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Leukemia

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For the journal, seeLeukemia (journal).For animal diseases, seeLeucosis.

Leukemia
Other namesLeukaemia
AWright's stainedbone marrow aspiratesmearfrom a person withB-cell acute lymphoblastic leukemia
Pronunciation
SpecialtyHematologyandoncology
SymptomsBleeding,bruising,fatigue,fever, increased risk of infections[2]
Usual onsetAll ages,[3]most common in 60s and 70s.[4]It is the most common malignant cancer in children, but the cure rates are also higher for them.
CausesInheritedand environmental factors[5]
Risk factorsSmoking,family history,ionizing radiation,some chemicals such astrichloroethylene,prior chemotherapy,Down syndrome.[3][5]
Diagnostic methodBlood tests,bone marrow biopsy[2]
TreatmentChemotherapy,radiation therapy,targeted therapy,bone marrow transplant,supportive care[3][6]
PrognosisFive-year survival rate57% (U.S.)[4]
Frequency2.3 million (2015)[7]
Deaths353,500 (2015)[8]

Leukemia(also spelledleukaemia;pronounced/luːˈkiːmiːə/[1]loo-KEE-mee-ə) is a group ofblood cancersthat usually begin in thebone marrowand produce high numbers of abnormalblood cells.[9]These blood cells are not fully developed and are calledblastsorleukemia cells.[2]Symptoms may include bleeding andbruising,bone pain,fatigue,fever,and an increased risk of infections.[2]These symptoms occur due to a lack of normalblood cells.[2]Diagnosis is typically made byblood testsorbone marrow biopsy.[2]

The exact cause of leukemia is unknown.[5]A combination ofgenetic factorsand environmental (non-inherited) factors are believed to play a role.[5]Risk factors includesmoking,ionizing radiation,petrochemicals (such asbenzene), prior chemotherapy, andDown syndrome.[5][3]People with a family history of leukemia are also at higher risk.[3]There are four main types of leukemia—acute lymphoblastic leukemia(ALL),acute myeloid leukemia(AML),chronic lymphocytic leukemia(CLL) andchronic myeloid leukemia(CML)—and a number of less common types.[3][10]Leukemias andlymphomasboth belong to a broader group oftumorsthat affect the blood, bone marrow, andlymphoid system,known astumors of the hematopoietic and lymphoid tissues.[11][12]

Treatment may involve some combination ofchemotherapy,radiation therapy,targeted therapy,andbone marrow transplant,withsupportiveandpalliative careprovided as needed.[3][6]Certain types of leukemia may be managed withwatchful waiting.[3]The success of treatment depends on the type of leukemia and the age of the patient. Outcomes have improved in the developed world.[10]Five-year survival ratewas 67% in the United States in the period from 2014 to 2020.[4]In children under 15 infirst-worldcountries, the five-year survival rate is greater than 60% or even 90%, depending on the type of leukemia.[13]In children who are cancer-free five years after diagnosis of acute leukemia, thecancer is unlikely to return.[13]

In 2015, leukemia was present in 2.3 million people worldwide and caused 353,500 deaths.[7][8]In 2012, it had newly developed in 352,000 people.[10]It is the most common type of cancer in children, with three-quarters of leukemia cases in children being the acute lymphoblastic type.[3]However, over 90% of all leukemias are diagnosed in adults, CLL and AML being most common.[3][14]It occurs more commonly in thedeveloped world.[10]

Classification

[edit]
Four major kinds of leukemia
Cell type Acute Chronic
Lymphocytic leukemia
(or "lymphoblastic" )		 Acute lymphoblastic leukemia
(ALL)		 Chronic lymphocytic leukemia
(CLL)
Myelogenous leukemia
( "myeloid" or "nonlymphocytic" )		 Acute myelogenous leukemia
(AML or myeloblastic)		 Chronic myelogenous leukemia
(CML)
An explanation of acute leukemia

General classification

[edit]

Clinically and pathologically, leukemia is subdivided into a variety of large groups. The first division is between itsacuteandchronicforms:[15]

  • Acute leukemiais characterized by a rapid increase in the number of immature blood cells. The crowding that results from such cells makes the bone marrow unable to produce healthy blood cells resulting in lowhemoglobinand lowplatelets.Immediate treatment is required in acute leukemia because of the rapid progression and accumulation of themalignant cells,which then spill over into the bloodstream and spread to other organs of the body. Acute forms of leukemia are the most common forms ofleukemia in children.
  • Chronic leukemiais characterized by the excessive buildup of relatively mature, but still abnormal,white blood cells(or, more rarely,red blood cells). Typically taking months or years to progress, the cells are produced at a much higher rate than normal, resulting in many abnormal white blood cells. Whereas acute leukemia must be treated immediately, chronic forms are sometimes monitored for some time before treatment to ensure maximum effectiveness of therapy. Chronic leukemia mostly occurs in older people but can occur in any age group.

