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Leukemia

Leukemia
City of Hope is recognized internationally for its breakthrough treatments for leukemia and other blood disorders. City of Hope is one of the largest transplant centers in the country for the treatment of leukemia and has had some of the consistently best outcomes for the last five years. Designated a Comprehensive Cancer Center by the National Cancer Institute, City of Hope is acknowledged as a leader in cancer research and treatment.

City of Hope is actively pursuing tomorrow’s breakthrough treatments today. We have created new treatment protocols for:

Lymphoid Leukemias:

  • Acute lymphoblastic leukemia (ALL)
  • Chronic lymphocytic leukemia (CLL)
  • Hairy Cell Leukemia
  • Adult T cell leukemia/lymphoma (ATLL)
     
Myeloid Leukemias:
 
  • Acute myeloid leukemia (AML)
  • Chronic myelogenous leukemia (CML)

City of Hope was one of the pioneers in “mini” hematopoietic cell transplants that allow for transplantation in older patients. We offer the broadest range of therapeutic options available, including protocols developed here at City of Hope and funded in part by the National Institutes of Health. Through ongoing clinical trials, our physicians and researchers continue to lead the way in improving outcomes in leukemia patients.

City of Hope utilizes stem cell transplantation and pioneering approaches such as radioimmunotherapy and adoptive T cell therapy in treating leukemia patients. These methods augment the effectiveness of chemotherapy.  In fact, for many patients, a stem cell transplant offers a real chance at curing leukemia rather than just achieving remission.

City of Hope’s acclaimed leadership in stem cell transplantation ensures that patients receive the latest treatment protocols designed to maximize successful transplant engraftment, while minimizing rejection and debilitating side effects. Our many patients who have been cured of leukemia provide a living testament to the expertise of City of Hope physicians.
 

About Leukemia

Leukemia and other diseases of the blood and bone marrow may affect red blood cells, white blood cells and platelets.
 
Normally, the bone marrow makes blood stem cells, also called hematopoietic stem cells, immature cells that develop into mature blood cells over time. A blood stem cell may become a myeloid stem cell or a lymphoid stem cell.
 
The myeloid stem cell develops into one of three types of mature blood cells:
 
  • Red blood cells that carry oxygen and other materials to all tissues of the body
  • Granulocytes (white blood cells comprising three subtypes – eosinophils, neutrophils and basophils) that fight infection and disease
  • Platelets that help prevent bleeding by causing blood clots to form
 
 
The lymphoid stem cell develops into a lymphoblast cell and then into one of three types of lymphocytes (white blood cells):
 
  • B lymphocytes that make antibodies to help fight infection
  • T lymphocytes that help B lymphocytes make the antibodies that help fight infection
  • Natural killer (NK) cells that attack cancer cells and viruses.
 
Leukemia is a cancer of the blood and bone marrow in which abnormal, immature blood cells (lymphoid or myeloid) are produced in great quantities. These cells do not perform their normal functions, and are known as leukemic cells. The leukemic cells are malignant (cancerous) and crowd out normal blood cells, preventing them from fighting infection and causing serious problems which may be fatal if untreated.
 
Acute lymphoblastic leukemia (ALL)
Acute lymphoblastic leukemia (ALL), one of two major lymphoid leukemias, is the most common type of cancer in children, though it may also occur in adults. It is also referred to as acute lymphocytic or acute lymphoid leukemia.

In ALL, too many stem cells develop into lymphoblasts, which would ordinarily develop into mature lymphocytes. However, in ALL, these blasts do not ever fully develop. These abnormal cells are known as leukemic cells, and are not able to fight infection. As the number of leukemic cells increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells and platelets. This may cause infection, anemia and easy bleeding. The cancerous leukemic cells can also spread to the central nervous system (brain and spinal cord). ALL is an aggressive, acute leukemia, and progresses rapidly without treatment. However, modern combination chemotherapy protocols have made childhood ALL highly treatable, with remission achieved in a majority of patients.
 
