Au Leukemia

8/4/2019 Au Leukemia

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Leukemia(American English) or leukaemia(British English) (from the Greekleukos - white,

and haima - blood[1]

) is a type ofcancerof thebloodorbone marrowcharacterized by anabnormal increase ofwhite blood cells. Leukemia is a broad term covering a spectrum of

diseases. In turn, it is part of the even broader group of diseases affecting the blood, bone

marrow andlymphoid system, which are all known ashematological neoplasms.

In 2000, approximately 256,000 children and adults around the world developed some form of

leukemia, and 209,000 died from it.[2]

About 90% of all leukemias are diagnosed in adults.[3]

A Wright's stained bone marrow aspirate

smear of patient with precursor B-cell acute lymphoblastic leukemia.

Classification

Four major kinds of leukemia

Cell type Acute Chronic

Lymphocytic leukemia(or "lymphoblastic")

Acute lymphoblastic

leukemia(ALL)

Chronic lymphocytic leukemia

(CLL)

Myelogenous leukemia(also "myeloid" or

"nonlymphocytic")

Acute myelogenous leukemia(AML)

(or Myeloblastic)

Chronic myelogenous

leukemia(CML)
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Clinically and pathologically, leukemia is subdivided into a variety of large groups. The first

division is between itsacuteandchronicforms:

Acute leukemiais characterized by a rapid increase in the numbers of immature bloodcells. Crowding due to such cells makes the bone marrow unable to produce healthy

blood cells. Immediate treatment is required in acute leukemia due to the rapidprogression and accumulation of the malignant cells, which then spill over into the

bloodstream and spread to other organs of the body. Acute forms of leukemia are themost common forms ofleukemia in children.

Chronic leukemiais characterized by the excessive build up of relatively mature, butstill abnormal, white blood cells. Typically taking months or years to progress, the cellsare produced at a much higher rate than normal cells, resulting in many abnormal white

blood cells in the blood. Whereas acute leukemia must be treated immediately, chronic

forms are sometimes monitored for some time before treatment to ensure maximum

effectiveness of therapy. Chronic leukemia mostly occurs in older people, but cantheoretically occur in any age group.

Additionally, the diseases are subdivided according to which kind of blood cell is affected. Thissplit divides leukemias into lymphoblastic orlymphocytic leukemiasand myeloid or

myelogenous leukemias:

In lymphoblastic orlymphocytic leukemias, the cancerous change takes place in a typeof marrow cell that normally goes on to formlymphocytes, which are infection-fighting

immune system cells. Most lymphocytic leukemias involve a specific subtype oflymphocyte, theB cell.

In myeloid ormyelogenous leukemias, the cancerous change takes place in atype ofmarrow cellthat normally goes on to formred blood cells, some other types of white

cells, andplatelets.

Combining these two classifications provides a total of four main categories. Within each of

these four main categories, there are typically several subcategories. Finally, some rarer types areusually considered to be outside of this classification scheme.

Acute lymphoblastic leukemia (ALL) is the most common type of leukemia in youngchildren. This disease also affects adults, especially those age 65 and older. Standard

treatments involve chemotherapy and radiotherapy. The survival rates vary by age: 85%in children and 50% in adults.[4]Subtypes includeprecursor B acute lymphoblastic

leukemia,precursor T acute lymphoblastic leukemia,Burkitt's leukemia, andacute

biphenotypic leukemia.

Chronic lymphocytic leukemia (CLL) most often affects adults over the age of 55. Itsometimes occurs in younger adults, but it almost never affects children. Two-thirds of

affected people are men. The five-year survival rate is 75%.[5]It is incurable, but there are

many effective treatments. One subtype isB-cell prolymphocytic leukemia, a more

aggressive disease.

Acute myelogenous leukemia (AML) occurs more commonly in adults than in children,and more commonly in men than women. AML is treated with chemotherapy. The five-
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year survival rate is 40%.[6]

Subtypes of AML includeacute promyelocytic leukemia,

acute myeloblastic leukemia, andacute megakaryoblastic leukemia.

