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Blood cell creation
The body produces millions of blood cells each day. Most develop in the bone marrow, the spongy interior of bones that contains immature stem cells.
In a healthy person, these immature stem cells first become either lymphoid stem cells or myeloid stem cells.
Lymphoid stem cells develop into white blood cells, which are immune system cells. They start by becoming immature white blood cells known as lymphoblasts, then mature into lymphocytes. The two types of lymphocytes that are usually involved in leukemia are B cells and T cells. B cells produce the antibodies responsible for attacking bacteria and viruses that invade the body. T cells help alert other immune cells to the presence of infection or fight infection directly.
Myeloid stem cells also develop into white blood cells. The myeloid stem cells first become immature white blood cells known as myeloblasts. They then mature into monocytes and granulocytes, including neutrophils, all of which fight disease. Other myeloid stem cells develop into red blood cells, which carry oxygen throughout the body; and platelets, which help the blood clot.
Leukemia occurs when the DNA (the genetic instructions that control cell activity) of a bone marrow stem cell mutates at some point in its development. The cell becomes cancerous, begins multiplying rapidly and crowds out healthy cells in the blood and bone marrow. These diseased cells can also gather in specific parts of the body, including the liver, lymph nodes, spleen and skin.
How is leukemia classified?
While there are many types of leukemia, they are typically classified by the type of stem cell that has turned cancerous, either lymphoid or myeloid.
Many types are also classified as either chronic or acute. Acute leukemia impacts immature cells, preventing them from developing and carrying out their function. These cells tend to multiply rapidly, making acute leukemia more aggressive.
Chronic leukemia involves mature or partially mature cells. These cells multiply more slowly and are less aggressive, making chronic leukemia less aggressive than acute leukemia.
Types of leukemia
CLL is a slow-growing type of leukemia. It develops from lymphoid stem cells that are further along in their development than ALL cells. This disease primarily impacts older patients and is nearly unheard of in children. Learn more about CLL.
CML grows from more mature myeloid stem cells. It is a slower growing form of leukemia. Treatment for the disease has advanced rapidly over the past few decades. It is rare in children and is usually diagnosed in older adults. Learn more about CML.
B-PLL is a rare leukemia developing from B cells, a type of white blood cell, that rapidly multiply. The disease can be difficult to diagnose and is often confused with other bone marrow and blood cancers, including different leukemias and lymphomas.
The disease is typically aggressive, though around 10% of patients do not have any symptoms when they are diagnosed. Instead of immediate treatment, in some cases doctors recommend active surveillance, in which the disease is closely monitored. Treatment begins when the disease advances to a set point.
BPDCN is an aggressive subtype of acute leukemia that impacts approximately 500 to 1,000 people in the U.S. each year. Though it can affect people of any age, the disease is most common among older patients, with about half of new diagnoses coming in patients age 70 or older. Historically, it has been associated with poor survival rates.
BPDCN is a cancer of a specific type of cell known as plasmacytoid dendritic cells. This rare type of immune system cell is usually found in the skin, bone marrow, blood, lymph nodes and spleen. As a result, symptoms usually can impact these areas. Skin lesions are the most common BPDCN symptom. These can show up anywhere on the body but often appear on the arms, legs, face and neck. Other symptoms include low counts of healthy blood cells and swollen lymph nodes.
Traditionally, BPDCN has been treated with chemotherapy, while younger, fitter patients have been given the option of a stem cell transplant. The Food and Drug Administration has recently approved a new targeted therapy drug that attacks CD123, a molecule commonly found on the surface of BPDCN cells. This targeted therapy is now considered a standard treatment for the disease. Learn more about BPDCN.
CMML is a rare, slow-growing type of leukemia that mainly impacts people in their 60s and older. Patients with CMML have low counts of healthy blood cells and high counts of diseased monocytes. Monocytes are a type of white blood cell that helps other immune system cells respond to infection. They also surround and consume bacteria that invade the body.
About 1,100 CMML cases are diagnosed in the U.S. each year. In 15% to 30% of patients, the disease will progress to acute myeloid leukemia.
CMML is typically treated with stem cell transplantation, which can cure the disease, or chemotherapy, which can’t cure the disease but can kill cancer cells and make room for healthy blood cells to develop. To address low blood counts, patients can also receive blood transfusions and drugs that stimulate the growth of healthy blood cells.
In hairy cell leukemia, lymphoid stem cells produce too many diseased B cells. These cells have thin growths on their surface that look like hairs, giving the disease its name. The disease typically is diagnosed in patients age 50 and older and is more likely to arise in males.
Hairy cell leukemia is typically slow to develop and progress. In some cases, it may never progress at all. Because of this, doctors often recommend active surveillance in which they closely monitor the disease. Other treatments include chemotherapy, immunotherapy and targeted therapy.
Juvenile myelomonocytic leukemia (JMML) is a rare type of leukemia, mostly found in children age 4 and younger. In JMML, the diseased cells are monocytes, a type of white blood cell. JMML is faster growing than chronic leukemia and slower growing than acute. It shares many symptoms with other types of leukemia, including a pale complexion, fever and infections.
Since JMML cells gather in certain organs, symptoms can also include an enlarged spleen and difficulty breathing caused by cancer cells accumulating in the lungs. A stem cell transplant is the recommended treatment for JMML, though about half of patients who undergo a successful transplant relapse.
