Leukemia

Everyone has bone marrow — the spongy center of bones where your body makes red blood cells, white blood cells and platelets.

But, before they become these kinds of cells, your blood cells start as young cells known as stem cells. These cells divide and make more like them — and develop into mature blood cells.

Leukemia starts when the DNA (the “code” that tells cells how to grow and multiply) in a stem cell changes (mutates). These abnormal cells (leukemia cells) grow out of control, crowding out healthy developing blood cells in your bone marrow.

This can happen quickly and suddenly (acute leukemia). Or it can take years to grow enough so that you have symptoms (chronic leukemia). Either type can start from two kinds of stem cells in your bone marrow.

Myeloid (myelogenous) leukemia

Normal myeloid cells grow into red blood cells, platelets and types of white blood cells called basophils, eosinophils and neutrophils. When there’s a mutation in even a single myeloid cell, you can get leukemia like:

• Acute myelogenous leukemia (AML).
• Chronic myelogenous leukemia (CML).

Lymphocytic leukemia

The other type of stem cells, lymphoid cells, develop into white blood cells called lymphocytes and natural killer cells. Both cells are part of your immune system. The most common kinds of leukemia starting from abnormal lymphoid cells are:

• Acute lymphocytic leukemia (ALL).
• Chronic lymphocytic leukemia (CLL).

Diagnosing Leukemia at Cleveland Clinic

Leukemia can sneak up on you — particularly if it’s the slow-growing, chronic kind. You may not notice anything out of the ordinary at first.

But then you might start feeling tired all the time. Or you’re sweating at night. You might also feel achy and easily bruise. And maybe wonder why you suddenly have tiny red spots (petechiae) on your skin.

Even if you don’t have symptoms, routine blood work at an annual checkup might show abnormal results. And your primary care provider may recommend that you see specialists for the next steps. That’s where we come in.

What to expect at your first visit

Hearing the word, “leukemia,” in response to test results can be unnerving and leave you wondering about what’s next. From the moment you reach out to us, our team is here to support you through every step. We answer your questions, listen to your concerns and help you understand what’s going on.

When you come to your first appointment, your provider will take time to get to know you. The best way for them to do this is by asking you to share your story. They’ll want to know:

• What brought you here today?
• What kind of symptoms have you had?
• How long have you had these symptoms?
• Have you had any tests before coming here?
• What other health conditions do you have or have you had?
• What kind of health conditions have family members had?

During this visit, your provider will do a physical exam to check out your overall health and look for any visible symptoms like bruising, petechiae and swollen lymph nodes. They’ll also order some tests.

Testing for leukemia

To help us confirm a diagnosis, you’ll have blood and imaging tests. These tests let us learn more about your blood cells and see if your bones, organs, brain and spine and body tissues are affected in any way. We call this a workup. You may have:

• Complete blood count (CBC).
• Peripheral blood smear (PBS).
• Flow cytometry.
• Bone marrow aspiration.
• Bone marrow biopsy.
• Chest X-ray.
• CT scan (computed tomography scan).
• MRI (magnetic resonance imaging).
• Spinal tap (lumbar puncture).

Second opinions for leukemia

A blood cancer diagnosis can weigh heavily on your mind. And you want to be sure you’re making the best decisions — including finding care that works for you. That’s why we encourage second opinions.

If you choose to come to us for a second opinion, we’ll work to schedule an appointment as quickly as possible. This gives you peace of mind and lets our leukemia care team dive in and review your records. They’ll talk with you about your diagnosis and treatment recommendations. And they’ll answer any questions you have about what’s next.

Second opinions help you to stay in control of your care so you can feel comfortable and confident about moving forward into treatment.

Meet Our Leukemia Team

When you have leukemia, you’ll get a team of expert providers working together to confirm a diagnosis, plan the most personalized treatment and keep an eye on your progress. Your team may include:

• Oncologists.
• Hematologists.
• Pathologists.
• Radiologists.
• Nurse practitioners.
• Social workers.
• Physician assistants.
• Care coordinators.

No two leukemia diagnoses are the same. And neither are any two treatments. We personalize your care plan based on the kind of leukemia you have, if it has spread, your age and your general health.

If you have a chronic form of leukemia and no symptoms, your care team may do “watchful waiting.” This means we’ll keep a close eye on your condition through regular checkups and testing. And if you start to show signs, we can start treatment quickly.

For other types of leukemia, we may recommend:

Chemotherapy

Chemotherapy uses powerful medications to kill leukemia cells, so they won’t keep multiplying. You may have it as a pill, injection into a vein or a shot under your skin. Chemo works throughout your whole body. So, it can also affect the growth of healthy cells, like those in your hair. That’s why people who have chemotherapy often lose their hair. Once chemotherapy ends, these good cells will start working normally again.

Targeted therapy

While chemotherapy is much like using a flamethrower in the forest (hint, it hits everything), targeted therapy is more precise — like how a laser pointer focuses on a single point. In this same way, targeted therapy attacks only specific parts of leukemia cells to keep them from multiplying and maturing.

Immunotherapy

Also known as “biologic therapy,” immunotherapy uses certain drugs to boost your internal defenses to attack leukemia cells. This treatment helps your immune system find these invading cells and ramp up immune cell production to go after them.

Stem cell transplant

You may also hear about something called a bone marrow transplant (BMT). It replaces the cancerous blood cells with healthy cells from your own blood (autologous BMT) or those from a donor (allogeneic transplant). You’ll have chemotherapy or radiation therapy to kill as many leukemia cells as possible before a stem cell transplant.

Cellular therapy (CAR-T cell therapy)

CAR T-cell therapy is a new treatment. It engineers your infection-fighting cells (T-cells) to recognize and attack leukemia cells. We remove healthy T-cells from your blood, treat these cells with something that rewrites their genetic instructions and infuse them back into your bloodstream through a vein.

Living with Leukemia

Our main treatment goal is to get you into long-term remission. This means there’s no sign of cancer with or without treatment. After you finish treatment, you’ll need to have regular follow-up visits and testing to make sure the cancer hasn’t returned.

While remission could last months, years or even indefinitely, we can’t predict what will happen. That’s why keeping up with follow-up care is so important. If the leukemia comes back, your care team will catch it early. And they’ll talk with you about a new treatment plan.

Taking the Next Step

When you hear, “You have leukemia,” it’s hard not to jump to worst-case scenarios. But leukemia diagnoses can have many different results. And treatments have become a lot more sophisticated. That’s why it’s important to find healthcare providers who have experience treating all types of this blood cancer. And who can compassionately walk you through everything you need to know about diagnosis, treatment and follow-up care. Our leukemia experts are here to do that for you.