leukemia

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leukemia

 [loo-ke´me-ah]
a progressive, malignant neoplasm of the blood-forming organs, marked by diffuse replacement of the bone marrow development of leukocytes and their precursors in the blood and bone marrow. It is accompanied by a reduced number of erythrocytes and blood platelets, resulting in anemia and increased susceptibility to infection and hemorrhage. Other typical symptoms include fever, pain in the joints and bones, and swelling of the lymph nodes, spleen, and liver. adj., adj leuke´mic.
Types of Leukemia. Leukemia is classified clinically in several ways: (1) acute versus chronic, terms that have become altered from their usual meanings and refer to the degree of cell differentiation; (2) the predominant proliferating cells: myelocytic, granulocytic, or lymphocytic; and (3) increase in or maintenance of the number of abnormal cells in the blood—preleukemic.

Acute leukemia is characterized by fatigue, headache, sore throat, and dyspnea, followed by symptoms of acute tonsillitis, stomatitis, bleeding from the mucous membranes of the mouth, alimentary canal, and rectum, and pain in the bones and joints. There eventually is enlargement of the lymph nodes, liver, and spleen. Common to all leukemias are the tendency to bleed and the resultant anemia and increased susceptibility to infection. The diagnosis of leukemia requires confirmation of leukemic cells in the bone marrow by bone marrow biopsy and aspiration. Abnormalities may also be seen in peripheral blood smears.
Treatment. The treatment of choice is systemic combination chemotherapy with a variety of antineoplastic drug regimens. The disease can also be treated by a bone marrow transplant after a remission is achieved with chemotherapy.
Patient Care. Leukemia affects almost every system within the body and can present a variety of patient care problems. Of primary concern are those symptoms attendant to suppression of normal bone marrow function, particularly susceptibility to infection due to the predominance of immature and abnormally functioning white blood cells, bleeding tendency owing to decreased platelet count, and anemia due to decreased erythrocyte count. Chronic abnormal tissue perfusion, increased need for rest, and decreased sensitivity to heat and cold require careful planning and intervention. Additionally, the patient will need relief from pain and discomfort arising from enlargement of the lymph nodes and distention of the liver and spleen.