Additionally, the diseases are subdivided according to which kind of blood cell is affected. This divides leukemias intolymphoblasticorlymphocytic leukemiasandmyeloidormyelogenous leukemias:[15]

Combining these two classifications provides a total of four main categories. Within each of these main categories, there are typically several subcategories. Finally, some rarer types are usually considered to be outside of this classification scheme.[15][16]

Specific types

[edit]

Pre-leukemia

[edit]

Signs and symptoms

[edit]
Common symptoms of chronic or acute leukemia[33]

The most common symptoms in children are easybruising,pale skin,fever,and anenlarged spleenorliver.[34]

Damage to the bone marrow, by way of displacing the normal bone marrow cells with higher numbers of immature white blood cells, results in a lack of bloodplatelets,which are important in theblood clottingprocess. This means people with leukemia may easily becomebruised,bleedexcessively, or develop pinprick bleeds (petechiae).[35]

White blood cells,which are involved in fightingpathogens,may be suppressed or dysfunctional. This could cause the person's immune system to be unable to fight off a simple infection or to start attacking other body cells. Because leukemia prevents the immune system from working normally, some people experience frequentinfection,ranging from infectedtonsils,sores in the mouth,ordiarrheato life-threateningpneumoniaoropportunistic infections.[36]

Finally, the red blood cell deficiency leads toanemia,which may causedyspneaandpallor.[37]

Some people experience other symptoms, such as fevers, chills, night sweats, weakness in the limbs, feelingfatiguedand other commonflu-like symptoms.Some people experience nausea or a feeling of fullness due to an enlargedliverandspleen;this can result in unintentionalweight loss.Blastsaffected by the disease may come together and become swollen in the liver or in thelymph nodescausing pain and leading to nausea.[38]

If the leukemic cells invade thecentral nervous system,then neurological symptoms (notablyheadaches) can occur. Uncommon neurological symptoms likemigraines,seizures,orcomacan occur as a result of brain stem pressure. All symptoms associated with leukemia can be attributed to other diseases. Consequently, leukemia is always diagnosed throughmedical tests.

The wordleukemia,which means 'white blood', is derived from the characteristic high white blood cell count that presents in most affected people before treatment. The high number of white blood cells is apparent when a blood sample isviewed under a microscope,with the extra white blood cells frequently being immature or dysfunctional. The excessive number of cells can also interfere with the level of other cells, causing further harmful imbalance in the blood count.[39]

Some people diagnosed with leukemia do not have high white blood cell counts visible during a regular blood count. This less-common condition is calledaleukemia.The bone marrow still contains cancerous white blood cells that disrupt the normal production of blood cells, but they remain in the marrow instead of entering the bloodstream, where they would be visible in a blood test. For a person with aleukemia, the white blood cell counts in the bloodstream can be normal or low. Aleukemia can occur in any of the four major types of leukemia, and is particularly common inhairy cell leukemia.[40]

Causes

[edit]

Studies in 2009 and 2010 have shown a positive correlation between exposure toformaldehydeand the development of leukemia, particularlymyeloid leukemia.[41][42]The different leukemias likely have different causes.[43]

Leukemia, like other cancers, results frommutationsin theDNA.Certain mutations can trigger leukemia by activatingoncogenesor deactivatingtumor suppressor genes,and thereby disrupting the regulation of cell death, differentiation or division. These mutations may occur spontaneously or as a result of exposure toradiationorcarcinogenicsubstances.[44]

Among adults, the known causes are natural and artificialionizing radiationand petrochemicals, notablybenzeneand alkylatingchemotherapyagents for previous malignancies.[45][46][47]Use oftobaccois associated with a small increase in the risk of developingacute myeloid leukemiain adults.[45]Cohort and case-control studies have linked exposure to somepetrochemicalsandhair dyesto the development of some forms of leukemia. Diet has very limited or no effect, although eating more vegetables may confer a small protective benefit.[48]

