leukemia

Assignment regarding blood cancer (leukemia)

Done by
NAME : G .VISHAL(11)
M . SAI VEERA(08)

Submitted to
Anusha madam Asst.prof

MAX Instituite of pharmacy Page 1

leukemia

S.No content

01 Introduction
02 Risk factors for leukemia
03 Types of leukemia
3.1 AML
3.2 ALL
3.3 CML
3.4 CLL
04 Symptoms of leukemia
05 Diagnosis
06 Treatement

MAX Instituite of pharmacy Page 2

leukemia

Introduction

Leukemia is a cancer of the blood cells. There are several broad categories of
blood cells, including red blood cells (RBCs), white blood cells (WBCs), and
platelets. Generally, leukemia refers to cancers of the WBCs.

WBCs are a vital part of your immune system. They protect your body from
invasion by bacteria, viruses, and fungi, as well as from abnormal cells and
other foreign substances. In leukemia, the WBCs don’t function like normal
WBCs. They can also divide too quickly and eventually crowd out normal cells.

WBCs are mostly produced in the bone marrow, but certain types of WBCs are
also made in the lymph nodes, spleen, and thymus gland. Once formed, WBCs
circulate throughout your body in your blood and lymph (fluid that circulates
through the lymphatic system, concentrating in the lymph nodes and spleen.

Risk factors for leukemia

The causes of leukemia aren’t known. However, several factors have been
identified which may increase your risk. These include:

 Family history of leukemia

 smoking, which increases your risk of developing acute myeloid
leukemia (AML)
 genetic disorders such as Down syndrome
 blood disorders, such as myelodysplastic syndrome, which is
sometimes called “preleukemia”
 previous treatment for cancer with chemotherapy or radiation
 exposure to high levels of radiation
 exposure to chemicals such as benzene

MAX Instituite of pharmacy Page 3

leukemia

 The types of leukemia

 The onset of leukemia can be acute (sudden onset) or chronic
(slow onset). In acute leukemia, cancer cells multiply quickly. In
chronic leukemia, the disease progresses slowly and early
symptoms may be very mild.
 Leukemia is also classified according to the type of cell.
Leukemia involving myeloid cells is called
myelogenousleukemia. Myeloid cells are immature blood cells
that’d normally become granulocytes or monocytes. Leukemia
involving lymphocytes is called lymphocytic leukemia. There are
four main types of leukemia:
 Acute myelogenousleukemia (AML)
 Acute myelogenousleukemia (AML) can occur in children and
adults. According to the Surveillance, Epidemiology, and End
Results Program of the National Cancer Institute (NCI), about
21,000 new cases of AML are diagnosed annually in the United
States. This is the most common form of leukemia. The five-year
survival rate for AML is 26.9 percent.
 Acute lymphocytic leukemia (ALL)
 Acute lymphocytic leukemia (ALL) occurs mostly in children.
The NCI estimates about 6,000 new cases of ALL are diagnosed
annually. The five-year survival rate for ALL is 68.2 percent.
 Chronic myelogenousleukemia (CML)
 Chronic myelogenousleukemia (CML) affects mostly adults.
About 9,000 new cases of CML are diagnosed annually,
according to the NCI. The five-year survival rate for CML is 66.9
percent.
 Chronic lymphocytic leukemia (CLL)
 Chronic lymphocytic leukemia (CLL) is most likely to affect
people over the age of 55. It’s very rarely seen in children.
According to the NCI, about 20,000 new cases of CLL are

MAX Instituite of pharmacy Page 4

leukemia

diagnosed annually. The five-year survival rate for CLL is 83.2

percent.
 Hairy cell leukemia is a very rare subtype of CLL. Its name
comes from the appearance of the cancerous lymphocytes under a
microscope.

symptoms of leukemia

The symptoms of leukemia include:

 excessive sweating, especially at night (called “night sweats”)

 fatigue and weakness that don’t go away with rest
 unintentional weight loss
 bone pain and tenderness
 painless, swollen lymph nodes (especially in the neck and armpits)
 enlargement of the liver or spleen
 red spots on the skin, called petechiae
 bleeding easily and bruising easily
 fever or chills
 frequent infections

Leukemia can also cause symptoms in organs that have been infiltrated or
affected by the cancer cells. For example, if the cancer spreads to the central
nervous system, it can cause headaches, nausea and vomiting, confusion, loss of
muscle control, and seizures.