Because of the malignant nature of leukemia and the fear and anxiety created by the knowledge that one has a form of cancer, patients and their families and significant others will need help in coping with anxiety, mental depression, and realistic fears about dying and death. The financial burden of the illness and disruption of the life of the individual and the family also impose a special burden on them. Referral to appropriate persons and agencies that can help meet their needs is an essential part of the holistic care of the patient with leukemia.
acute leukemia leukemia in which the involved cell line shows little or no differentiation, usually consisting of blast cells; two types are distinguished, acute lymphoblastic leukemia and acute myelogenous leukemia.
acute granulocytic leukemia acute myelogenous leukemia.
acute lymphoblastic leukemia (ALL) (acute lymphocytic leukemia) acute leukemia of the lymphoblastic type, one of the two major categories of acute leukemia, primarily affecting young children. Symptoms include anemia, fatigue, weight loss, easy bruising, thrombocytopenia, granulocytopenia with bacterial infections, bone pain, lymphadenopathy, hepatosplenomegaly, and sometimes spread to the central nervous system (meningism) or to other organs. There are three major subtypes: The pre–B-cell is the most common, consisting of small uniform lymphoblasts that do not synthesize complete functional immunoglobulins or synthesize heavy chains only. The B-cell type is rare and consists of lymphoblasts that express surface immunoglobulins and have a surface translocation similar to that of Burkitt's lymphoma. The T-cell type has cells that express surface antigens characteristic of T cells.
acute megakaryoblastic leukemia (acute megakaryocytic leukemia) a form of acute myelogenous leukemia in which megakaryocytes are predominant and platelets are increased in the blood, often with fibrosis; it can occur at any age. Called also megakaryoblastic or megakaryocytic leukemia.
acute monocytic leukemia an uncommon form of acute myelogenous leukemia in which the predominating cells are identified as monocytes; a few myelocytes may also be present. It can affect any age group. Called also monocytic leukemia.
acute myeloblastic leukemia
1. a common kind of acute myelogenous leukemia, in which myeloblasts predominate; it usually occurs in infants and middle-aged to older adults. Two types are distinguished; those that have minimal cell differentiation or maturation and those that have more advanced differentiation. Called also myeloblastic leukemia and acute myeloid leukemia.
acute myelocytic leukemia acute myelogenous leukemia.
acute myelogenous leukemia (AML) acute leukemia of the myelogenous type, one of the two major categories of acute leukemia; most types affect primarily middle-aged to elderly people. Symptoms include anemia, fatigue, weight loss, easy bruising, thrombocytopenia, and granulocytopenia that leads to persistent bacterial infections. Several types are distinguished, named according to the stage in which abnormal proliferation begins: acute undifferentiated l., acute myeloblastic l., acute promyelocytic l., acute myelomonocytic l., acute monocytic l., acute erythroleukemia, and acute megakaryocytic l. Called also acute myelocytic l. and acute nonlymphocytic l.
acute myeloid leukemia
acute myelomonocytic leukemia one of the more common types of acute myelogenous leukemia, characterized by both malignant monocytes and myeloblasts; it usually affects middle aged to older adults. See also chronic myelomonocytic leukemia. Called also myelomonocytic or Naegeli's leukemia.
acute nonlymphocytic leukemia acute myelogenous leukemia.
acute promyelocytic leukemia acute myelogenous leukemia in which more than half the cells are malignant promyelocytes, often associated with abnormal bleeding secondary to thrombocytopenia, hypofibrinogenemia, and decreased levels of coagulation factor V; it usually occurs in young adults. Called also promyelocytic leukemia.
acute undifferentiated leukemia acute myelogenous leukemia in which the predominating cell is so immature and primitive that it cannot be classified. Called also stem cell leukemia and undifferentiated cell leukemia.
adult T-cell leukemia (adult T-cell leukemia/lymphoma) a form of leukemia with onset in adulthood, leukemic cells with T-cell properties, frequent dermal involvement, lymphadenopathy and hepatosplenomegaly, and a subacute or chronic course; it is associated with human T-cell leukemia-lymphoma virus.
aleukemic leukemia leukemia in which the leukocyte count is normal or below normal; it may be lymphocytic, monocytic, or myelocytic.
basophilic leukemia a rare type of leukemia in which basophils predominate; both acute and chronic varieties have been observed.
blast cell leukemia acute undifferentiated leukemia.
chronic leukemia leukemia in which the involved cell line is well-differentiated, usually B-lymphocytes, but immunologically incompetent; types distinguished include chronic granulocytic, chronic lymphocytic, chronic myelomonocytic, eosinophilic, and hairy cell leukemia.
chronic granulocytic leukemia chronic leukemia of the myelogenous type, occurring mainly between the age of 25 and 60, usually associated with a unique chromosomal abnormality. The major clinical manifestations of malaise, hepatosplenomegaly, anemia, and leukocytosis are related to abnormal, excessive, unrestrained overgrowth of granulocytes in the bone marrow. Called also chronic myelocytic or chronic myeloid leukemia.
chronic lymphocytic leukemia chronic leukemia of the lymphoblastic type, a common form mainly seen in the elderly; symptoms include lymphadenopathy, fatigue, renal involvement, and pulmonary leukemic infiltrates. Circulating malignant cells are usually differentiated B-lymphocytes; a minority of cases have mixed T and B lymphocytes or entirely T-lymphocytes.
chronic myelocytic leukemia (chronic myelogenous leukemia,) (chronic myeloid leukemia) chronic granulocytic leukemia.
chronic myelomonocytic leukemia a slowly progressing form of chronic leukemia that usually affects the elderly and sometimes progresses to acute myelomonocytic leukemia. Symptoms include splenomegaly, monocytosis with granulocytosis, and thrombocytopenia.
leukemia cu´tis leukemia with leukocytic invasion of the skin marked by pink, reddish brown, or purple macules, papules, and tumors.
eosinophilic leukemia a form of leukemia in which the eosinophil is the predominating cell. Although resembling chronic granulocytic leukemia in many ways, this form may follow an acute course despite the absence of predominantly blast forms in the peripheral blood.
granulocytic leukemia myelogenous leukemia.
hairy cell leukemia a form of chronic leukemia marked by splenomegaly and by an abundance of abnormal large mononuclear cells covered by hairlike villi (hairy cells) in the bone marrow, spleen, liver, and peripheral blood. Called also leukemic reticuloendotheliosis.
leukopenic leukemia aleukemic leukemia.
lymphatic leukemia (lymphoblastic leukemia) leukemia associated with hyperplasia and overactivity of the lymphoid tissue; there are increased numbers of circulating malignant lymphocytes and lymphoblasts. See also acute lymphoblastic leukemia and chronic lymphocytic leukemia.
lymphocytic leukemia (lymphogenous leukemia) (lymphoid leukemia) lymphoblastic leukemia.
lymphosarcoma cell leukemia the B-cell type of acute lymphoblastic leukemia.
mast cell leukemia a rare type marked by overwhelming numbers of tissue mast cells in the peripheral blood.
megakaryoblastic leukemia acute megakaryocytic leukemia.
micromyeloblastic leukemia a form of myelogenous leukemia in which the immature, nucleoli-containing cells are small and are distinguishable from lymphocytes only by special staining.
monocytic leukemia acute monocytic leukemia.
myelocytic leukemia (myelogenous leukemia) (myeloid granulocytic leukemia) a form arising from myeloid tissue in which polymorphonuclear leukocytes and their precursors predominate.
myelomonocytic leukemia (Naegeli's leukemia) acute myelomonocytic leukemia.
plasma cell leukemia (plasmacytic leukemia) a rare type in which the predominating cell in the peripheral blood is the plasma cell; it is often seen in asociation with multiple myeloma.
prolymphocytic leukemia a type of chronic leukemia marked by large numbers of circulating lymphocytes, predominantly prolymphocytes, with massive splenomegaly and occasionally lymphadenopathy; prognosis is often poor.
promyelocytic leukemia acute promyelocytic leukemia.
Rieder cell leukemia a form of acute myelogenous leukemia in which the blood contains the abnormal cells called Rieder's lymphocytes, asynchronously developed lymphocytes that have immature cytoplasm and a lobulated, indented, comparatively more mature nucleus.
subleukemic leukemia aleukemic leukemia.
undifferentiated leukemia acute undifferentiated leukemia.

leu·ke·mi·a

(lū-kē'mē-ă),
Progressive proliferation of abnormal leukocytes found in hemopoietic tissues, other organs, and usually in the blood in increased numbers. Leukemia is classified by the dominant cell type, and by duration from onset to death. This occurs in acute leukemia within a few months in most cases, and is associated with acute symptoms including severe anemia, hemorrhages, and slight enlargement of lymph nodes or the spleen. The duration of chronic leukemia exceeds one year, with a gradual onset of symptoms of anemia or marked enlargement of spleen, liver, or lymph nodes.
Synonym(s): leukocytic sarcoma
[leuko- + G. haima, blood]