LGLL is a rare leukemia that develops from mature T cells or natural killer (NK) cells. Both are lymphocytes, white blood cells that help fight disease.
In LGLL, the diseased T cells or NK cells begin to multiply rapidly, crowding out healthy cells.
This leukemia is primarily diagnosed in older patients. In about 20% of cases, the patient also has an autoimmune disorder such as rheumatoid arthritis.
Though the NK cell version can be more aggressive than the T cell version, LGLL in general is slow growing. Because of this, doctors may recommend active surveillance, in which the disease is closely monitored, instead of immediate treatment. Treatment begins when the disease advances to a set point.
Because LGLL involves the overproduction of immune system cells, it is often treated with drugs meant to suppress the immune system. Chemotherapy is another treatment option. Patients are also given medicines to treat cytopenias, or low counts of healthy blood cells.
T-cell prolymphocytic leukemia is an aggressive, extremely rare form of leukemia involving T-lymphoid stem cells.
The cause of T-PLL is not known, but recent research has uncovered several chromosome and genetic abnormalities associated with the disease. These abnormalities can be used to help diagnose T-PLL and could lead to the development of new treatments for the disease.
Much like CLL, T-PLL can be slow growing when it is first diagnosed. In most cases, though, it progresses to a more advanced, aggressive disease. Symptoms include high white blood cell counts; enlarged lymph nodes, liver and spleen; rashes; and an accumulation of fluid around the lungs and heart.
The recommendation for early, slow-growing T-PLL is active surveillance. During this phase, the patient does not receive treatment, but is closely monitored for signs that the disease is advancing. When these signs develop, T-PLL needs to be treated rapidly, often in the hospital.
While there are no medications specifically approved for T-PLL, a monoclonal antibody drug produces a high response rate. Doctors recommend a stem cell transplantation for patients who are in remission and eligible for the procedure.
Leukemia risk factors
- Sex: Men are more likely to develop leukemia than women.
- Age: Most types of leukemia impact older adults, though some are common among pediatric patients.
- Past treatment with chemotherapy or radiation therapy for a previous cancer: While these therapies can cause leukemia, their benefits as cancer treatments far outweigh their risks.
- Family history: People with a parent, sibling or child who have certain types leukemia are more likely to develop the disease.
- Myeloproliferative neoplasms (MPNs): MPNs are chronic cancers of the bone marrow and blood. While they are not classified as leukemia, MPNs (especially myelofibrosis) can transform to acute myeloid leukemia. MPNs are treated in the Leukemia Center by our experts at the Clinical Research Center for Myeloproliferative Neoplasms. Learn more about MPNs.
- Genetic disorders: Individuals with certain genetic disorders are at a higher risk of developing leukemia. These include:
- Ataxia telangiectasia
- Bloom syndrome
- Down syndrome
- Fanconi anemia
- Klinefelter syndrome
- Li-Fraumeni syndrome, a hereditary cancer syndrome
- Wiskott-Aldrich syndrome
- Chemical exposure: Long-term exposure to benzene, a chemical used in the petroleum industry, can cause leukemia. People who have been exposed to Agent Orange, which was used in the Vietnam War, are also at an increased risk for leukemia.
- Radiation exposure: After World War II, people in Japan who were exposed to radiation from nuclear bombs were more likely to develop leukemia. People who have been exposed to radiation through accidents at nuclear power plants also have a higher chance of developing leukemia.
Some cases of leukemia can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
Why choose MD Anderson for your leukemia treatment?
Choosing the right cancer center may be the most important decision you can make as a leukemia patient. At MD Anderson’s Leukemia Center and Stem Cell Transplantation and Cellular Therapy Center, you’ll get treatment from one of nation’s the largest, most experienced leukemia teams at a top-ranked cancer center.
Using a comprehensive team approach, we work together to give you customized care that includes the most advanced diagnostic methods and treatments. These include clinical trials of new drugs and drug combinations. We offer clinical trials for all situations – from patients receiving their first treatment, to patients who have exhausted all standard treatment options.
As a leading center for leukemia care, we offer access to innovative new therapies and clinical trials that may help increase your chances for successful treatment. Many of these were developed by our own researchers.
We are constantly striving to find new and better ways to fight leukemia. We are one of the few cancer centers in the nation to house a prestigious federally-funded SPORE (Specialized Program of Research Excellence) focused on leukemia. We offer a wide range of clinical trials and innovative, advanced leukemia treatment for all patients who seek care at MD Anderson.
Treatment designed specifically for you
Successful leukemia treatment begins with accurate and precise diagnosis. Many of our leukemia patients have been misdiagnosed before they come to MD Anderson. We have the expertise and experience gained from being one of the most active programs in the world, and our specialized pathologists are highly skilled in diagnosing leukemia.
Our approach to leukemia is customized especially for you. We carefully evaluate your risk factors and the specific characteristics of your leukemia to determine if immediate treatment is necessary. If it is, we recommend the most effective therapies while aiming to limit treatment side effects.
Whether you are treated as an inpatient or outpatient, our comprehensive program offers all the services needed to care for leukemia and respond to its impact on your body. We aim to accomplish as much care as possible on an outpatient basis. If hospitalization is needed, our expert staff is specially trained to care for patients at every phase of the treatment journey.
MD Anderson is my hope. I know that without it, I wouldn’t be alive today.
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Many cancers can be prevented with lifestyle changes and regular screening.
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