Viruses have also been linked to some forms of leukemia. For example,human T-lymphotropic virus(HTLV-1) causesadult T-cell leukemia.[49]

A few cases ofmaternal-fetal transmission(a baby acquires leukemia because its mother had leukemia during the pregnancy) have been reported.[45]Children born to mothers who usefertility drugsto induce ovulation are more than twice as likely to develop leukemia during their childhoods than other children.[50]

In a recent systematic review and meta-analysis of any type of leukemia in neonates usingphototherapy,typically to treatneonatal jaundice,a statistically significant association was detected between using phototherapy and myeloid leukemia. However, it is still questionable whether phototherapy is genuinely the cause of cancer or simply a result of the same underlying factors that gave rise to cancer.[51]

Radiation

[edit]

Large doses ofSr-90(called abone seekingradioisotope) fromnuclear reactoraccidents, increases the risk ofbone cancerand leukemia in animals and is presumed to do so in people.[52]

Genetic conditions

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Some people have a genetic predisposition towards developing leukemia. This predisposition is demonstrated by family histories andtwin studies.[45]The affected people may have a single gene or multiple genes in common. In some cases, families tend to develop the same kinds of leukemia as other members; in other families, affected people may develop different forms ofleukemia or related blood cancers.[45]

In addition to these genetic issues, people with chromosomal abnormalities or certain other genetic conditions have a greater risk of leukemia.[46]For example, people withDown syndromehave a significantly increased risk of developing forms of acute leukemia (especiallyacute myeloid leukemia), andFanconi anemiais a risk factor for developing acute myeloid leukemia.[45]Mutation inSPRED1 genehas been associated with a predisposition to childhood leukemia.[53]

Chronic myelogenous leukemiais associated with a genetic abnormality called thePhiladelphia translocation;95% of people with CML carry the Philadelphia mutation, although this is not exclusive to CML and can be observed in people with other types of leukemia.[54][55][56][57]

Non-ionizing radiation

[edit]

Whether or not non-ionizing radiation causes leukemia has been studied for several decades. TheInternational Agency for Research on Cancerexpert working group undertook a detailed review of all data on static andextremely low frequencyelectromagnetic energy, which occurs naturally and in association with the generation, transmission, and use of electrical power.[58]They concluded that there is limited evidence that high levels ofELFmagnetic (but not electric) fields might cause some cases ofchildhood leukemia.[58]No evidence for a relationship to leukemia or another form of malignancy in adults has been demonstrated.[58]Since exposure to such levels of ELFs is relatively uncommon, theWorld Health Organizationconcludes that ELF exposure, if later proven to be causative, would account for just 100 to 2400 cases worldwide each year, representing 0.2 to 4.9% of the total incidence of childhood leukemia for that year (about 0.03 to 0.9% of all leukemias).[59]

Diagnosis

[edit]
The increase inwhite blood cellsin leukemia

Diagnosis is usually based on repeatedcomplete blood countsand abone marrow examinationfollowing observations of the symptoms. Sometimes, blood tests may not show that a person has leukemia, especially in the early stages of the disease or during remission. Alymph node biopsycan be performed to diagnose certain types of leukemia in certain situations.[60]

Following diagnosis, blood chemistry tests can be used to determine the degree of liver and kidney damage or the effects of chemotherapy on the person. When concerns arise about other damages due to leukemia, doctors may use anX-ray,MRI,orultrasound.These can potentially show leukemia's effects on such body parts as bones (X-ray), the brain (MRI), or the kidneys, spleen, and liver (ultrasound).CT scanscan be used to check lymph nodes in the chest, though this is uncommon.[61]

Despite the use of these methods to diagnose whether or not a person has leukemia, many people have not been diagnosed because many of the symptoms are vague,non-specific,and can refer to other diseases. For this reason, the American Cancer Society estimates that at least one-fifth of the people with leukemia have not yet been diagnosed.[40]

Treatment

[edit]

Most forms of leukemia are treated with pharmaceuticalmedication,typically combined into a multi-drugchemotherapy regimen.Some are also treated withradiation therapy.In some cases, abone marrow transplantis effective.