leukemia

/leu·ke·mia/ (loo-ke´me-ah) a progressive, malignant disease of the blood-forming organs, marked by distorted proliferation and development of leukocytes and their precursors in the blood and bone marrow.leuke´mic
acute leukemia  leukemia in which the involved cell line shows little or no differentiation, usually consisting of blast cells; it comprises two types, acute lymphocytic leukemia and acute myelogenous leukemia.
acute granulocytic leukemia  acute myelogenous l.
acute lymphoblastic leukemia  (ALL) one of the two major categories of acute leukemia, characterized by anemia, fatigue, weight loss, easy bruising, thrombocytopenia, granulocytopenia with bacterial infections, bone pain, lymphadenopathy, hepatosplenomegaly, and sometimes spread to the central nervous system. It is subclassified on the basis of the surface antigens expressed, e.g., B-cell type, T-cell type.
acute lymphocytic leukemia  acute lymphoblastic l.
acute megakaryoblastic leukemia , acute megakaryocytic leukemia a form of acute myelogenous leukemia in which megakaryocytes are predominant and platelets are increased in the blood.
acute monocytic leukemia  an uncommon form of acute myelogenous leukemia in which the predominating cells are monocytes.
acute myeloblastic leukemia 
1. a common type of acute myelogenous leukemia in which myeloblasts predominate; it is divided into two types on the basis of degree of cell differentiation.
acute myelocytic leukemia  acute myelogenous l.
acute myelogenous leukemia  (AML) one of the two major categories of acute leukemia, with symptoms including anemia, fatigue, weight loss, easy bruising, thrombocytopenia, and granulocytopenia.
acute myeloid leukemia 
acute myelomonocytic leukemia  a common type of acute myelogenous leukemia, with both malignant monocytes and monoblasts.
acute nonlymphocytic leukemia  acute myelogenous l.
acute promyelocytic leukemia  acute myelogenous leukemia in which more than half the cells are malignant promyelocytes.
acute undifferentiated leukemia  (AUL) acute myelogenous leukemia in which the predominating cell is so immature it cannot be classified.
adult T-cell leukemia/lymphoma  (ATL) an adult-onset, subacute or chronic malignancy of mature T lymphocytes, believed to be caused by human lymphotropic virus type I.
aleukemic leukemia  a form in which the total white blood cell count in the peripheral blood is not elevated; it may be lymphocytic, monocytic, or myelogenous.
basophilic leukemia  leukemia in which the basophilic leukocytes predominate.
chronic leukemia  leukemia in which the involved cell line is well differentiated, usually B lymphocytes, but immunologically incompetent.
chronic granulocytic leukemia  chronic leukemia of the myelogenous type, usually associated with a specific chromosomal abnormality and occurring in adulthood.
chronic lymphocytic leukemia  (CLL) chronic leukemia of the lymphoblastic type, characterized by lymphadenopathy, fatigue, renal involvement, and pulmonary leukemic infiltrates.
chronic myelocytic leukemia , chronic myelogenous leukemia, chronic myeloid leukemia chronic granulocytic l.
chronic myelomonocytic leukemia  a chronic, slowly progressing form characterized by malignant monocytes and myeloblasts, splenomegaly, and thrombocytopenia.
leukemia cu´tis  a cutaneous manifestation of leukemia resulting from infiltration of the skin by malignant leukocytes.
eosinophilic leukemia  a form in which eosinophils are the predominating cells.
granulocytic leukemia  myelogenous l.
hairy cell leukemia  chronic leukemia marked by splenomegaly and an abundance of large, mononuclear abnormal cells with numerous irregular cytoplasmic projections that give them a flagellated or hairy appearance in the bone marrow, spleen, liver, and peripheral blood.
histiocytic leukemia  acute monocytic l.
lymphatic leukemia , lymphoblastic leukemia, lymphocytic leukemia a form associated with hyperplasia and overactivity of the lymphoid tissue, with increased levels of circulating malignant lymphocytes or lymphoblasts.
lymphogenous leukemia , lymphoid leukemia lymphatic l.
lymphosarcoma cell leukemia  (B-cell type) acute lymphoblastic l.
mast cell leukemia  a rare form marked by overwhelming numbers of tissue mast cells in the peripheral blood.
megakaryoblastic leukemia  acute megakaryocytic l.
megakaryocytic leukemia 
micromyeloblastic leukemia  a form of myelogenous leukemia in which the immature nucleoli-containing cells are small and similar to lymphocytes.
monocytic leukemia  acute monocytic l.
myeloblastic leukemia 
myelocytic leukemia , myelogenous leukemia, myeloid granulocytic leukemia a form arising from myeloid tissue in which the granular polymorphonuclear leukocytes and their precursors predominate. See also acute myelogenous l. and chronic granulocytic l.
myelomonocytic leukemia  acute myelomonocytic l.
plasma cell leukemia , plasmacytic leukemia a form in which the predominating cell in the peripheral blood is the plasma cell.
promyelocytic leukemia  acute promyelocytic l.
Rieder cell leukemia  a form of acute myelogenous leukemia in which the blood contains asynchronously developed cells with immature cytoplasm and a lobulated, relatively more mature nucleus.
stem cell leukemia  acute undifferentiated l.

leukemia

(lo͞o-kē′mē-ə)
n.
Any of various acute or chronic neoplastic diseases of the bone marrow in which unrestrained proliferation of white blood cells occurs, usually accompanied by anemia, impaired blood clotting, and enlargement of the lymph nodes, liver, and spleen.

leu·ke′mic adj. & n.

leukemia

[lo̅o̅kē′mē·ə]
Etymology: Gk, leukos + haima, blood
a group of malignant neoplasms of hematopoietic tissues characterized by diffuse replacement of bone marrow or lymph nodes with proliferative white blood cell precursors. Peripheral blood WBC counts become elevated and immature or variant forms appear in the peripheral blood. Leukemia may be chronic or acute, lymphoid, myeloid, or erythroid. In some chronic leukemias, when untreated, the WBC count becomes grossly elevated and the blood may appear whitish, giving leukemia its name. Also spelled leukaemia. See also acute childhood leukemia,acute lymphocytic leukemia, acute myelocytic leukemia. leukemic, adj.

