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Overview
What are leukemia and myeloid disorders?
Leukemia and myeloid disorders are conditions that develop in the bone marrow. Both are the result of bone marrow stem cells that do not mature properly.
In a healthy body, stem cells arising in the bone marrow mature into myeloid stem cells and lymphoid stem cells. Myeloid stem cells can mature into red blood cells, platelets or white blood cells, which bring oxygen to tissues, help stop bleeding and fight infections. Lymphoid stem cells mature into a different types of white blood cells that become part of the immune system.
Here is a closer look at some of these conditions:
About Leukemia
In leukemia, the bone marrow makes abnormal white blood cells. As these cancer cells accumulate, they interfere with the production of other blood cells. Eventually, the body has too few red cells for supplying oxygen to the body, too few platelets for proper blood clotting and too few healthy white cells for fighting infection.
There are many types and subtypes of leukemia. The most common forms include:
- Chronic myeloid leukemia (CML) — A cancer of the myeloid cells that tends to occur in middle-aged adults and grows slowly.
- Acute lymphocytic leukemia (ALL) — The most common leukemia in children, but also occurs in adults, which can worsen quickly and requires immediate treatment.
- Acute myeloid leukemia (AML) — The most common form of acute leukemia in adults. Like ALL, it requires immediate treatment.
About Myelodysplastic Syndrome (MDS)
In people with MDS, the bone marrow cells fail to develop normally. A person with MDS is then left with too few red blood cells, platelets, and/or too few white blood cells, which makes them anemic, predisposed to bleeding and/or developing infections.
There are many categories of myelodysplastic syndromes, including:
- MDS with single lineage dysplasia (MDS-SLD) — Either too few red blood cells only, white blood cells only, or platelets only, but a normal number of the other types of blood cells
- MDS with multilineage dysplasia (MDS-MLD) — Too few of at least two types of blood cells.
- MDS with ring sideroblasts (MDS-RS) — Too few red blood cells, but a normal number of white cells and platelets. Some existing red blood appear “ringed” under a microscope.
- MDS with excess blasts (MDS-EB) — An excess percentage of “blasts” (immature white blood cells) in the bone marrow. This type of MDS may progress to acute myeloid leukemia.
- Myelodysplastic syndrome with an isolated del(5q) chromosome abnormality — Too few red blood cells resulting from a defective chromosome.
- Unclassifiable myelodysplastic syndrome (MDS-U) — MDS that does not fit into one of the above categories.
About one-third of people with MDS go on to develop acute myeloid leukemia. Treatments try to prevent this from happening, and minimize transfusions and other consequences of having low blood counts.
Diagnosis
How are leukemia and MDS diagnosed?
In their early stages, leukemia and MDS may not produce symptoms and may be found accidentally during a routine blood test.
If you have symptoms that suggest a blood or bone marrow disorder (such as fatigue, bleeding, or frequent infections), your doctor will conduct a physical exam to look for enlarged lymph nodes, swollen gums, an enlarged liver or spleen, significant bruising or a small pinpoint rash. Your doctor also will perform standard blood tests to look for abnormal numbers of red cells, white cells, platelets and blasts. A sample of your bone marrow will be taken to confirm any diagnosis and identify the specific form of leukemia or MDS.
If you are diagnosed with leukemia, your doctor also may order tests to see whether any cancer cells have spread outside the blood and bone marrow. These may include a chest X-ray to look for swollen lymph nodes in your chest, a lumbar puncture to obtain spinal fluid for examination, and an ultrasound or CT scan to look for lymph nodes in your abdomen.
Leukemia Treatments
How is leukemia treated?
Standard treatments for leukemia include:
- Chemotherapy — Drugs used to kill cancer cells throughout the body. In the hospital, chemotherapy is given through a person’s vein, or injected into the spinal column or a reservoir implanted under the scalp to target the spinal fluid. Outpatient chemotherapy is given either in pill form or through the vein.
- Targeted therapy — Using monoclonal antibodies or pills to deliver drugs directly to cancer cells to kill the cells, stop their growth, and prevent them from spreading.
- Radiation therapy — A form of cancer treatment that uses radiation (strong beams of energy) to kill cancer cells or keep them from growing and dividing. It is used mainly prior to bone marrow transplantation.
- Cellular therapy (also adoptive cellular therapy) — A form of treatment that involves injecting intact, living cells into a patient. On example is chimeric antigen receptor (CAR) T-cells therapy. This is where T cells are collected from a patient’s blood, then are genetically engineered to produce special receptors capable of fighting cancer cells, grown in a lab, then injected back into the patient.