Chronic myelogenous leukemia (CML) occurs mainly in adults. A very small numberof children also develop this disease. Treatment is withimatinib(Gleevec in US, Glivec

in Europe)[7]

or other drugs. The five-year survival rate is 90%.[8][9]

One subtype is

chronic monocytic leukemia. Hairy cell leukemia(HCL) is sometimes considered a subset of CLL, but does not fit

neatly into this pattern. About 80% of affected people are adult men. There are no

reported cases in young children. HCL is incurable, but easily treatable. Survival is 96%to 100% at ten years.[10]

T-cell prolymphocytic leukemia(T-PLL) is a very rare and aggressive leukemiaaffecting adults; somewhat more men than women are diagnosed with this disease.

[11]

Despite its overall rarity, it is also the most common type of matureT cellleukemia;[12]

nearly all other leukemias involveB cells. It is difficult to treat, and the median survival

is measured in months.

Large granular lymphocytic leukemiamay involve either T-cells orNK cells; likehairy cell leukemia, which involves solely B cells, it is a rare and indolent (notaggressive) leukemia.

[13]

Adult T-cell leukemiais caused byhuman T-lymphotropic virus(HTLV), a virussimilar toHIV. Like HIV, HTLV infects CD4+ T-cells and replicates within them;

however, unlike HIV, it does not destroy them. Instead, HTLV "immortalizes" the

infected T-cells, giving them the ability to proliferate abnormally.
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Signs and symptoms

Damage to the bone marrow, by way of displacing the normal bone marrow cells with higher

numbers of immature white blood cells, results in a lack of bloodplatelets, which are importantin theblood clottingprocess. This means people with leukemia may easily becomebruised,

bleedexcessively, or develop pinprick bleeds (petechiae).

White blood cells, which are involved in fightingpathogens, may be suppressed or

dysfunctional. This could cause the patient's immune system to be unable to fight off a simple

infection or to start attacking other body cells. Because leukemia prevents the immune systemfrom working normally, some patients experience frequentinfection, ranging from infectedtonsils,sores in the mouth, ordiarrheato life-threateningpneumoniaoropportunistic infections.

Finally, the red blood cell deficiency leads toanemia, which may causedyspneaandpallor.

Some patients experience other symptoms, such asfeeling sick, having fevers, chills, nightsweats and otherflu-like symptoms, or feelingfatigued. Some patients experience nausea or a
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feeling of fullness due to an enlargedliverandspleen; this can result in unintentionalweight

loss. If the leukemic cells invade thecentral nervous system, then neurological symptoms(notablyheadaches) can occur. All symptoms associated with leukemia can be attributed to other

diseases. Consequently, leukemia is always diagnosed throughmedical tests.

The word leukemia, which means 'white blood', is derived from the disease's namesake highwhite blood cell counts that most leukemia patients have before treatment. The high number of

white blood cells are apparent when a blood sample is viewed under a microscope. Frequently,these extra white blood cells are immature or dysfunctional. The excessive number of cells can

also interfere with the level of other cells, causing a harmful imbalance in the blood count.

Some leukemia patients do not have high white blood cell counts visible during a regular blood

count. This less-common condition is called aleukemia. The bone marrow still contains

cancerous white blood cells which disrupt the normal production of blood cells, but they remain

in the marrow instead of entering the bloodstream, where they would be visible in a blood test.For an aleukemic patient, the white blood cell counts in the bloodstream can be normal or low.

Aleukemia can occur in any of the four major types of leukemia, and is particularly common inhairy cell leukemia.[15]

Causes

No single known cause for all of the different types of leukemia exists. The known causes, which

are not generally factors within the control of the average person, account for relatively few

cases.[16]

The different leukemias likely have different causes.