leukemia

Hematology An uncommon–incidence, US 3.5/105/yr—malignant clonal expansion of myeloid or lymphoid cells characterized by an ↑ in circulating WBCs; leukemias may be an incidental finding when evaluating an unrelated clinical problem, or when the expansion compromises BM production of one or more cell lines causing anemia, thrombocytopenia, granulocytopenia; leukemias are divided by chronology–acute or chronic, by cell lineage–lymphoid, myeloid/myelocytic, monocytic or megakaryocytic and divided by stage of maturation or cell size Clinical BM infiltration by leukemia, resulting in anemia, thrombocytopenia, granulocytopenia, immune paralysis, ↓ B cells and CD4–helper T cells, ↑ CD8–suppressor T cells, infiltration and leukostasis, cranial nerve palsies, meningitis, lymphadenopathy, hepatosplenomegaly, testicular and cutaneous involvement, metabolic derangements–eg, ↑ Ca2+, K+, LD, ammonia, weight loss, less commonly, autoimmune hemolytic anemia, pallor and arthralgia Diagnosis Hx, physical exam, peripheral smear Management Chemotherapy, RT, BMT. See Accelerated leukemia, Acute leukemia, Acute lymphocytic leukemia, Acute myelocytic leukemia, Acute promyelocytic leukemia, Adult T-cell leukemia-lymphoma, Aleukemic leukemia, Biphenotypic leukemia, Central nervous system leukemia, Chemotherapy-induced leukemia, Chronic leukemia, Chronic lymphocytic leukemia, Chronic myelocytic leukemia, Chronic myelomonocytic leukemia, Congenital leukemia, Erythroleukemia, FAB classification, Hairy cell leukemia, Hand mirror cell leukemia, Herald state of leukemia, Mast cell leukemia, Megakaryoblastic leukemia, Multilineage leukemia, Plasma cell leukemia, Preleukemia, Prolymphocytic leukemia, Promyelocytic leukemia, Smoldering myeloid leukemia.
Leukemia Acute v. Chronic
Acute leukemia More common in children, 80% are ALL, often before age 10, peak at ages 3–7 in whites, ♂:♀ ratio, 1.3:1 Cell types Early pre-B cell 67%; pre-B cell 18%; B cell 1%; T cell 14%; 50-85% are cALLA positive–common acute lymphocytic leukemia antigen, CD10; 5% have Philadelphia chromosome Clinical ALL is more abrupt than AML, with petechial hemorrhage, bone and abdominal pain, headache and vomiting due to ↑ intracranial pressure, lymphadenopathy, splenomegaly, hepatomegaly Lab 70% have low-grade lymphocytosis–< 20 x 109 when diagnosed Evaluation Acute leukemia immunophenotypic profile Specimen EDTA–lavender top tube and sodium heparin–green top tube, peripheral blood smears Method of analysis Flow cytometry, immunofluorecesence Markers measured CD1, -2, -3, -4, -5, -7, -8, -10, -19. -20, -21, -33, -34, -56, megakaryocytic markers, HLA D/DR, kappa, lambda, TdT Management Protocols vary according to standard- or high-risk clinical features, and may include BMT
Chronic leukemia More common in adults/older children, often myelocytic; CML is Philadelphia chromosome positive; may occur < age 5 with myelomonocytosis, anemia, thrombocytopenia, lymphadenopathy; WBC count < 50 x 109, ≠ HbF, ≠ muraminidase; adult CML comprises 20% of all leukemias Clinical Gradual onset of fatigability, anorexia, splenomegaly; lymphadenopathy is uncommon Lab > 25 x 109/L leukemic cells in blood–often an absolute lymphocytosis of > 15 x 1010/L, < 10% blasts in BM, myeloid:erythroid ratio is 10-30:1, 90% of cases have low-to-absent leukocyte alkaline phosphatase and rarely also, ≠ vitamin B12 and B12-binding capacity Evaluation Chronic leukemia immunophenotype profile Specimen EDTA–lavender top tube and sodium heparin–green top tube, peripheral blood smears Method of analysis Flow cytometry, immunofluorescence Markers measured CD3, -5, -19, -20, -21, kappa, lambda Management see Chemotherapy, Induction Prognosis see Remission.
Leukemia–prognostic features
Acute lymphocytic leukemia
Good Age 2-10, CD10 positivity, hyperdiploid karyotype
Poor Age < 2; >10, B-cell phenotype, especially L2 phenotype by FAB classification, presence of chromosome translocations, CNS involvement, mediastinal masses, high initial WBC count
Acute myelocytic leukemia
Good Younger, presence of Auer rods, rapid therapeutic response
Poor Older, prior malignancy or therapy, multiple chromosome defects  

leu·ke·mi·a

(lū-kē'mē-ă)
Progressive proliferation of abnormal white blood cells found in hemopoietic tissues, other organs, and usually in the blood in increased numbers. Leukemia is classified by the dominant cell type, and by duration from onset to death, which occurs in acute leukemia within a few months in most cases, and is associated with acute symptoms including severe anemia, hemorrhages, and slight enlargement of lymph nodes or the spleen. The duration of chronic leukemia exceeds 1 year, with a gradual onset of symptoms of anemia or marked enlargement of spleen, liver, or lymph nodes.
Synonym(s): leucaemia, leukaemia.
[leuko- + G. haima, blood]

leukemia

, leucemia (loo-ke'me-a) [ leuko- + -emia]
Any of a class of hematological malignancies of bone marrow cells in which immortal clones of immature blood cells multiply at the expense of normal blood cells. As normal blood cells are depleted from the body, anemia, infection, hemorrhage, or death result. The leukemias are categorized as chronic or acute; by the cell type from which they originate; and by the genetic, chromosomal, or growth factor aberration present in the malignant cells.

