient does not respond to Gleevac, they may respond to Sprycel. There are also other investigational abl tyrosine kinase agents available at certain centers for those patients who do not respond to Gleevac or Sprycel.

If you do not respond to an abl tryonsine kinase agent, your physician may recommend you undergo a bone marrow/stem cell transplant in order to give you the best chance of your leukemia being cured. BMT Process

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Other Types of Leukemia’s

Myelodysplastic Syndromes are now thought to be the most common blood and bone marrow disorders. While estimates vary, as many as 20,000 to 30,000 people in the U.S. may be diagnosed annually with MDS. The disorders can lead to low blood counts, infections, bleeding, the need for transfusions, and life-threatening bone-marrow failure. As the disease progresses, it can evolve into an aggressive type of acute myelogenous leukemia (AML).

Treatment Approach

MDS treatments focus on improving blood counts, quality of life and preventing or delaying progression to more severe forms of acute leukemia. This is particularly important because the more aggressive forms of acute leukemia associated with MDS do not respond well to chemotherapy.

Low-dose chemotherapy medications (e.g. Vidaza, Dacogen, Revlimid) are sometimes given to slow down the growth of MDS and delay progression to AML. However, bone marrow/stem cell transplantation remains the only curative treatment for this disease.BMT Process

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