Leukemia, like other cancers, results frommutationsin theDNA. Certain mutations can trigger

leukemia by activatingoncogenesor deactivatingtumor suppressor genes, and thereby disrupting

the regulation of cell death, differentiation or division. These mutations may occur spontaneouslyor as a result of exposure toradiationorcarcinogenicsubstances.[17]

Among adults, the known causes are natural and artificialionizing radiation, a fewvirusessuch

asHuman T-lymphotropic virus, and some chemicals, notablybenzeneand alkylating

chemotherapyagents for previous malignancies.[18][19][20]

Use oftobaccois associated with a

small increase in the risk of developingacute myeloid leukemiain adults.[18]

Cohort and case-control studies have linked exposure to somepetrochemicalsandhair dyesto the development of

some forms of leukemia. A few cases ofmaternal-fetal transmissionhave been reported.[18]

Diet

has very limited or no effect, although eating more vegetables may confer a small protective

benefit.[16]

Viruses have also been linked to some forms of leukemia. Experiments on mice and othermammals have demonstrated the relevance ofretrovirusesin leukemia, and human retroviruses

have also been identified. The first human retrovirus identified wasHuman T-lymphotropic

virus, or HTLV-1, is known to causeadult T-cell leukemia.[21]

Some people have a genetic predisposition towards developing leukemia. This predisposition is

demonstrated by family histories andtwin studies.[18]

The affected people may have a single
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e_note-isbn1-55009-111-5-17http://en.wikipedia.org/wiki/Leukemia#cite_note-isbn1-55009-111-5-17http://en.wikipedia.org/wiki/Leukemia#cite_note-isbn1-55009-111-5-17http://en.wikipedia.org/wiki/Leukemia#cite_note-isbn1-55009-111-5-17http://en.wikipedia.org/wiki/Twin_studyhttp://en.wikipedia.org/wiki/Leukemia#cite_note-20http://en.wikipedia.org/wiki/Adult_T-cell_leukemiahttp://en.wikipedia.org/wiki/Human_T-lymphotropic_virushttp://en.wikipedia.org/wiki/Human_T-lymphotropic_virushttp://en.wikipedia.org/wiki/Retroviruseshttp://en.wikipedia.org/wiki/Leukemia#cite_note-pmid12163333-15http://en.wikipedia.org/wiki/Leukemia#cite_note-isbn1-55009-111-5-17http://en.wikipedia.org/wiki/Maternal-fetal_transmissionhttp://en.wikipedia.org/wiki/Hair_dyehttp://en.wikipedia.org/wiki/Petrochemicalshttp://en.wikipedia.org/wiki/Leukemia#cite_note-isbn1-55009-111-5-17http://en.wikipedia.org/wiki/Acute_myeloid_leukemiahttp://en.wikipedia.org/wiki/Tobaccohttp://en.wikipedia.org/wiki/Leukemia#cite_note-isbn0-8247-0170-4-19http://en.wikipedia.org/wiki/Leukemia#cite_note-isbn1-55009-111-5-17http://en.wikipedia.org/wiki/Leukemia#cite_note-isbn1-55009-111-5-17http://en.wikipedia.org/wiki/Chemotherapyhttp://en.wikipedia.org/wiki/Benzenehttp://en.wikipedia.org/wiki/Human_T-lymphotropic_virushttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Ionizing_radiationhttp://en.wikipedia.org/wiki/Leukemia#cite_note-16http://en.wikipedia.org/wiki/Carcinogenhttp://en.wikipedia.org/wiki/Ionizing_radiationhttp://en.wikipedia.org/wiki/Tumor_suppressor_genehttp://en.wikipedia.org/wiki/Oncogenehttp://en.wikipedia.org/wiki/DNAhttp://en.wikipedia.org/wiki/Somatic_mutationhttp://en.wikipedia.org/wiki/Leukemia#cite_note-pmid12163333-15http://en.wikipedia.org/wiki/Leukemia#cite_note-ACS1-14http://en.wikipedia.org/wiki/Hairy_cell_leukemiahttp://en.wikipedia.org/wiki/Medical_testhttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Weight_loss#Intentional_weight_losshttp://en.wikipedia.org/wiki/Weight_loss#Intentional_weight_losshttp://en.wikipedia.org/wiki/Spleenhttp://en.wikipedia.org/wiki/Liver