  • Subgroups of Childhood ALL
    Four of the subgroups of childhood ALL are based on the type of blood cell that is affected, whether there are certain changes in the chromosomes, and age at diagnosis:
    • T cell ALL (most ALL is B cell in origin)
    • Philadelphia chromosome-positive ALL
    • ALL diagnosed in an infant
    • ALL diagnosed in children age 10 and older and adolescents (teenagers)

       
These subgroups are treated differently from other types of ALL.
 
 
Chronic lymphocytic leukemia (CLL)
Chronic lymphocytic leukemia (CLL) represents the other major form of lymphoid leukemia. CLL is the second most common type of leukemia in adults. It often occurs during or after middle age; it rarely occurs in children. As in ALL, too many blood stem cells develop into abnormal lymphocytes (leukemic cells) and do not become healthy white blood cells. These immature leukemic lymphocytes are not able to fight infection. Also, as the number of lymphocytes increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells and platelets. This may result in infection, anemia and easy bleeding.
 
Unlike ALL, however, CLL usually progresses slowly, and often requires no treatment initially. This is known as an “indolent” or “smoldering” variety of CLL. However, depending on the individual patient’s genetics, CLL may progress rapidly and have a poorer prognosis. In addition to a complete blood work-up, cytogenetic testing using the fluorescence in situ hybridization technique is recommended to determine the best course of treatment. Most CLL cases are known as B-CLL, meaning that the cancer derives from B lymphocytes. Much rarer is T-CLL, in which the leukemic cells are T cells rather than B cells.
 
Hairy cell leukemia
Hairy cell leukemia is a rare type of lymphoid leukemia often classified as a subtype of CLL, and is usually slow-growing. However, there is a variant (called HCL-V) which behaves more aggressively. The disease is called hairy cell leukemia because the leukemia cells look "hairy" when viewed under a microscope.
 
In hairy cell leukemia, as in other lymphoid leukemias, too many blood stem cells develop into lymphocytes. These lymphocytes are abnormal and do not become healthy white blood cells. They may also be called leukemic cells. The leukemic cells can build up in the blood and bone marrow so there is less room for healthy white blood cells, red blood cells and platelets. This may cause infection, anemia and easy bleeding. Some of the leukemia cells may collect in the spleen and cause it to swell.

Adult T cell leukemia/lymphoma (ATLL)
Adult T cell leukemia/lymphoma (ATLL) is a rare type of lymphoid leukemia in which T cells are the abnormal leukemic cells, rather than the B cells found in most lymphoid leukemias. ATLL is thought to be almost exclusively caused by infection with a retrovirus called human T cell lymphotropic virus (HTLV-1). ATLL may exist in both acute and chronic forms. The acute form progresses rapidly and has a poorer prognosis. It also has a smoldering form, in which the disease is more stable than the chronic form, and a lymphoma form, where the lymph nodes are involved to a greater extent than the blood.

Acute myeloid leukemia (AML)
Acute myeloid leukemia (AML) is one of two major types of myeloid leukemia. AML is also called acute myelogenous leukemia, acute myeloblastic leukemia, acute granulocytic leukemia or acute nonlymphocytic leukemia. It is the second most common type of leukemia in adults.
 
In AML, the myeloid stem cells usually develop into a type of immature white blood cell called myeloblasts (or myeloid blasts). The myeloblasts in AML are abnormal and do not become healthy white blood cells. These abnormal blasts are leukemic cells. Sometimes in AML, too many stem cells develop into abnormal red blood cells or platelets. These abnormal red blood cells or platelets are also called leukemia cells or blasts. The leukemia cells can build up in the blood and bone marrow so there is less room for healthy white blood cells, red blood cells and platelets. When this happens, infection, anemia or easy bleeding may occur.
 