- Immunotherapy — A method of enhancing the patient’s own immune system to fight cancer.
- Blood and marrow transplantation (BMT) — A technique for replacing defective bone marrow with new stem cells, which multiply and create a healthy bone marrow.
If you have a chronic form of leukemia and no symptoms, treatment may not be necessary. Your doctor will watch your condition closely. This approach is called “watchful waiting.”
The most appropriate treatment depends on the type of leukemia, its stage and symptoms:
- Chronic lymphocytic leukemia — Many patients never need treatment. If the disease progresses, however, chemotherapy targeted therapy, or bone marrow transplantation may be recommended.
- Chronic myeloid leukemia — Most cases can be treated with drugs that target the abnormal myeloid cells without harming other cells. Occasionally, CML requires treatment with chemotherapy drugs, chemotherapy combined with a bone marrow transplant, or a combination of these therapies.
- Acute lymphocytic leukemia — May be treated with chemotherapy introduced into the bloodstream or spinal column, chemotherapy with bone marrow transplantation, or with cellular and immuno therapy.
- Acute myeloid leukemia — May be treated with chemotherapy or other drugs introduced into the bloodstream or spinal column, targeted therapy, or with bone marrow transplantation
MDS Treatments
How is MDS treated?
Standard treatments for myelodysplastic syndromes include:
- Supportive care — May include blood or platelet transfusions to replace missing blood components, or antibiotics to fight infection.
- Growth factor therapy with erythropoiesis stimulating agents (ESAs) — Shots given weekly or every two or three weeks, which stimulate the remaining normal bone marrow cells to make more red blood cells.
- Immunosuppressive therapy — Delivered through the vein or as a pill, this treatment prevents the immune system from attacking the bone marrow.
- Chemotherapy — Drugs used to kill the abnormal immature blood cells or prevent them from dividing. Chemotherapy may be taken in pill form or delivered under the skin or through a vein.
- Bone marrow transplantation — A technique taking bone marrow or stem cells from another person and transfusing them through a vein into someone with MDS.
Clinical Trials
Can I participate in a clinical trial?
Cleveland Clinic is one of the world’s leading leukemia and myeloid disorders clinical trial centers, with over 250 patients participating in clinical trials annually. Many clinical trials of new treatments or combinations of treatments are available for patients with both conditions.
If your Cleveland Clinic hematologist/oncologist feels you might benefit from participating in a clinical trial, the options will be discussed with you in detail.
Patient Services
Making your care easier
Support Services
The life-changing events that occur when you or a loved one is diagnosed with cancer are challenging. Cleveland Clinic Cancer Center offers many support services and programs to help you navigate those changes while promoting your well-being. Services include the 4th Angel Mentoring Program, educational resources, psycho-social programs, support groups, financial services, free wigs and a variety of wellness programs.
Medical Concierge
If you are traveling from out of state and need any assistance, call the complimentary Medical Concierge at 800.223.2273, ext. 55580, or email medicalconcierge@ccf.org.
Global Patient Services
Complimentary assistance for national and international patients and families is available at 001.216.444.8184.
MyChart
This secure online tool connects patients to their own health information from the privacy of their home anytime, day or night. Some features include renewing prescriptions, reviewing test results and viewing medications, all online. For the convenience of physicians and patients across the country, MyChart now offers a secure connection to Google™ Health. Google Health users can securely share personal health information with Cleveland Clinic, and record and share the details of their Cleveland Clinic treatment with the physicians and healthcare providers of their choice.
Our Treatment Team
Find more information about the staff of physicians and other health specialists at Cleveland Clinic's Cancer Center, including complete profiles.
Online Resources
Find more information in our Health Library about the diagnosis and treatment of leukemia.
Cleveland Clinic oncologists also recommend the following resources:
Appointments & Locations
Contacting Cleveland Clinic
Still have questions? Call our Cancer Answer Line
We are here to help you get the cancer information you need. Please contact Cleveland Clinic Cancer Answer Line at 216.444.HOPE (4673) or toll-free at 866.223.8100. Two oncology clinical nurse specialists and their staff provide information and answer questions about cancer. The Cancer Answer Line operates from 8 a.m. to 4:30 p.m., ET, Monday-Friday.
Ready to schedule an appointment?