Acute lymphoblastic

[edit]
Further information:Acute lymphoblastic leukemia § Treatment

Management of ALL is directed towards control of bone marrow and systemic (whole-body) disease. Additionally, treatment must prevent leukemic cells from spreading to other sites, particularly thecentral nervous system(CNS) e.g. monthly lumbar punctures.[clarification needed]In general, ALL treatment is divided into several phases:

  • Induction chemotherapyto bring about bone marrow remission. For adults, standard induction plans includeprednisone,vincristine,and ananthracyclinedrug; other drug plans may includeL-asparaginaseorcyclophosphamide.For children with low-risk ALL, standard therapy usually consists of three drugs (prednisone, L-asparaginase, and vincristine) for the first month of treatment.
  • Consolidation therapyorintensification therapyto eliminate any remaining leukemia cells. There are many different approaches to consolidation, but it is typically a high-dose, multi-drug treatment that is undertaken for a few months. People with low- to average-risk ALL receive therapy withantimetabolitedrugs such asmethotrexateand6-mercaptopurine(6-MP). People who are high-risk receive higher drug doses of these drugs, plus additional drugs.
  • CNS prophylaxis(preventive therapy) to stop cancer from spreading to the brain and nervous system in high-risk people. Standardprophylaxismay include radiation of the head and/or drugs delivered directly into the spine.
  • Maintenance treatmentswith chemotherapeutic drugs to prevent disease recurrence once remission has been achieved. Maintenance therapy usually involves lower drug doses and may continue for up to three years.
  • Alternatively,allogeneic bone marrow transplantationmay be appropriate for high-risk or relapsed people.[62]

Chronic lymphocytic

[edit]
Further information:Chronic lymphocytic leukemia § Treatment

Decision to treat

[edit]

Hematologistsbase CLL treatment on both the stage and symptoms of the individual person. A large group of people with CLL have low-grade disease, which does not benefit from treatment. Individuals with CLL-related complications or more advanced disease often benefit from treatment. In general, the indications for treatment are:

Treatment approach

[edit]

Most CLL cases are incurable by present treatments, so treatment is directed towards suppressing the disease for many years, rather than curing it. The primary chemotherapeutic plan iscombinationchemotherapy withchlorambucilorcyclophosphamide,plus acorticosteroidsuch asprednisoneorprednisolone.The use of a corticosteroid has the additional benefit of suppressing some related autoimmune diseases, such asimmunohemolytic anemiaorimmune-mediated thrombocytopenia.In resistant cases,single-agenttreatments with nucleoside drugs such asfludarabine,[64]pentostatin,orcladribinemay be successful. Younger and healthier people may chooseallogeneicorautologousbone marrow transplantationin the hope of a permanent cure.[65]

Acute myelogenous

[edit]
Further information:Acute myeloid leukemia § Treatment

Many different anti-cancer drugs are effective for the treatment of AML. Treatments vary somewhat according to the age of the person and according to the specific subtype of AML. Overall, the strategy is to control bone marrow and systemic (whole-body) disease, while offering specific treatment for the central nervous system (CNS), if involved.[66]

In general, most oncologists rely on combinations of drugs for the initial,induction phaseof chemotherapy. Such combination chemotherapy usually offers the benefits of earlyremissionand a lower risk of disease resistance.Consolidationandmaintenancetreatments are intended to prevent disease recurrence. Consolidation treatment often entails a repetition of induction chemotherapy or the intensification of chemotherapy with additional drugs. By contrast, maintenance treatment involves drug doses that are lower than those administered during the induction phase.[67]

Chronic myelogenous

[edit]
Further information:Chronic myelogenous leukemia § Treatment

There are many possible treatments for CML, but the standard of care for newly diagnosed people isimatinib(Gleevec) therapy.[68]Compared to most anti-cancer drugs, it has relatively few side effects and can be takenorallyat home. With this drug, more than 90% of people will be able to keep the disease in check for at least five years,[68]so that CML becomes a chronic, manageable condition.

In a more advanced, uncontrolled state, when the person cannot tolerate imatinib, or if the person wishes to attempt a permanent cure, then an allogeneic bone marrow transplantation may be performed. This procedure involves high-dose chemotherapy and radiation followed by infusion of bone marrow from a compatible donor. Approximately 30% of people die from this procedure.[68]

Hairy cell

[edit]
Further information:Hairy cell leukemia § Treatment

Decision to treat
People with hairy cell leukemia who are symptom-free typically do not receive immediate treatment. Treatment is generally considered necessary when the person shows signs and symptoms such as low blood cell counts (e.g., infection-fighting neutrophil count below 1.0 K/μL), frequent infections, unexplained bruises, anemia, or fatigue that is significant enough to disrupt the person's everyday life.[69]

