It is a cancer that starts in blood-forming tissue, such as the bone marrow, and causes a large numbers of blood cells to be produced and enter the bloodstream.

 

Leukemia can be separated into two catagories, acute or chronic, depending on the pace the cancer cells grow. It is also categorized based on the origin of the cell type and how it develops.

 

The most common type of acute leukemia in adults is acute myelogenous leukemia (AML). Patient with AML requires treatment in a timely fashion because it can progress quickly.

 

Many patients with chronic lymphocytic leukemia (CLL) may not require treatment and can be simply followed for years without intervention. Certain patients with more aggressive chronic lymphocytic leukemia may require treatment with chemotherapy.

 

Patients with chronic myelogenous leukemia (CML) used to be treated with bone marrow transplant, which was the only therapy associated with a chance of cure, but was accompanied with serious toxicities. Approximately 10 years ago a drug called imatinib opened a new era of treatment for CML. This drug is very effective for CML and very few patients now require bone marrow transplant. Newer generation of drugs that can overcome resistance to imatinib are also available.

 

The online booklet What You Need To Know About™ Leukemia from NCI contains excellent information about the leukemia symptoms, diagnosis, treatment, and questions to ask the doctor.

Multiple myeloma is a cancer of blood cell called plasma cell. Normal plasma cells make antibodies to help defend body's immune system. However, when a normal plasma cell becomes bad, it can gradually evolve to become cancer cells that grow and divide and accumulate in the blood and bone marrow. The abnormal plasma cells do not have the normal function of a normal plasma cell and do not protect body's immune system. Rather, these cells can invade bone marrows and bones and often cause thinning of bones and sometimes lead to bone fracture.

Risk Factors

The exact causes of multiple myeloma are not clear. Most of patients are older than age 65. It appears highest among African Americans and lowest among Asian Americans. The reason for the difference between racial groups is not known. More men than women are diagnosed with multiple myeloma each year.

A patient has increased risk of developing multiple myeloma if found to have a condition called monoclonal gammopathy of undetermined significance (MGUS): MGUS is a benign condition in which abnormal plasma cells make M proteins. Usually, there are no symptoms, and the abnormal level of M protein is found with a blood test. Sometimes, people with MGUS develop certain cancers, such as multiple myeloma. There is no treatment, but people with MGUS get regular laboratory tests (every 1 or 2 years) to check for a further increase in the level of M protein. They also get regular exams to check for the development of symptoms.

Common symptoms of multiple myeloma include:

• Bone pain, usually in the back and ribs
• Broken bones, usually in the spine
• Feeling weak and very tired
• Feeling very thirsty
• Frequent infections and fevers
• Weight loss
• Nausea or constipation
• Frequent urination

Diagnosis by tests

Blood tests:

• Multiple myeloma causes high levels of proteins in the blood. The lab checks the levels of many different proteins, including M protein and other immunoglobulins (antibodies), albumin, and beta-2-microglobulin.
• Myeloma may also cause anemia and low levels of white blood cells and platelets. The lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets.
• The lab also checks for high levels of calcium.
• To see how well the kidneys are working, the lab tests for creatinine.

Urine tests:

The lab checks for Bence Jones protein, a type of M protein, in urine.

X-rays:

You may have x-rays to check for broken or thinning bones. An x-ray of your whole body can be done to see how many bones could be damaged by the myeloma.

Bone marrow aspiration is usually performed to make a diagnosis.

 

Treatment

Patients with multiple myeloma have many treatment options, including watchful waiting, induction therapy, and stem cell transplant, or a combination of these.
Radiation therapy is used to treatment an area of bone if a painful lesion is there.

The choice of treatment depends mainly on how advanced the disease is and how bad symptoms are. When a patient has multiple myeloma without symptoms (smoldering myeloma), he or she may not need cancer treatment right away. The doctor monitors your health closely (watchful waiting) so that treatment can start when you begin to have symptoms.

If a patient has symptoms, chemotherapy with one or more drugs may be used. Sometimes a stem cell transplant is part of the treatment plan.

When treatment for myeloma is needed, it is often effective in controlling the disease and its symptoms. Patients may receive therapy to keep the cancer in remission, but myeloma is usually not curable. However, there has been several drugs developed over the past several years that are effective in treating myeloma and patients with myeloma are doing better than before.

The myelodysplastic syndromes (MDS, formerly known as "preleukemia") are a collection of several blood conditions caused by ineffective production of blood cells from the bone marrow, with risk of transforming into acute myelogenous leukemia (AML).

 
In the early stage of MDS, many patients require observation only. In some cases, blood transfusion may be needed to maintain adequate levels of hemoglobin or platelets.

A particular type of MDS called 5q Deletion Syndrome, which is caused by the loss of the long arm of chromosome 5, often presents with anemia. A fairly effective drug called Lenalidomide, reduces the need for blood transfusion in these patients.

In most cases, the course of MDS is indolent and chronic with gradual deterioration of bone marrow function. There are other drugs that may be potentially beneficial.

Approximately one-third of patients with MDS evolve into acute myeloid leukemia (AML) within months to a few years.