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gene or multiple genes in common. In some cases, families tend to develop the same kind of

leukemia as other members; in other families, affected people may develop different forms ofleukemia or related blood cancers.[18]

In addition to these genetic issues, people with chromosomal abnormalities or certain other

genetic conditions have a greater risk of leukemia.

[19]

For example, people withDown syndromehave a significantly increased risk of developing forms of acute leukemia (especiallyacute

myeloid leukemia), andFanconi anemiais a risk factor for developingacute myeloidleukemia.[18]

Whether non-ionizing radiation causes leukemia has been studied for several decades. TheInternational Agency for Research on Cancerexpert working group undertook a detailed review

of all data on static and extremely low frequency electromagnetic energy, which occurs naturally

and in association with the generation, transmission, and use of electrical power.[22]

They

concluded that there is limited evidence that high levels ofELFmagnetic (but not electric) fieldsmight cause childhood leukemia. Exposure to significant ELF magnetic fields might result in

twofold excess risk for leukemia for children exposed to these high levels of magnetic fields .

[22]

However, the report also says that methodological weaknesses and biases in these studies havelikely caused the risk to be overstated.[22]No evidence for a relationship to leukemia or another

form of malignancy in adults has been demonstrated.[22]

Since exposure to such levels of ELFs is

relatively uncommon, theWorld Health Organizationconcludes that ELF exposure, if laterproven to be causative, would account for just 100 to 2400 cases worldwide each year,

representing 0.2 to 4.9% of the total incidence of childhood leukemia for that year (about 0.03 to

0.9% of all leukemias).[23]

Diagnosis

Diagnosis is usually based on repeatedcomplete blood countsand abone marrow examinationfollowing observations of the symptoms, however, in rare cases blood tests may not show if a

patient has leukemia, usually this is because the leukemia is in the early stages or has entered

remission. A lymph node biopsy can be performed as well in order to diagnose certain types ofleukemia in certain situations.

Following diagnosis, blood chemistry tests can be used to determine the degree of liver andkidney damage or the effects of chemotherapy on the patient. When concerns arise about visible

damage due to leukemia, doctors may use anX-ray,MRI, orultrasound. These can potentially

view leukemia's effects on such body parts as bones (X-ray), the brain (MRI), or the kidneys,

spleen, and liver (ultrasound). Finally,CT scansare rarely used to check lymph nodes in the

chest.

Despite the use of these methods to diagnose whether or not a patient has leukemia, many peoplehave not been diagnosed because many of the symptoms are vague, unspecific, and can refer to

other diseases. For this reason, the American Cancer Society predicts that at least one-fifth of the

people with leukemia have not yet been diagnosed.[15]
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Mutation inSPRED1 genehas been associated with a predisposition to childhood leukemia.[24]

SPRED1 gene mutations can be diagnosed with genetic sequencing.

Treatment

Most forms of leukemia are treated with pharmaceuticalmedication, typically combined into amulti-drugchemotherapy regimen. Some are also treated withradiation therapy. In some cases, a

bone marrow transplantis useful. Promising treatment through gene therapy is currently beingpursued.

[edit] Acute lymphoblastic

Further information:Acute lymphoblastic leukemia#Treatment

Management of ALL focuses on control of bone marrow and systemic (whole-body) disease.Additionally, treatment must prevent leukemic cells from spreading to other sites, particularly

thecentral nervous system(CNS) e.g. monthly lumbar punctures. In general, ALL treatment isdivided into several phases:

Induction chemotherapyto bring about bone marrow remission. For adults, standard inductionplans includeprednisone,vincristine, and ananthracyclinedrug; other drug plans may includeL-

asparaginaseorcyclophosphamide. For children with low-risk ALL, standard therapy usually

consists of three drugs (prednisone, L-asparaginase, and vincristine) for the first month of

treatment.