Typical treatment approach
People who need treatment usually receive either one week ofcladribine,given daily by intravenous infusion or a simple injection under the skin, or six months ofpentostatin,given every four weeks by intravenous infusion. In most cases, one round of treatment will produce a prolonged remission.[70]

Other treatments includerituximabinfusion or self-injection withInterferon-alpha.In limited cases, the person may benefit fromsplenectomy(removal of thespleen). These treatments are not typically given as the first treatment because their success rates are lower than cladribine or pentostatin.[71]

T-cell prolymphocytic

[edit]
Further information:T-cell prolymphocytic leukemia § Treatment

Most people with T-cell prolymphocytic leukemia, a rare and aggressive leukemia with a median survival of less than one year, require immediate treatment.[72]

T-cell prolymphocytic leukemia is difficult to treat, and it does not respond to most available chemotherapeutic drugs.[72]Many different treatments have been attempted, with limited success in certain people:purine analogues(pentostatin, fludarabine, cladribine),chlorambucil,and various forms of combination chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisoneCHOP,cyclophosphamide, vincristine, prednisone [COP], vincristine, doxorubicin, prednisone, etoposide, cyclophosphamide, bleomycinVAPEC-B).Alemtuzumab(Campath), amonoclonal antibodythat attacks white blood cells, has been used in treatment with greater success than previous options.[72]

Some people who successfully respond to treatment also undergostem cell transplantationto consolidate the response.[72]

Juvenile myelomonocytic

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Treatment forjuvenile myelomonocytic leukemiacan includesplenectomy,chemotherapy,andbone marrow transplantation.[73]

Prognosis

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The success of treatment depends on the type of leukemia and the age of the person. Outcomes have improved in the developed world.[10]The averagefive-year survival rateis 65% in the United States.[4]In children under 15, the five-year survival rate is greater (60 to 85%), depending on the type of leukemia.[13]In children with acute leukemia who are cancer-free after five years, the cancer is unlikely to return.[13]

Outcomes depend on whether it is acute or chronic, the specific abnormal white blood cell type, the presence and severity ofanemiaorthrombocytopenia,the degree of tissue abnormality, the presence ofmetastasisandlymph nodeandbone marrowinfiltration, the availability of therapies and the skills of the health care team. Treatment outcomes may be better when people are treated at larger centers with greater experience.[74]

Epidemiology

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Deaths due to leukemia per million persons in 2012
0–7
8–13
14–22
23–29
30–34
35–39
40–46
47–64
65–85
86–132

In 2010, globally, approximately 281,500 people died of leukemia.[75]In 2000, approximately 256,000 children and adults around the world developed a form of leukemia, and 209,000 died from it.[76]This represents about 3% of the almost seven million deaths due to cancer that year, and about 0.35% of all deaths from any cause.[76]Of the sixteen separate sites the body compared, leukemia was the 12th most common class ofneoplastic diseaseand the 11th most common cause of cancer-related death.[76]Leukemia occurs more commonly in thedeveloped world.[77]

United States

[edit]

About 245,000 people in the United States are affected with some form of leukemia, including those that have achieved remission or cure. Rates from 1975 to 2011 have increased by 0.7% per year among children.[78]Approximately 44,270 new cases of leukemia were diagnosed in the year 2008 in the US.[79]This represents 2.9% of all cancers (excluding simple basal cell and squamous cell skin cancers) in the United States, and 30.4% of allblood cancers.[80]

Among children with some form of cancer, about a third have a type of leukemia, most commonlyacute lymphoblastic leukemia.[79]A type of leukemia is the second most common form of cancer in infants (under the age of 12 months) and the most common form of cancer in older children.[81]Boys are somewhat more likely to develop leukemia than girls, and white American children are almost twice as likely to develop leukemia than black American children.[81]Only about 3% cancer diagnoses among adults are for leukemias, but because cancer is much more common among adults, more than 90% of all leukemias are diagnosed in adults.[79]

Raceis arisk factorin the United States.Hispanics,especially those under the age of 20, are at the highest risk for leukemia, whilewhites,Native Americans,Asian Americans,andAlaska Nativesare at higher risk thanAfrican Americans.[82]

More men than women are diagnosed with leukemia and die from the disease. Around 30 percent more men than women have leukemia.[83]

Australia

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In Australia, leukemia is the eleventh most common cancer.[84]In 2014–2018, Australians diagnosed with leukaemia had a 64% chance (65% for males and 64% for females) of surviving for five years compared to the rest of the Australian population–there was a 21% increase in survival rates between 1989–1993.[84]