Chronic leukemias, which have a relatively slow course, include chronic lymphocytic (CLL), chronic myelogenous or granulocytic (CML), and hairy cell leukemia (a subtype of CLL). Median survival in these illnesses is about 4 yr.

Acute leukemias include acute lymphocytic (ALL) and acute myeloid (myelogenous) (AML) leukemia. If untreated, these diseases are fatal within weeks or months. Each of these types of leukemia is discussed in subentries, below.

Etiology

All the different molecular events leading to the development of unchecked cellular reproduction in the leukemias result from genetic or chromosomal lesions in blood-forming cells. Duplications of genetic material (hyperdiploidy), loss of genetic information (hypodiploidy), inactivation of genes that normally suppress tumor development, chromosomal translocations, and the release of abnormal fusion proteins can all cause leukemia. These genetic lesions in turn can be produced by viruses, ionizing radiation, chemotherapeutic drugs, and toxic chemicals. Rarely, leukemias are caused by familial genetic syndromes (e.g., as ataxia telangiectasia, Bloom's syndrome, or Fanconi's syndrome).

Symptoms

Clinical findings such as anemia, fatigue, lethargy, fever, and bone and joint pain may be present. Physical findings include combinations of pallor, petechiae, or purpura; mucous membrane bleeding; enlarged liver, spleen, and kidneys; and tenderness over the sternum and other bones.

Diagnosis

Microscopic examination of peripheral blood and specimens of bone marrow are used to establish the diagnosis. These studies are followed by cytochemical and cytogenetic studies of abnormal cells found in the marrow or the peripheral blood to confirm the diagnosis with special stains and chromosomal analysis. Leukemic cells can also be identified by flow cytometry and immunocytochemistry, which rely on antibodies binding to and helping to identify malignant cells. The spread of leukemias to internal organs (e.g., the brain, the kidneys, or the lungs) may be evaluated with imaging tests (e.g., MRI studies, CT scans, or ultrasound).

Treatment

Chemotherapy, bone marrow transplantation, or both are used to treat leukemias. Regimens are devised regularly and are tailored to specific illnesses. Treatment is often given in several phases, with a period of induction chemotherapy to induce remission by completely eliminating leukemic cells from the bone marrow, followed by consolidation and maintenance phases. This multiphase treatment is designed to further deplete malignant cells from the bone marrow and to achieve complete cure.

Patient care

Patient care measures focus on eradicating the illness; managing complications; minimizing the effects of chemotherapy; preserving veins (often an indwelling port is inserted to administer chemotherapy); and providing comfort, education, and psychological support. The specific needs of patients (many of whom are children) and their families must be considered. Instruction is provided about drugs the patient will receive, including any adverse reactions and measures that will be taken to prevent or alleviate these effects. Prescribed chemotherapy is administered with special precautions when indicated for infusion and drug disposal. If the chemotherapy causes weight loss or anorexia, nutritional guidance is provided. Oral, skin, and rectal care must be meticulous, e.g., the nurse must thoroughly clean the skin before all invasive procedures, inspect the patient for perirectal erosions, use strict aseptic technique when starting an intravenous line, and change sets (i.e., intravenous tubing and associated equipment) according to chemotherapeutic protocols. Ports are irrigated according to agency protocol. If the patient is receiving intrathecal chemotherapy, the lumbar puncture site is checked frequently for bleeding or oozing. The patient and family are taught to recognize signs of infection (fevers, chills, sore throat, cough, urinary difficulties) and are urged to report these to the oncologist/hematologist promptly. To prevent infection in neutropenic patients, strict hand hygiene protocols, special diets, and (in hospitalized patients) laminar airflow or other reverse isolation measures are instituted. The patient is monitored for bleeding. If bleeding occurs, compresses are applied and the bleeding site is elevated. Transfusions of platelets and other blood cells are often needed. Complications associated with specific chemotherapeutic regimens (e.g., hair loss, nausea and vomiting, anemia, neutropenia, and low platelets) are explained to the patient, along with management strategies that will be employed. Prescribed analgesics are administered as needed, and noninvasive pain relief techniques and comfort measures (e.g., position changes, cutaneous stimulation, distraction, relaxation breathing, and imagery) may be used. Gentle oral hygiene measures and protective skin care are explained. Fluid intake should be increased to eliminate chemotherapy metabolites, and the patient advised to void more frequently to prevent cystitis. Dietary fiber is important, and stool softeners may be used to ensure normal bowel movements. Antidiarrheals usually control diarrhea, but the patient should be monitored for signs of dehydration. Fatigue is an anticipated adverse effect of treatment; therefore the patient is encouraged to alternate activity with rest periods and to obtain assistance with daily activities as necessary. Reproductive issues should be discussed with the patient. Patient care routines and visiting times should be flexible when hospitalization is required. The patient and family are encouraged to participate in care as much as possible. Referrals are made to social service agencies, home health care agencies, and support groups. If the patient does not respond to treatment and has reached the terminal phase of the disease, supportive nursing, palliative care, or hospice care should be discussed sensitively with patients and their caregivers.

acute lymphoblastic leukemia

Acute lymphocytic leukemia.
Enlarge picture
ACUTE LYMPHOCYTIC LEUKEMIA: Peripheral blood smear

acute lymphocytic leukemia

Abbreviation: ALL
A hematological malignancy marked by the unchecked multiplication of immature lymphoid cells in the bone marrow, blood, and body tissues. In 2008 the American Cancer Society estimated about 5400 Americans would be diagnosed with ALL. It is rapidly fatal if left untreated. Synonym: acute lymphoblastic l. See: illustration; leukemia

Etiology

Any of a wide range of acquired or congenital chromosomal abnormalities can cause ALL, including lesions that result in the release of excess growth factors from cells and those that cause the loss of cancer-suppressing genes.