If you would like to set up a consultation with a Cleveland Clinic specialist, please call the Cancer Answer Line at 216.444. HOPE (4673) or toll-free at 866.223.8100. Our leukemia/MDS direct consultation line is: 216.445.0087. To make an appointment with our Akron General specialists, please call 330.344.6505.
Locations
Cleveland Clinic Cancer Specialists are located in Cleveland, regionally throughout Northern Ohio and in Florida. View a complete list of cancer care locations.
Virtual Second Opinion
If you cannot travel to Cleveland Clinic, help is available. You can connect with Cleveland Clinic specialists from any location in the world via a phone, tablet, or computer, eliminating the burden of travel time and other obstacles. If you’re facing a significant medical condition or treatment such as surgery, this program provides virtual access to a Cleveland Clinic physician who will review the diagnosis and treatment plan. Following a comprehensive evaluation of medical records and labs, you’ll receive an educational second opinion from an expert in their medical condition covering diagnosis, treatment options or alternatives as well as recommendations regarding future therapeutic considerations. You’ll also have the unique opportunity to speak with the physician expert directly to address questions or concerns.
Why Choose Us?
Cleveland Clinic Cancer Center is dedicated to providing exceptional care and support to individuals with cancer. More than 400 cancer specialists, nurses and technicians work together to best meet your unique needs.
Today, the prognosis for many patients with leukemia or myeloid disorders is very good. While you have many available treatment options to choose from, you should consider the experience of the program when selecting where to seek care.
Cleveland Clinic’s Leukemia and Myeloid Disorders Program is one of the largest and best respected in the world.
A Team Approach
Each patient in the Leukemia and Myeloid Disorders Program has a dedicated team of doctors and nurses who stays with them throughout their journey. The team meets weekly to discuss each patient’s care plan, progress and make decisions, such as whether to recommend bone marrow transplantation. This means everyone treated at Cleveland Clinic receives the input of the entire team.
We will take into consideration your goals and your desire for quality of life as well as length of life. You can be assured you will receive the most advanced, most patient-friendly treatment possible.
Our Specialists
We offer a team of more than 30 specialists, including nine physicians, solely dedicated to treating leukemia and myeloid disorders. To find a physician, visit clevelandclinic.org/staff or call 866.223.8100.
Facilities Second to None
If you have leukemia, a myeloid disorder, or need a bone marrow transplant, there’s a chance you will need to spend four to six weeks in the hospital. We make every effort to make our hospital feel like your home away from home, so the experience will be as comfortable as possible.
Our two dedicated 22-bed units were designed to meet the unique clinical and emotional needs of leukemia, myeloid disorder and bone marrow transplant patients. Large, private rooms feature pull-out beds for family members, wireless Internet, flat screen TVs with built-in DVD players and expansive windows. The units include amenities such as computers, an exercise room, a washer and dryer, kitchen and lounge areas.
The special floor is not only more comfortable, it also is equipped to ensure the best patient care. The contained unit has the latest air handling system to minimize infection in patients whose immune systems are not functioning at their best. The system continually filters the air on the floor, removing 99.98 percent of potential pollutants.
Support Every Step of the Way
During this intense time, our staff provides close monitoring. In addition to appointments, our doctors and nurses are available by phone and email. Cancer care doesn’t end after treatment. Once you have cancer, you need to be followed regularly to watch for issues common to survivors, such as recurrences or side effects from treatment.
You may find it comforting to know that your Cleveland Clinic hematologist/oncologist is dedicated to continuing to provide your follow up care for years to come. If you live out of town or move away, we understand this may not be possible. In these cases, we will be happy to coordinate your care with a local physician.
Why choose a Comprehensive Cancer Center?
The multidisciplinary approach used at nationally-ranked cancer centers like Cleveland Clinic brings the expertise of multiple specialists, including medical oncologists, radiation oncologists, pathologists, surgeons, nurses, social workers and others, to bear in customizing treatment for each patient. The collaboration ensures that patients get the opinions of multiple specialists. It also means that patients get the care they need right away, rather than waiting for weeks between appointments. Finally, while the treatment for some forms of leukemia is standardized, for many cancers there may be a significant difference in outcomes between centers. Besides improved survival rates, comprehensive cancer centers offer shorter hospital stays, reduced complication rates, better management of side effects and access to the latest clinical trials.
Cleveland Clinic makes patient outcomes available each year through a series of Outcomes, which are available at clevelandclinic.org/outcomes.
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