Consolidation therapyor intensification therapyto eliminate any remaining leukemia cells. Thereare many different approaches to consolidation, but it is typically a high-dose, multi-drug

treatment that is undertaken for a few months. Patients with low- to average-risk ALL receive

therapy withantimetabolitedrugs such asmethotrexateand6-mercaptopurine(6-MP). High-

risk patients receive higher drug doses of these drugs, plus additional drugs. CNS prophylaxis (preventive therapy) to stop the cancer from spreading to the brain and

nervous system in high-risk patients. Standardprophylaxismay include radiation of the head

and/or drugs delivered directly into the spine.

Maintenance treatments with chemotherapeutic drugs to prevent disease recurrence onceremission has been achieved. Maintenance therapy usually involves lower drug doses, and may

continue for up to three years.

Alternatively,allogeneic bone marrow transplantationmay be appropriate for high-risk orrelapsed patients.[25]

[edit] Chronic lymphocytic

Decision to treat

Hematologistsbase CLL treatment on both the stage and symptoms of the individual patient. Alarge group of CLL patients have low-grade disease, which does not benefit from treatment.

Individuals with CLL-related complications or more advanced disease often benefit from

treatment. In general, the indications for treatment are:
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Fallinghemoglobinorplateletcount Progression to a later stage of disease Painful, disease-related overgrowth oflymph nodesorspleen An increase in the rate oflymphocyteproduction[26]

[edit]Typical treatment approach

CLL is probably incurable by present treatments. The primary chemotherapeutic plan is

combinationchemotherapy withchlorambucilorcyclophosphamide, plus acorticosteroidsuchasprednisoneorprednisolone. The use of a corticosteroid has the additional benefit of

suppressing some related autoimmune diseases, such asimmunohemolytic anemiaorimmune-

mediated thrombocytopenia. In resistant cases,single-agenttreatments with nucleoside drugssuch asfludarabine,[27]pentostatin, orcladribinemay be successful. Younger patients may

considerallogeneicorautologousbone marrow transplantation.[28]

Acute myelogenous

Further information:Acute myeloid leukemia#Treatment

Many different anti-cancer drugs are effective for the treatment of AML. Treatments varysomewhat according to the age of the patient and according to the specific subtype of AML.Overall, the strategy is to control bone marrow and systemic (whole-body) disease, while

offering specific treatment for the central nervous system (CNS), if involved.

In general, most oncologists rely on combinations of drugs for the initial, induction phase of

chemotherapy. Such combination chemotherapy usually offers the benefits of earlyremission

and a lower risk of disease resistance. Consolidation and maintenance treatments are intended toprevent disease recurrence. Consolidation treatment often entails a repetition of induction

chemotherapy or the intensification chemotherapy with additional drugs. By contrast,maintenance treatment involves drug doses that are lower than those administered during theinduction phase.[29]

[edit] Chronic myelogenous

Further information:Chronic myelogenous leukemia#Treatment

There are many possible treatments for CML, but the standard of care for newly diagnosedpatients isimatinib(Gleevec) therapy.

[30]Compared to most anti-cancer drugs, it has relatively

few side effects and can be takenorallyat home. With this drug, more than 90% of patients will

be able to keep the disease in check for at least five years,[30]so that CML becomes a chronic,

manageable condition.