Symptoms

Fatigue, lethargy, bleeding, bone and joint pain, and a predisposition to fever and infection are characteristic of ALL and other leukemias.

Diagnosis

The disease is suggested by the presence of abnormalities on the complete blood count or peripheral blood smear and is confirmed by immunophenotyping.

Treatment

In childhood, ALL induction chemotherapy often begins with steroids, vinca alkaloids, and asparaginase. This is followed, after bone marrow recovery, by consolidation chemotherapy with multidrug regimens, including high-dose methotrexate. Maintenance therapies, which may last 2 years or longer, include methotrexate, mercaptopurines, and other cytotoxic agents. Prophylaxis against central nervous system disease is accomplished by intrathecal drug administration. In referral hospitals, allogeneic stem cell transplantation is sometimes used for refractory disease. About 90% of treated children achieve remission. The 5-year survival of children with ALL is about 85%. Adult ALL is much less responsive to therapy; only about a third of adult patients are cured. In both childhood and adult ALL, allopurinol and hydration precede induction chemotherapy to prevent hyperuricemia caused by tumor lysis.

Prognosis

Late complications of therapy are not uncommon.

acute myelogenous leukemia

Abbreviation: AML
Acute myeloid leukemia.

acute myeloid leukemia

Abbreviation: AML
Any of a group of hematological malignancies in which neoplastic cells develop from myeloid, monocytic, erythrocytic, or megakaryocytic precursors. AML is four times more common in adults than acute lymphocytic leukemia (ALL). In 2008, the American Cancer Society estimated about 13,300 Americans would be diagnosed with AML, and that the disease would cause 8,800 deaths. It occasionally follows a myelodysplastic disorder or aplastic anemia and sometimes occurs as a consequence of a familial disorder of fragile chromosomes (e.g., Fanconi's syndrome).

All forms of AML are marked by neoplastic replacement of normal bone marrow and circulation of immature cells (“blasts”) in the peripheral blood. Anemia and thrombocytopenia commonly occur. The central nervous system and other organs are occasionally invaded. Complete remissions occur in approximately 65% of treated patients; responses to treatment lasting 5 years are achieved in 15% to 25% of treated patients. Synonym: acute myelogenous l.; acute nonlymphocytic l.

Etiology

Genetic and chromosomal aberrations, such as are found in other leukemias, are characteristic.

Symptoms

Exertional fatigue as a result of anemia, bleeding due to thrombocytopenia, and infections due to a lack of normal white blood cells are common.

Treatment

Cytotoxic chemotherapies, with an induction phase followed by consolidation, are used. Typically, cytosine arabinoside and an anthracycline are used during induction for AML. Allogeneic bone marrow transplantation is used when a matching donor is available; stem cell transplantation is an option for some patients with specific cytogenetic abnormalities.

acute nonlymphocytic leukemia

Abbreviation: ANLL
Acute myeloid leukemia.

aleukemic leukemia

Leukemia cutis.
Enlarge picture
CHRONIC LYMPHOCYTIC LEUKEMIA: Peripheral blood smear

chronic lymphocytic leukemia

Abbreviation: CLL
A malignancy in which abnormal lymphocytes (usually B cells) proliferate and infiltrate body tissues, often causing lymph node enlargement and immune dysfunction. Infectious complications are common. Median life expectancy is about 4 years. Chronic lymphocytic leukemia is the most common leukemia in industrialized nations. It usually occurs in people (older men) above age 60. Its incidence rises to 20 cases per 100,000 in people over 80. In 2008 the American Cancer Society estimated that 15,100 people would be diagnosed with CLL and that 4,400 would die of the disease. The timing of treatment and the prognosis in CLL depend on the stage of the disease. Staging includes such factors as the number of abnormal lymphocytes in the bloodstream, how quickly they double, and the presence of lymphadenopathy, organomegaly, or cytopenias. See: illustration

Treatment

Patients with advanced stages of the illness are often treated with chlorambucil, fludarabine, or other cytotoxic agents, often with rituximab (a monoclonal antibody) added to enhance response. Patients with early-stage disease are not usually given therapy.

chronic myelogenous leukemia

Abbreviation: CML
Chronic myeloid leukemia.

chronic myeloid leukemia

Abbreviation: CML
A hematological malignancy marked by a sustained increase in the number of granulocytes, splenic enlargement, and a specific cytogenetic anomaly (the “Philadelphia chromosome”) in the bone marrow of more than 90% of patients. The disease affects one or two people per 100,000. In 2008 the American Cancer Society estimated that 4830 people would be diagnosed with CML and that 450 would die of the disease. The course of the disease has three phases: a chronic one in which blood counts are relatively easy to control with medications; an accelerated phase in which granulocyte counts become more resistant to chemotherapy; and a “blast” crisis, which resembles acute leukemia. Median survival is about 4 years. It generally occurs between ages 40 and 50, affecting slightly more men than women (4600 adults in the U.S. in 2005). Synonym: chronic myelogenous l See: leukemia

Etiology

CML results from a translocation of genetic material between chromosomes 9 and 22. The translocation results in the production of an abnormal tyrosine kinase that makes affected cells immortal.

Symptoms

CML often is diagnosed in asymptomatic patients who are found to have an unexplained leukocytosis when their complete blood counts are checked. Subsequent evaluation, including bone marrow aspiration and biopsy with cytogenetic analysis, reveal the Philadelphia chromosome.