Leukemia can also spread to other parts of your body, including:

 the lungs
 gastrointestinal tract
 heart
MAX Instituite of pharmacy Page 5
leukemia

 kidneys

Diagnosing leukemia
AML and ALL are staged based on how cancer cells look under the microscope
and the type of cell involved. ALL and CLL are staged based on the WBC count
at the time of diagnosis. The presence of immature white blood cells, or
myeloblasts, in the blood and bone marrow is also used to stage AML and
CML.

Leukemia may be suspected if you have certain risk factors or concerning

symptoms. Your doctor will begin with a complete history and physical
examination, but leukemia can’t be fully diagnosed by a physical exam. Instead,
doctors will use blood tests, biopsies, and imaging tests to make a diagnosis.

Once leukemia is diagnosed, it’ll be staged. Staging helps your doctor

determine your outlook.

Staging

Tests

There are a number of different tests that can be used to diagnose leukemia.
A complete blood count determines the numbers of RBCs, WBCs,
and platelets in the blood. Looking at your blood under a microscope can also
determine if the cells have an abnormal appearance.

Tissue biopsiescan be taken from the bone marrow or lymph nodes to look for

evidence of leukemia. These small samples can identify the type of leukemia
MAX Instituite of pharmacy Page 6
leukemia

and its growth rate. Biopsies of other organs such as the liver and spleen can
show if the cancer has spread.

 Assessing the progression

 A number of other tests can be used to assess the progression of the
disease:

 Flow cytometry examines the DNA of the cancer cells and determines
their growth rate.
 Liver function tests show whether leukemia cells are affecting or
invading the liver.
 Lumbar puncture is performed by inserting a thin needle between the
vertebrae of your lower back. This allows your doctor to collect spinal
fluid and determine if the cancer has spread to the central nervous system.
 Imaging tests, such as X-rays, ultrasounds, and CT scans, help doctors
look for any damage to other organs that’s caused by the leukemia.

Treating leukemia

Leukemia is usually treated by a hematologist-oncologist. These are doctors

who specialize in blood disorders and cancer. The treatment depends on the
type and stage of the cancer. Some forms of leukemia grow slowly and don’t
need immediate treatment. However, treatment for leukemia usually involves
one or more of the following:

 Chemotherapy uses drugs to kill leukemia cells. Depending on the type of

leukemia, you may take either a single drug or a combination of different
drugs.
 Radiation therapy uses high-energy radiation to damage leukemia cells
and inhibit their growth. Radiation can be applied to a specific area or to
your entire body.

MAX Instituite of pharmacy Page 7

leukemia

 Stem cell transplantation replaces diseased bone marrow with healthy

bone marrow, either your own (called autologous transplantation) or from
a donor (called allologous transplantation). This procedure is also called
a bone marrow transplant.
 Biological or immune therapy uses treatments that help your immune
system recognize and attack cancer cells.
 Targeted therapy uses medications that take advantage of vulnerabilities
in cancer cells. For example, imatinib (Gleevec) is a targeted drug that’s
commonly used against CML.

MAX Instituite of pharmacy Page 8

leukemia

Chemotherapy for Acute Lymphocytic Leukemia

(ALL)

Chemotherapy (chemo) is the use of drugs to treat cancer. Chemo drugs travel
through the bloodstream to reach cancer cells all over the body. This makes
chemo useful for cancers such as leukemia that has spread throughout the body.

Chemo is the main treatment for just about all people with acute lymphocytic
leukemia (ALL). Because of its potential side effects, chemo might not be
recommended for patients in poor health, but advanced age by itself is not a
barrier to getting chemo.

How is chemo given?

Chemo treatment for ALL is typically divided into 3 phases:

 Induction, which is short and intensive, usually lasts about a month.