In a more advanced, uncontrolled state, when the patient cannot tolerate imatinib, or if the patient

wishes to attempt a permanent cure, then an allogeneic bone marrow transplantation may be

performed. This procedure involves high-dose chemotherapy and radiation followed by infusionof bone marrow from a compatible donor. Approximately 30% of patients die from this

procedure.[30]
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[edit] Hairy cell

Further information:Hairy cell leukemia#Treatment

Decision to treatPatients with hairy cell leukemia who are symptom-free typically do not receive immediate

treatment. Treatment is generally considered necessary when the patient shows signs andsymptoms such as low blood cell counts (e.g., infection-fighting neutrophil count below

1.0 K/L), frequent infections, unexplained bruises, anemia, or fatigue that is significant enough

to disrupt the patient's everyday life.

Typical treatment approachPatients who need treatment usually receive either one week ofcladribine, given daily byintravenous infusion or a simple injection under the skin, or six months ofpentostatin, given

every four weeks by intravenous infusion. In most cases, one round of treatment will produce a

prolonged remission.[31]

Other treatments includerituximabinfusion or self-injection withInterferon-alpha. In limitedcases, the patient may benefit fromsplenectomy(removal of the spleen). These treatments are

not typically given as the first treatment because their success rates are lower than cladribine orpentostatin.[32]

T-cell prolymphocytic

Further information:T-cell prolymphocytic leukemia#Treatment

Most patients with T-cell prolymphocytic leukemia, a rare and aggressive leukemia with a

median survival of less than one year, require immediate treatment.[33]

T-cell prolymphocytic leukemia is difficult to treat, and it does not respond to most availablechemotherapeutic drugs.

[33]Many different treatments have been attempted, with limited success

in certain patients:purine analogues(pentostatin, fludarabine, cladribine),chlorambucil, and

various forms of combination chemotherapy (cyclophosphamide, doxorubicin, vincristine,

prednisoneCHOP, cyclophosphamide, vincristine, prednisone [COP], vincristine, doxorubicin,prednisone, etoposide, cyclophosphamide, bleomycinVAPEC-B).Alemtuzumab(Campath), a

monoclonal antibodythat attacks white blood cells, has been used in treatment with greater

success than previous options.[33]

Some patients who successfully respond to treatment also undergostem cell transplantationto

consolidate the response.[33]

[edit] Juvenile myelomonocytic

Further information:Juvenile myelomonocytic leukemia#Treatment

Treatment for juvenile myelomonocytic leukemia can includesplenectomy,chemotherapy, and

bone marrow transplantation.[34]
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edia.org/wiki/Splenectomyhttp://en.wikipedia.org/wiki/Interferon-alphahttp://en.wikipedia.org/wiki/Rituximabhttp://en.wikipedia.org/wiki/Leukemia#cite_note-30http://en.wikipedia.org/wiki/Pentostatinhttp://en.wikipedia.org/wiki/Cladribinehttp://en.wikipedia.org/wiki/Hairy_cell_leukemia#Treatmenthttp://en.wikipedia.org/w/index.php?title=Leukemia&action=edit&section=12


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[edit] Other potential treatment being developed

A promising treatment being pursued by a team led by Dr. Carl June has recently been foundthroughgene therapy, by turning T-cells into cancer-targeting attackers. As of August 2011, a

year after treatment, two of the three patients are cancer-free while the third still has some cancer

but is improved.[35]

History

Leukemia was first observed by pathologistsRudolf VirchowandJohn Hughes Bennettin 1845.

Observing an abnormally large number of white blood cells in a blood sample from a patient,Virchow called the conditionLeukmie inGerman, which he formed from the twoGreekwords

leukos(), meaning "white", and aima(), meaning "blood". Around ten years after

Virchow and Bennett's findings, pathologistFranz Ernst Christian Neumannfound that one

deceased leukemia patient's bone marrow was colored "dirty green-yellow" as opposed to thenormal red. This finding allowed Neumann to conclude that a bone marrow problem was

responsible for the abnormal blood of leukemia patients.