Treatment

Imatinib mesylate (a drug that blocks an abnormal kinase made by Philadelphia chromosome positive CML cells) effectively reduces the number of tumor cells in the chronic phase of CML to normal in nearly 90% of patients. An alternative is stem cell transplantation.

leukemia cutis

An invasion of the dermis and subcutaneous fat by leukemic cells. The invasion often happens before these cells proliferate in the bone marrow or are detectable in the peripheral blood. The cells may cause several different types of skin rashes, including blue nodules (giving the skin a “blueberry muffin” appearance), papules, plaques, and ulcers.
Synonym: aleukemic l
Enlarge picture
HAIRY CELL LEUKEMIA: Bone marrow aspirate
Enlarge picture
LYMPHOCYTES IN HAIRY CELL LEUKEMIA

hairy cell leukemia

Abbreviation: HCL
A chronic, low-grade hematological malignancy of abnormally shaped B lymphocytes (“hairy cells”). The disease is marked by pancytopenia and splenomegaly. Median survival in untreated patients is about 5 years. The disease is rare, being only 1% to 2% of all leukemias. The median age of patients is 50 years; men are affected more commonly than women by a 4-to-1 ratio. See: illustration

Symptoms

Weight loss, hypermetabolism, infectious complications, and abdominal discomfort due to splenic enlargement are common.

Treatment

Cladribine, pentostatin, interferon alfa, and rituximab (a monoclonal antibody) are representative chemotherapeutic options.

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mixed-lineage leukemia

Abbreviation: MLL
An aggressive, primarily childhood leukemia caused by the translocation of a gene from chromosome 11 to a region that overproduces fusion proteins.

Leukemia

A cancer of blood cells characterized by the abnormal increase in the number of white blood cells in the tissues. There are many types of leukemias and they are classified according to the type of white blood cell involved.

Bennett,

John Hughes, English physician, 1812-1875.
Bennett disease - disease characterized by progressive proliferation of abnormal leukocytes found in hemopoietic tissues, other organs, and usually in the blood in increased numbers; often fatal. Synonym(s): leukemia

leukemia (lōō·kēˑ·mē·),

n a group of chronic or acute malignant disorders characterized by an abnormal increase in the number and types of white blood cells; permeation of liver, lymph nodes, and spleen; replace-ment of bone marrow with proliferating precursors to white blood cells. Lethargy, paleness, loss of weight, and easy bruising are early signs. Fever, extreme weakness, hemorrhages, and pain in the joints or bones may be later indications. An intensive combination of chemotherapy, antibiotics, and blood transfusions or bone marrow transplant is currently the most effective treatment.
leukemia, acute lymphocytic (·kyōōtˑ lim·fˑ·tik lōō·kēˑ·mē·),
n malignant blood disease, where healthy blood cell numbers are reduced while underdeveloped cells and lymphoblasts proliferate in blood vessels, bone marrow, lymph nodes, and organs. One of the most common malignancies in children.
leukemia, acute myelocytic (·kyōōtˑ mīˑ··lō·si·tik lōō·kēˑ·mē·),
n bone marrow disease most often occurring in young adults in which undeveloped granular leukocytes multiply in the body. Individuals exposed to high amounts of radiation are at higher risk of developing this disease, as are those with a variety of blood dyscrasias, such as refractory anemia, among others. Also called
acute granulocytic leukemia, acute myelogenous leukemia, acute nonlymphocytic leukemia, myeloid leukemia, splenomedullary leukemia, or
splenomyelogenous leukemia.
leukemia, chronic lymphocytic,
n cancer of hematopoeitic tissues common in older men distinguished by proliferation of lymphocytes, especially B cells. Symptoms include malaise, weight loss, fatigue, nighttime sweating, and lymphadenopathy.
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Leukemia, chronic lymphocytic.

leu·ke·mi·a

(lū-kē'mē-ă)
Progressive proliferation of abnormal leukocytes found in hemopoietic tissues, other organs, and usually in the blood in increased numbers; classified by dominant cell type, and by duration from onset to death. This occurs in acute leukemia within a few months in most cases, and is associated with acute symptoms including severe anemia, hemorrhages, and slight enlargement of lymph nodes or the spleen. Chronic leukemia lasts over 1 year, with a gradual onset of symptoms of anemia or marked enlargement of spleen, liver, or lymph nodes.
Synonym(s): leucaemia, leukaemia.
[leuko- + G. haima, blood]

leukemia (lookē´mēə),

n a usually fatal disease of the blood-forming tissues characterized by the abnormal proliferation of leukocytes and their precursors and attended by fatigue, weakness, fever, lymphadenopathy, splenomegaly, and a tendency toward profuse tissue hemorrhage. Oral lesions include gingival enlargement, severe gingivitis, and necrosis. Lymphatic, monocytic, and myelogenous leukemias are the main types.
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Leukemia.
leukemia, aleukemia
(ā´lookē´mēə),
n a phase of the leukemic state marked by proliferation of leukocytes within the blood-forming tissues but without an increase in the white blood cell count: relatively few precursor cells are found in the blood smear until the phase passes and the blood becomes flooded with white cells. Oral lesions, when present, are ulceronecrotic and hypertrophic.
leukemia, lymphatic (lymphoid leukemia),
n a hyperplasia, of undetermined origin, affecting lymphoid tissue. Predominating cells are lymphocytes and lymphoblasts. Generally assumes a more chronic course than other forms of leukemia but may be acute. Oral lesions include swollen and hyperplastic gingivae, ulceronecrotic lesions, and marked tendency to gingival hemorrhage.
leukemia, monocytic,
n a form characterized by an abnormal increase in the number of monocytes. Manifestations include progressive weakness, anorexia, lymphadenopathy, hepatomegaly, splenomegaly, and secondary anemia. Oral lesions may be ulceronecrotic or hemorrhagic.
leukemia, myelogenous,
n a form in which the leukocytes are of bone marrow origin (e.g., polymorphonuclear leukocytes, myelocytes, myeloblasts). Oral manifestations may include gingival enlargement, hemorrhage, and necrosis.