 Consolidation (intensification), which is also intensive, typically lasts
for a few months.
 Maintenance (post-consolidation), which is less intensive, typically
lasts for about 2 years.
During the more intensive phases of treatment, people can often have serious
side effects from chemo, so they might need to spend time in the hospital. For
more on the different phases of treatment, see Typical Treatment of Acute
Lymphocytic Leukemia.

Chemo is typically given in cycles, with each period of treatment followed by a

rest period to allow the body time to recover.

Most often, chemo drugs are injected into a vein (IV), into a muscle, or under
the skin, or are taken by mouth. These drugs enter the blood and can reach
leukemia cells all over the body.

Most chemo drugs have trouble reaching the area around the brain and spinal
cord, so chemo may need to be injected into the cerebrospinal fluid (CSF) to kill
cancer cells in that area. This is called intrathecal chemo. Intrathecal chemo
MAX Instituite of pharmacy Page 9
leukemia

can be given during a spinal tap or by using a special catheter called

an Ommaya reservoir.

Which chemo drugs are used to treat ALL?

Chemo for ALL uses a combination of anti-cancer drugs. The most commonly
used chemo drugs include:

 Vincristine or liposomal vincristine (Marqibo)

 Daunorubicin (daunomycin) or doxorubicin (Adriamycin)
 Cytarabine (cytosine arabinoside, ara-C)
 L-asparaginase or PEG-L-asparaginase (pegaspargase or Oncaspar)
 6-mercaptopurine (6-MP)
 Methotrexate
 Cyclophosphamide
 Prednisone
 Dexamethasone
 Nelarabine (Arranon) 
People typically get several of these drugs at different times during the course
of treatment, but they do not get all of them.

Possible side effects

Chemo drugs can affect some normal cells in the body, which can lead to side
effects. The side effects of chemo depend on the type and dose of drugs given
and the length of time they are taken. Common side effects can include:

 Hair loss
 Mouth sores
 Loss of appetite
 Nausea and vomiting
 Diarrhea or constipation

MAX Instituite of pharmacy Page 10

leukemia

Chemo drugs also affect the normal cells in bone marrow, which can lower
blood cell counts. This can lead to:

 Increased risk of infections (from having too few normal white blood

cells)
 Easy bruising or bleeding (from having too few blood platelets)
 Fatigue and shortness of breath (from having too few red blood cells)
Most side effects from chemo go away once treatment is finished. Low blood
cell counts can last weeks, but then should return to normal. There are often
ways to lessen chemo side effects. For example, drugs can be given to help
prevent or reduce nausea and vomiting. Be sure to ask your cancer care team
about medicines to help reduce side effects, and let your doctor or nurse know
when you do have side effects so they can be managed effectively.

Low white blood cell counts: Some of the most serious side effects of chemo
are caused by low white blood cell counts.

You may get antibiotics and drugs that help prevent fungal and viral infections
before before you have signs of infection or at the earliest sign that an infection
may be developing (such as a fever).

Drugs known as growth factors, such as filgrastim (Neupogen), pegfilgrastim

(Neulasta), and sargramostim (Leukine), are sometimes given to increase the
white blood cell counts after chemo, to help lower the chance of infection.
However, it’s not clear if they have an effect on treatment success.

There are also steps that you can take to lower your risk of infection, such as
washing your hands often. These are discussed in Infections in People With
Cancer.

Low platelet counts: If your platelet counts are low, you may be given drugs or
platelet transfusions to help protect against bleeding.

Low red blood cell counts: Shortness of breath and extreme fatigue caused by
low red blood cell counts (anemia) may be treated with drugs or with red blood
cell transfusions.
MAX Instituite of pharmacy Page 11
leukemia

Decisions about when a patient can leave the hospital are often influenced by
his or her blood counts. Some people find it helpful to keep track of their
counts. If you are interested in this, ask your doctor or nurse about your blood
cell counts and what these numbers mean.

