LEUKEMIA, ACUTE

General Information

DEFINITION--A cancer of the white blood cells in bone marrow or tissues that are part of the lymphatic system (lymph glands, spleen, liver). These excess cells accumulate and spill into the bloodstream, eventually involving other tissues. Common forms of leukemia include: acute lymphocytic leukemia (ALL; especially prevalent in children), acute myelogenous leukemia (AML) and acute non-lymphocytic leukemia (ANLL). Acute leukemia is the most common form of cancer in children.

BODY PARTS INVOLVED--Bone marrow and lymph tissue in early stages. The disease eventually affects all body tissues.

SEX OR AGE MOST AFFECTED

• Both sexes, but more common in males.
• All ages. Acute lymphocytic leukemia has a peak incidence between ages 2 and 5.

SIGNS & SYMPTOMS

• Low fever; tiredness; anemia.
• Increasing paleness; general ill feeling.
• Easy bruising and spontaneous bleeding (nosebleeds, bleeding from the gums or prolonged menstruation).
• Enlarged spleen and abdominal pain.
• Susceptibility to infection, especially pneumonia.
• Mouth infections with ulcers and sores.
• Headache and lethargy, if meninges (brain membranes) are affected.

CAUSES--Precise cause unknown, but there are many suspected, predisposing factors.

RISK INCREASES WITH

• Family history of leukemia.
• Excess exposure to x-rays.
• Congenital disorders, especially Down syndrome.
• Identical twins.
• Exposure to benzenes and other toxic industrial chemicals; use of cytotoxic drugs.
• Immunosuppression due to illness or medications.
• Smoking.

HOW TO PREVENT--Cannot be prevented. If you have a family history of leukemia, seek genetic counseling before starting a family.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Laboratory studies of blood, bone marrow and cerebrospinal fluid
• Chest x-ray, CT scan, ultrasound (See Glossary for both) and spinal tap.

APPROPRIATE HEALTH CARE

• Treatment steps include transfusions of blood and platelets, anticancer drugs to kill the leukemic cells, followed by radiation therapy.
• Bone marrow transplant may be considered in patients if leukemia relapses after the first remission.

POSSIBLE COMPLICATIONS

• Hemorrhage.
• Death from destruction of the body's defenses against infection.

PROBABLE OUTCOME--Treatment brings remission in 90% of patients and cure in 30% for some forms of leukemia--especially in children.

How To Treat

GENERAL MEASURES--

• Remission occurs when there is no evidence of leukemic cells in the blood or bone marrow.
• Patient should avoid ill persons and crowds to prevent dangerous exposure to infection.
• Mouth care is important. Rinse the mouth often with a warm salt-water solution to decrease mouth ulcers. Use 1 tablespoon salt in 8 oz. water. Use a soft toothbrush to prevent gum abrasion.
• See Resources for Additional Information.

MEDICATION--Your doctor may prescribe:

• Blood transfusions.
• Anticancer drugs; cortisone drugs.
• Pain relievers. Don't take aspirin or any product containing aspirin. Aspirin increases the likelihood of bleeding.
• Antibiotics to fight infection.
• Uricosuric drugs to increase excretion of uric acid that may accumulate as a side effect of anticancer drugs.

ACTIVITY--No restrictions during remissions. Bed rest is usually necessary during active phases.

DIET--Drink extra fluids. Adults should drink 8 to 10 glasses of fluid daily and children should drink 4 to 6 glasses of fluid. During chemotherapy, eat and drink high-calorie foods and beverages, such as milkshakes or eggnog.

Call Your Doctor If

• You or your child have symptoms of leukemia.
• The following occurs during active stages or remissions: Fever, chills, cough or sore throat. Abnormal bleeding. Apply pressure and ice while awaiting your doctor's return call. Constipation.