The leukemia cells can spread outside the blood to other parts of the body, including the central nervous system (brain and spinal cord), skin (known as leukemia cutis) and gums. Sometimes leukemia cells form a solid tumor called a granulocytic sarcoma or chloroma (so-called because of its blue-green color). While these tumors may occur almost anywhere, the most common sites are the skin and gums.
 
AML is an aggressive disease, and commensurately aggressive treatment is required. This may include combination chemotherapy, radiation and/or bone marrow or stem cell transplantation.
 
  • Subtypes of Acute Myeloid Leukemia
    There are subtypes of acute myeloid leukemia (AML) based on the type of blood cell that is affected as well as specific genetic characteristics. Genetic mutations called translocations, in which a section of genes on one chromosome is literally swapped with a section of genes on a completely different chromosome, are quite prevalent in AML.
    • Acute promyelocytic leukemia (APL)
      Acute promyelocytic leukemia (APL), also called acute progranulocytic leukemia, results from the overaccumulation of immature myelocytes called progranulocytes. As with other forms of AML, a genetic translocation is thought to be the cause, with a section of chromosome containing a gene called RARA being translocated in this case. The RARA gene encodes for a receptor for retinoic acid, a derivative of vitamin A. This knowledge has led to APL being treated with all-trans-retinoic acid, to which it is uniquely sensitive and highly therapeutically responsive.
    • Juvenile myelomonocytic leukemia (JMML)
      Juvenile myelomonocytic leukemia (JMML) is a rare childhood cancer that occurs more often in children younger than two years. In JMML, too many bone marrow stem cells develop into two types of white blood cells called myelocytes and monocytes. Some of these bone marrow stem cells never become mature white blood cells. These immature cells, called blasts, are unable to do their usual work. Over time, the myelocytes, monocytes, and blasts crowd out the red blood cells and platelets in the bone marrow. When this happens, infection, anemia or easy bleeding may occur.
    • Transient myeloproliferative disorder (TMD)
      Transient myeloproliferative disorder (TMD) is a disorder of the bone marrow that can develop in newborns who have Down's syndrome. This disorder usually goes away on its own within the first three weeks of life. Infants who have Down's syndrome and TMD have an increased chance of developing AML before three years of age.
    • Myelodysplastic syndromes
      In myelodysplastic syndromes, the bone marrow makes too few red blood cells, white blood cells and platelets. These blood cells may not mature and enter the blood. The treatment for myelodysplastic syndromes depends on how much lower than normal the number of red blood cells, white blood cells or platelets is. Myelodysplastic syndromes may progress to AML.
    • Down's syndrome and AML
      Children with Down's syndrome and certain other genetic abnormalities such as neurofibromatosis type 1 have a much greater chance of developing AML, JMML, TMD and myelodysplastic syndrome. Most AML in Down's syndrome patients originates as some type of myelodysplasia. AML patients with Down's syndrome have two important characteristics: 1) they are significantly more responsive to chemotherapy than non-Down AML patients, and 2) their leukemic cells exhibit much greater sensitivity to a chemotherapy drug called cytosine arabinoside.
 
 
About Chronic Myelogenous Leukemia (CML)
In chronic myelogenous leukemia (CML), the other major form of myeloid leukemia, too many bone marrow stem cells develop into a type of white blood cell called granulocytes. Some of these bone marrow stem cells never become mature white blood cells. These immature cells are called blasts. Over time, the granulocytes and blasts crowd out the red blood cells and platelets in the bone marrow. CML is rare in children. The hallmark of CML is the presence of what is known as the Philadelphia chromosome, an abnormal chromosome containing an oncogene (cancer-causing gene). The course of this disease is much slower than with AML (hence the description “chronic.”) However, patients with advanced CML may experience what is known as a “blast crisis,” which resembles AML clinically, where there is a large and sudden proliferation of blasts. CML is also particularly responsive to a relatively new drug therapy called Gleevec.
 

