I.

OVERVIEW OF THE LEUKEMIA GROUP 9

Leukemia is a progressive, malignant disease of the blood-forming organs, characterized by distorted proliferation
and development of leukocytes and their precursors in the blood and bone marrow. Leukemia is cancer that starts in the
tissue that forms blood. Most blood cells develop from cells in the bone marrow called stem cells. Unlike normal blood
cells, leukemia cells don't die when they should. They may crowd out normal white blood cells, red blood cells, and
platelets. This makes it hard for normal blood cells to do their work. It can be classified as acute or chronic, according to
the degree of cell differentiation (not the duration of disease), and as myelogenous or lymphocytic, according to the
predominant type of cell involved (myeloid or lymphoid). These are being classified into subtypes .The exact cause of
leukemia is unknown, but genetic and environmental risk factors have been identified for many subtypes.
.
The four most common types of leukemia are:
• Acute lymphoblastic leukemia (ALL): ALL affects lymphoid cells and grows quickly. Leukemic blast cells usually
collect in the bone marrow and blood.
• Acute myelogenous leukemia (AML): AML affects myeloid cells and grows quickly. Leukemic blast cells collect in the
bone marrow and blood.
• Chronic lymphocytic leukemia (CLL): CLL affects lymphoid cells and usually grows slowly. Blood tests show an
increase in the number of white blood cells. The abnormal cells work almost as well as the normal white blood cells.
• Chronic myelogenous leukemia (CML): CML affects myeloid cells and usually grows slowly at first. Blood tests show
an increase in the number of white blood cells. The abnormal blood cells work adequately. There may be a small number
of leukemic blast cells in the bone marrow.

II. SYMPTOMS OF DISORDER

Leukemia symptoms vary, depending on the type of leukemia. Common leukemia signs and symptoms include:
• Fever or chills • Easy bleeding or bruising
• Persistent fatigue, weakness • Recurrent nosebleeds
• Frequent or severe infections • Tiny red spots in your skin (petechiae)
• Losing weight without trying • Excessive sweating, especially at night
• Swollen lymph nodes, enlarged liver or spleen • Bone pain or tenderness

III. CAUSES OF THE ALTIRATION

The exact cause of leukemia is not known, but it is thought to involve a combination of genetic and environmental
factors. Leukemia cells have acquired mutations in their DNA that cause them to grow abnormally and lose functions of
typical white blood cells. It is not clear what causes these mutations to occur. One type of change in the cells' DNA that is
common in leukemias is known as a chromosome translocation. In this process, a portion of one chromosome breaks off
and attaches to a different chromosome. One translocation seen in almost all cases of CML and in sometimes in other
types of leukemia is an exchange of DNA between chromosomes 9 and 22, which leads to what is known as the
Philadelphia chromosome. This creates an oncogene (cancer-promoting gene) known as BCR-ABL. This change in DNA
is not inherited but occurs sometime in the life of the affected individual.

IV. RISK FACTOR OF THE DISORDE

Exposure to high levels of radiation and certain chemicals are the main risk factors we know about for leukemia,
particularly acute myeloid leukemia (AML). Our researchers have led efforts to identify many genes that are associated
with the disease and that can guide us in selecting the most-effective treatment.

Specific risk factors for leukemia include:

 Exposure to cancer-causing agents. People exposed to high doses of radiation (from the explosion of an atomic
bomb, working in an atomic weapons plant, or a nuclear reactor accident) have a heightened risk of developing
leukemia. Long-term exposure to high levels of solvents such as benzene — in the workplace, for example — is a
known risk factor.
 CLL may also be linked to exposure to Agent Orange, a chemical used widely during the Vietnam War.
 Smoking. Cigarettes contain dozens of cancer-causing chemicals. Researchers estimate that about 20 percent of
AML cases are related to smoking.
 History of radiation therapy or chemotherapy. Radiation therapy and chemotherapy can cause mutations, or
changes in a cell’s DNA, that later may lead to cancers including leukemia.
AML is linked to treatments for Hodgkin’s disease, non-Hodgkin lymphoma, childhood ALL, and other malignancies
such as breast cancer, and ovarian cancer.
 Myelodysplastic syndromes. About one-third of patients who have this bone marrow failure disorder may
eventually develop leukemia. Learn more about MDS.
  Rare genetic syndromes. People with Down syndrome, Fanconi anemia, ataxia-telangiectasia, and Bloom
syndrome are at slightly higher risk for developing leukemia.
 Family history. People who have a first-degree relative — a parent, child, or sibling — with CLL have a two- to
four-fold increased risk of developing CLL. Most people who develop leukemia, however, do not have a relative
with the disease.
Many people with one or more of these risk factors never develop leukemia. In fact, most people who develop leukemia
have no known risk factors.

V. TREATMENT MODALITIES

Common treatments used to fight leukemia include:

 Chemotherapy. Chemotherapy is the major form of treatment for leukemia. This drug treatment uses chemicals
to kill leukemia cells.

Depending on the type of leukemia you have, you may receive a single drug or a combination of drugs. These drugs
may come in a pill form, or they may be injected directly into a vein.

 Biological therapy. Biological therapy works by using treatments that help your immune system recognize and
attack leukemia cells.

 Targeted therapy. Targeted therapy uses drugs that attack specific vulnerabilities within your cancer cells.

For example, the drug imatinib (Gleevec) stops the action of a protein within the leukemia cells of people with
chronic myelogenous leukemia. This can help control the disease.

 Radiation therapy. Radiation therapy uses X-rays or other high-energy beams to damage leukemia cells and stop
their growth. During radiation therapy, you lie on a table while a large machine moves around you, directing the
radiation to precise points on your body.

You may receive radiation in one specific area of your body where there is a collection of leukemia cells, or you
may receive radiation over your whole body. Radiation therapy may be used to prepare for a stem cell transplant.

 Stem cell transplant. A stem cell transplant is a procedure to replace your diseased bone marrow with healthy
bone marrow.

Before a stem cell transplant, you receive high doses of chemotherapy or radiation therapy to destroy your diseased
bone marrow. Then you receive an infusion of blood-forming stem cells that help to rebuild your bone marrow.