leukemia

a progressive, malignant disease of the blood-forming organs, marked by distorted proliferation and development of leukocytes and their precursors in the blood and bone marrow. Signs include fever and enlargement of the lymph nodes, spleen and liver. The persistent lymphocytosis that occurs in some cattle is a response to infection with the bovine viral leukosis virus. Similarly, leukemia may occur in the lymphoproliferative and myeloproliferative diseases caused by feline leukemia virus in cats.

aleukemic leukemia
leukemia in which the leukocyte count is normal or below normal.
avian leukemia
see avian leukosis.
basophilic leukemia, basophilocytic leukemia
leukemia in which basophilic granulocytes predominate.
B-cell leukemia
leukemia arising from B lymphocytes.
bovine leukemia
see bovine viral leukosis.
leukemia cutis
skin lesions associated with dissemination of systemic leukemia; they may be neoplastic or nonspecific.
embryonal leukemia
stem cell leukemia.
eosinophilic leukemia
occurs rarely in cats. There are large numbers of eosinophils with infiltration of spleen, liver, lymph nodes and bone marrow.
feline leukemia complex
the array of diseases associated with infection of cats by the feline leukemia virus; includes lymphoreticular neoplasms, myelodysplastic disorders and abnormalities of the immune system.
feline leukemia virus (FeLV)
see feline leukemia virus.
granulocytic leukemia
myelocytic leukemia.
leukopenic leukemia
aleukemic leukemia.
lymphatic leukemia, lymphoblastic leukemia, lymphocytic leukemia, lymphogenous leukemia, lymphoid leukemia
leukemia associated with hyperplasia and overactivity of the lymphoid tissue, in which the leukocytes are lymphocytes or lymphoblasts.
lymphosarcoma cell leukemia
a form marked by large numbers of lymphosarcoma cells in the peripheral blood; depending on the degree of bone marrow involvement, it may be a variant of lymphosarcoma.
mast cell leukemia
a form marked by overwhelming numbers of tissue mast cells in the peripheral blood.
megakaryoblastic leukemia
a rare disease of young dogs, characterized by intestinal hemorrhage, anemia and a fatal outcome within a few weeks. There is a pancytopenia and marked thrombocytopenia.
megakaryocytic leukemia
a form with numerous megakaryocytes in the spleen, bone marrow, and other tissues, but decreased numbers or abnormal thrombocytes in the peripheral blood, and anemia. Reported in dogs and cats. Called also megakaryocytic myelosis.
monocytic leukemia
leukemia in which the predominating leukocytes are monocytes.
myeloblastic leukemia
characterized by a predominance of immature myeloid series of cells in the blood; largely a disease of young male dogs and cats.
myelocytic leukemia, myelogenous leukemia, myeloid leukemia
a form arising from myeloid tissue in which the granular polymorphonuclear leukocytes and their precursors predominate.
myelomonocytic leukemia
concurrent neoplasia of the neutrophilic and monocytic cell lines with a monocytic leukemia, a high total leukocyte count, anemia and thrombocytopenia.
plasma cell leukemia, plasmacyte leukemia
a form in which the predominating cell in the peripheral blood is the plasma cell.
premyelocytic leukemia
a form in which the predominant cells are premyeloblasts, rather than myeloblasts, often associated with abnormal bleeding secondary to thrombocytopenia, hypofibrinogenemia and decreased levels of clotting factor V.
promyelocytic leukemia
characterized by a predominance of promyelocytes in peripheral blood and in the bone marrow. A disease of dogs and cats with bleeding tendencies, anemia and a susceptibility to septicemia with a fatal outcome within a few weeks.
stem cell leukemia
leukemia in which the predominating cell is so immature and primitive that its classification is difficult.
subleukemic leukemia
aleukemic leukemia.
undifferentiated leukemia
an acute myeloproliferative disorder in which the cells involved cannot be identified.

Patient discussion about leukemia

Q. What is Leukemia? My brother's best friend has been diagnosed with Leukemia. What is it? Is it dangerous? Can you recover from it?

A. Leukemia is the general name for four different types of blood cancers. In people with leukemia, the bone marrow produces abnormal white blood cells. The abnormal cells are leukemia cells. At first, leukemia cells function almost normally. In time, they may crowd out normal white blood cells, red blood cells, and platelets. This makes it hard for blood to do its work. After diagnosis, many people with leukemia do survive and live many good, quality years. The relative five-year survival rate has more than tripled in the past 47 years for patients with leukemia. In 1960-63, when compared to a person without leukemia, a patient had a 14 percent chance of living five years. By 1975-77, the five year relative survival rate had jumped to 35 percent, and in 1996-2003 the overall relative survival rate was nearly 50 percent.

Q. What causes Leukemia? How can one get Leukemia?

A. Not all the causes of leukemia are known. However there are some causes that are suspected. Nowadays as the pollution is increasing and use of chemicals in various parts of life has increased, people who come in contact with toxic chemicals, radiations etc. are at greater risk of developing leukemia, hereditary also plays a role at some extent.

Q. Is Leukemia hereditary? My Grandpa died of Leukemia when he was 50. I am worried that it might be hereditary. Is it?

A. Overall leukemia is not hereditary but there are rare reports of family clusters, that is, more than one case in a family. Therefore, you should consult your Doctor and tell him about your family's medical history.

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