By 1900 leukemia was viewed as a family of diseases as opposed to a single disease. By 1947

Boston pathologistSydney Farberbelieved from past experiments thataminopterin, a folic acid

mimic, could potentially cure leukemia in children. The majority of the children with ALL whowere tested showed signs of improvement in their bone marrow, but none of them actually were

cured. This, however, led to further experiments.

In 1962, researchers Emil J. Freireich Jr. and Emil Frei III used combination chemotherapy to

attempt to cure leukemia. The tests were successful with some patients surviving long after the

tests.[39]

Research

Significant research into the causes, prevalence, diagnosis, treatment, and prognosis of leukemiais being performed. Hundreds ofclinical trialsare being planned or conducted at any given

time.[40]

Studies may focus on effective means of treatment, better ways of treating the disease,

improving the quality of life for patients, or appropriate care in remission or after cures.

In general, there are two types of leukemia research: clinical/translational research and basic

science research. Clinical/translational research focuses on studying the disease in a defined and

generally immediately patient-applicable way, whereas basic science research studies the diseaseprocess at a distance and the results from such studies are generally less immediately useful to

patients with the disease.[41]

[edit] Society and culture
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Leukemias are often romanticized in 20th century fiction. It is presented as a pure, clean disease

(unlike, say,rectal cancer), whose innocent, beautiful, and spiritually sensitive victims tragicallydie young. As such, it is the successor totuberculosis.[

http://en.wikipedia.org/wiki/Leukemia

Leukemia Overview

Canceris a process of uncontrolled abnormal cell growth and development. Under normalcircumstances, cells are formed, mature, carry out their intended function, and then die. New

cells are constantly regenerated in the body to replace those cells and to maintain normal cellular

function.

Cancer represents the disturbance of this process, which can occur in several ways.

Cells may grow and reproduce in a disorganized and out-of-control fashion. Cells may fail to

develop properly, so they will not function normally. Cells may fail to die normally. One or a

combination of these processes may occur when cells become cancerous.

Leukemia is a cancer of blood-forming cells in thebone marrow. These deranged, immature cells

accumulate in the blood and within organs of the body. They are not able to carry out the normalfunctions of blood cells.

Normal blood contains 3 major groups of cells: white blood cells,red blood cells, and platelets.

All 3 types of blood cells develop from one immature cell type, called blood/marrow stem cells,in a process calledhematopoiesis.

These stem cells divide and develop to a more developed, but still immature precursor, called ablast, which then develops through several more stages, into a mature blood cell.

This process takes place in the bone marrow, which is the soft spongy material found in thecenter of most bones.

Each type of blood cells has its own different and essential function in the body.

White blood cells (leukocytes) are part of theimmune systemand help fight a variety ofinfections. They also help in the healing of wounds,cuts, and sores.

Red blood cells (erythrocytes) containhemoglobin, which carriesoxygento, and removescarbon dioxidefrom, the cells throughout the various organs of the body.
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Platelets, along with certainplasmaproteins, help plug the holes in blood vessels and form clotsonce blood vessels are damaged or cut.

The first step in the process ofstem cellmaturation is differentiation into 2 groups: themyeloidstemcell line and thelymphoidstem cell line.

The myeloid stem cells, or lineage, develop into red blood cells, platelets, and certain types ofwhite blood cells (granulocytes or monocytes).

The lymphoid stem cells, or lineage, develop into another type ofwhite blood cell(lymphocytes).

Either lineage can be affected by leukemia. Leukemias that affect the myeloid lineage are calledmyelocytic (alsomyelogenous, myeloblastic, or nonlymphocytic) leukemias. Leukemias that

affect the lymphoid lineage are called lymphocytic (also lymphoblastic or lymphogenous)

leukemias.

Each of the 2 major types of leukemia, myelogenous andlymphocytic, include bothacuteandchronic

forms.

Acute essentially refers to a disorder of rapidonset. In the acute myelocytic leukemias, theabnormal cells grow rapidly and do not mature. Most of these immature cells tend to dierapidly. In the acute lymphocytic leukemias, growth is not as rapid as that of the myelocytic

cells. Rather, the cells tend to accumulate. Common to both types of leukemia is their inability

to carry out the functions of healthy white blood cells. Untreated, death occurs within weeks or

a few months.