Side effects of specific drugs: Certain drugs might cause specific side effects.
For example:

 Cytarabine (ara-C), especially when used at high doses, can cause

dryness in the eyes and can affect certain parts of the brain, which can
lead to problems with coordination and balance.
 Vincristine can damage nerves, which can lead to numbness, tingling, or
weakness in hands or feet.
 Anthracyclines (such as daunorubicin or doxorubicin) can damage the
heart, so the total dose needs to be watched closely, and these drugs
might not be used in someone who already has heart problems.
Other organs that could be damaged by certain chemo drugs include the
kidneys, liver, testicles, ovaries, and lungs. Doctors and nurses carefully
monitor treatment to reduce the risk of these side effects as much as possible. If
serious side effects occur, the chemo may have to be reduced or stopped, at least
for a time.

Second cancers: One of the most serious side effects of ALL therapy is an

increased risk of getting acute myeloid leukemia (AML) at a later time. This
occurs in a small portion of patients after they have received certain chemo
drugs. Less often, people cured of leukemia may later develop non-Hodgkin
lymphoma or other cancers. Of course, the risk of getting these second
cancers must be balanced against the obvious benefit of treating a life-
threatening disease such as leukemia with chemotherapy.

Tumor lysis syndrome: This side effect of chemo is most common in patients

who have large numbers of leukemia cells in the body, so it is seen most often
in the first (induction) phase of treatment. When chemo kills the leukemia cells,
they break open and release their contents into the bloodstream. This can
overwhelm the kidneys, which aren’t able to get rid of all of these substances at
once. Excess amounts of certain minerals can also affect the heart and nervous
system. This can often be prevented by giving extra fluids during treatment and

MAX Instituite of pharmacy Page 12

leukemia

by giving certain drugs, such as bicarbonate, allopurinol, and rasburicase, which

help the body get rid of these substances.

MAX Instituite of pharmacy Page 13

leukemia

Radiation Therapy for Acute Lymphocytic

Leukemia (ALL)

Radiation therapy uses high-energy radiation to kill cancer cells. It is not

usually part of the main treatment for people with acute lymphocytic leukemia
(ALL), but it is used in certain situations:

 Radiation is sometimes used to treat leukemia that has spread to the brain
and spinal fluid, or to the testicles.
 Radiation to the whole body is often an important part of treatment before
a bone marrow or peripheral blood stem cell transplant (see High-dose
Chemotherapy and Stem Cell Transplant for Acute Lymphocytic
Leukemia).
 Radiation is used (rarely) to help shrink a tumor if it is pressing on the
trachea (windpipe) and causing breathing problems. But chemotherapy is
often used instead, as it may work more quickly.
 Radiation can also be used to reduce pain in an area of bone invaded by
leukemia, if chemotherapy hasn’t helped.
External beam radiation therapy, in which a machine delivers a beam of
radiation to a specific part of the body, is the type of radiation used most often
for ALL. Before your treatment starts, the radiation team will take careful
measurements to determine the correct angles for aiming the radiation beams
and the proper dose of radiation. This planning session, called simulation,
usually includes getting imaging tests such as CT or MRI scans.

Radiation treatment is much like getting an x-ray, but the radiation is much
stronger. The procedure itself is painless. Each treatment lasts only a few
minutes, although the setup time – getting you into place for treatment – usually
takes longer. The number of treatments you get depends on the reason radiation
therapy is being used. 

The possible side effects of radiation therapy depend on where the radiation is

aimed. They include:

 Fatigue (tiredness)

MAX Instituite of pharmacy Page 14

leukemia

 Skin changes in the treated area, which can range from mild redness to
burning and peeling
 Hair loss in the area being treated
 Nausea and vomiting (if the head or belly is being treated)
 Diarrhea (if the belly or pelvis is being treated)
 Mouth sores and trouble swallowing (if the head and neck area are being
treated)
 Headaches (if the head is being treated)
 Lowered blood cell counts, which can lead to fatigue and shortness of
breath (from low red blood cell counts), bleeding or bruising (from low
platelet counts), and an increased risk of infection (from low white blood
cell counts)

MAX Instituite of pharmacy Page 15

leukemia

Reference by
https://www.cancer.org/cancer/acute-lymphocytic-leukemia/treating/radiation-therapy.html

https://www.cancer.org/cancer/acute-lymphocytic-leukemia/treating/chemotherapy.html

MAX Instituite of pharmacy Page 16

leukemia

MAX Instituite of pharmacy Page 17