UK

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Overall, leukemia is the eleventh most common cancer in the UK (around 8,600 people were diagnosed with the disease in 2011), and it is the ninth most common cause of cancer death (around 4,800 people died in 2012).[85]

History

[edit]
Photo of the upper body of a bespectacled man
Rudolf Virchow

Leukemia was first described by anatomist and surgeonAlfred-Armand-Louis-Marie Velpeauin 1827. A more complete description was given by pathologistRudolf Virchowin 1845. Around ten years after Virchow's findings, pathologistFranz Ernst Christian Neumannfound that the bone marrow of a deceased person with leukemia was colored "dirty green-yellow" as opposed to the normal red. This finding allowed Neumann to conclude that a bone marrow problem was responsible for the abnormal blood of people with leukemia.[86]

By 1900, leukemia was viewed as a family of diseases as opposed to a single disease. By 1947, Boston pathologistSidney Farberbelieved from past experiments thataminopterin,a folic acid mimic, could potentially cure leukemia in children. The majority of the children with ALL who were tested showed signs of improvement in their bone marrow, but none of them were actually cured. Nevertheless, this result did lead to further experiments.[87]

In 1962, researchers Emil J. Freireich, Jr. and Emil Frei III used combination chemotherapy to attempt to cure leukemia. The tests were successful with some people surviving long after the tests.[88]

Etymology

[edit]

Observing an abnormally large number of white blood cells in a blood sample from a person, Virchow called the conditionLeukämieinGerman,which he formed from the twoGreekwordsleukos(λευκός), meaning 'white', andhaima(αἷμα), meaning 'blood'.[89]It was formerly also calledleucemia.[90]

Society and culture

[edit]

According toSusan Sontag,leukemia was often romanticized in 20th-century fiction, portrayed as a joy-ending, clean disease whose fair, innocent and gentle victims die young or at the wrong time. As such, it was the cultural successor totuberculosis,which held this cultural position until it was discovered to be an infectious disease.[91]The 1970 romance novelLove Storyis an example of this romanticization of leukemia.[92]

In the United States, around $5.4 billion is spent on treatment a year.[93]

Research directions

[edit]

Significant research into the causes, prevalence, diagnosis, treatment, and prognosis of leukemia is being performed. Hundreds ofclinical trialsare being planned or conducted at any given time.[94]Studies may focus on effective means of treatment, better ways of treating the disease, improving the quality of life for people, or appropriate care inremissionor after cures.[95]

In general, there are two types of leukemia research: clinical ortranslational researchandbasic research.Clinical/translational research focuses on studying the disease in a defined and generally immediately applicable way, such as testing a new drug in people. By contrast, basic science research studies the disease process at a distance, such as seeing whether a suspected carcinogen can cause leukemic changes in isolated cells in the laboratory or how the DNA changes inside leukemia cells as the disease progresses. The results from basic research studies are generally less immediately useful to people with the disease.[96]

Treatment throughgene therapyis currently being pursued. One such approach used genetically modifiedT cells,known aschimeric antigen receptor T cells(CAR-T cells), to attack cancer cells. In 2011, a year after treatment, two of the three people with advanced chronic lymphocytic leukemia were reported to be cancer-free[97]and in 2013, three of five subjects who had acute lymphocytic leukemia were reported to be in remission for five months to two years.[98]Subsequent studies with a variety of CAR-T types continue to be promising.[99]As of 2018, two CAR-T therapies have been approved by theFood and Drug Administration.CAR-T treatment has significant side effects,[100]and loss of theantigentargeted by the CAR-T cells is a common mechanism for relapse.[99]The stem cells that cause different types of leukemia are also being researched.[101]

Pregnancy

[edit]

Leukemia is rarely associated with pregnancy, affecting only about 1 in 10,000 pregnant women.[102]How it is handled depends primarily on the type of leukemia. Nearly all leukemias appearing in pregnant women are acute leukemias.[103]Acute leukemias normally require prompt, aggressive treatment, despite significant risks ofpregnancy lossandbirth defects,especially if chemotherapy is given during the developmentally sensitivefirst trimester.[102]Chronic myelogenous leukemia can be treated with relative safety at any time during pregnancy withInterferon-alphahormones.[102]Treatment for chronic lymphocytic leukemias, which are rare in pregnant women, can often be postponed until after the end of the pregnancy.[102][103]

See also

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