In the chronic leukemias, the onset tends to be slow, and the cells generally mature abnormallyand often accumulate in various organs, often over long intervals. Their ability to fight infections

and assist in repairing injured tissues is impaired. However, unlike the acute forms of leukemia,

untreated, these disorders may persist for many months or, as in the chronic lymphocytic group,many years. A distinctive feature of the chronic myelocytic type is its invariable conversion, if

untreated, to a more rapidly fulminating acute type, leading to rapid death.

In summary, the 4 main types of leukemia are as follows:

Acute lymphocytic leukemia
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Chronic lymphocytic leukemia

Acute myelocytic leukemia

Chronic myelocytic leukemiaLess common types includehairy cell leukemiaand humanT-cell leukemia.

Leukemia affects people of all ages. Approximately 85% of leukemias in children are of the acute type.

Acute lymphocytic leukemia (ALL) affects both children and adults but is more common inchildren. It accounts for 65% of the acute leukemias in children.

Chronic lymphocytic leukemia (CLL) is essentially an adult disorder and is almost twice ascommon as chronic myelocytic leukemia.

Acute myelocytic leukemia (AML) is the most commonacute leukemiain adults.

Chronic myelocytic leukemia (CML) is far more common in adults than in children.As leukemic cells grow and eventually outnumber normal cells, the following events occur:

The normal blood cells are disabled, resulting in conditions such as frequent infections, bleedingproblems (poor healing of small cuts or sores), andanemia(lowred blood cellcount).

The leukemia cells may collect in certain parts of the body, causingpain, swelling, and otherproblems.

Identifying the type of leukemia is important, since this determines which treatment is given.
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Leukemia is newly diagnosed in about 29,000 adults and 2000 children each year in the United States.

In adults, the acute leukemias occur in those of all ages, whereas the chronic varieties,particularly CLL, tend to occur in people older than 40 years.

Leukemia is one of the most common cancers of children.

Leukemia is more common in people of European descent than in African Americans, HispanicAmericans, Asian Americans, or Native Americans.

Survival rates in leukemia have risen dramatically in the last 40 years with improvements in diagnosis

and treatment.

In 1960, the overall 5-year survival rate for all leukemias was about 14%. It is now about 50%.

The highest survival rates occur in children with the so-called "common" ALL type.Leukemia Causes

The exact cause of leukemia is unknown.

As with other cancers, smoking is considered arisk factorfor leukemia, but many people whodevelop leukemia have never smoked, and many people who smoke never develop leukemia.

Long-term exposure to chemicals such asbenzeneorformaldehyde, typically in the workplace,is considered a risk factor for leukemia, but this accounts for relatively few cases of the disease.

Prolonged exposure toradiationis a risk factor, although this accounts for relatively few cases ofleukemia. Doses of radiation used for diagnostic imaging such asx-raysand CT scans are

nowhere near as prolonged or high as the doses needed to cause leukemia.

Other risk factors for leukemia include the following:

Previouschemotherapy: Chemotherapy, particularly certain of the alkylating agents andtopoisomeraseinhibitors, used to treat certain types of cancers, are linked to development of
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leukemia later. It is likely that radiation treatment adds to the risk of leukemia associated with

certain chemotherapy drugs.

Human T-cell leukemiavirus1 (HTLV-1):Infectionwith this virus is linked to human T-cellleukemia.

Myelodysplastic syndromes: In this unusual group of blood disorders, the net outcome isinvariably an acute myelocytic process.

Down syndromeand othergeneticdiseases: Some diseases caused by abnormalchromosomesmay increase risk for leukemia.

Family history: Having a first-degree relative (parent, brother, sister, or child) who has chroniclymphocytic leukemia increases ones risk

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