Leukemia Risk Factors

Acute Lymphoblastic Leukemia (ALL)
 
 
  • Childhood ALL
    Possible risk factors include the following:
    • Having a brother or sister with leukemia
    • Caucasian or Hispanic descent
    • Exposure to X-rays before birth
    • Exposure to radiation
    • Past treatment with chemotherapy or other drugs that weaken the immune system. Certain types of chemotherapeutic drugs are known to be carcinogens (cause cancer) or leukemogens (cause leukemia) in their own right
    • Certain genetic disorders, such as Down's syndrome
       
  • Adult ALL
    Possible risk factors include the following:
    • Male gender
    • Caucasian descent
    • Older than 70 years of age
    • Past treatment with chemotherapy or radiation therapy. This is because certain chemotherapy drugs, particularly those known as alkylating agents, and ionizing radiation, while successfully treating a cancer initially, may produce a secondary malignancy such as leukemia
    • Treatment with Thorotrast (a commonly used contrast medium for diagnostic X-rays from the 1930s through the 1950s). Leukemia risk in patients exposed to just one injection of Thorotrast is over 20 times that of the normal population
    • Exposure to atomic bomb radiation or other ionizing radiation sources, e.g., workplace or other environmental contamination
    • Having certain genetic disorders such as Down's syndrome
People who think they may be at risk should discuss this with their doctor.
 
 
Chronic Lymphocytic Leukemia (CLL)
Risk factors for CLL include the following:
 
  • Being middle-aged or older (average age of diagnosis is 65-70)
  • Male gender
  • Caucasian
  • A family history of CLL or cancer of the lymph system
  • Having relatives who are Russian Jews or Eastern European Jews
  • Exposure to the herbicide Agent Orange
 
People who think they may be at risk should discuss this with their doctor.
 
Hairy Cell Leukemia
 
  • The cause of hairy cell leukemia is unknown. It occurs more often in older men.
 
Adult T Cell Leukemia/Lymphoma (ATLL)
Exposure to the HTLV-1 virus. The virus is more prevalent in Japan, the Caribbean, some parts of Central and South America, and the southeastern United States. Infection may result from:
 
  • Transfusions of blood or blood products
  • Intravenous drug use (sharing needles)
  • Sexual transmission (unprotected sex, particularly with multiple partners)
 
Acute Myeloid Leukemia (AML)
 
  • Childhood AML
    The risk factors for developing childhood AML, childhood chronic myelogenous leukemia, JMML, TMD, and myelodysplastic syndrome are similar. Possible risk factors include:
    • Having a brother or sister, especially a twin, with leukemia. Because these disorders often involve chromosome translocations, the same mutation may occur in genetically identical or similar individuals
    • Hispanic descent
    • Exposure to cigarette smoke or alcohol before birth. Cigarettes are known to contain benzene and other potent leukemogens
    • History of myelodysplastic syndrome (also called preleukemia) or aplastic anemia
    • Previous chemotherapy or radiation therapy
    • Exposure to ionizing radiation or chemicals such as benzene
    • Certain genetic disorders such as Down's syndrome, Fanconi anemia, neurofibromatosis type 1 or the congenital genetic condition Noonan's syndrome
       
  • Adult AML
    • Possible risk factors for adult acute myeloid leukemia include the following:
    • Male gender
    • Smoking, especially after age 60
    • Previous chemotherapy or radiation therapy
    • Previous treatment for childhood acute lymphoblastic leukemia (ALL). This treatment is likely to have included alkylating agents, which are themselves leukemogenic, and may thus cause secondary malignancies
    • Exposure to atomic bomb radiation or the chemical benzene
    • History of a blood disorder such as myelodysplastic syndrome
 
People who think they may be at risk should discuss this with their doctor.
 
 
Chronic Myelogenous Leukemia (CML)
 
Researchers are not sure of the cause of CML, although there has been some correlation with exposure to ionizing radiation
 

Leukemia Symptoms

Acute Lymphoblastic Leukemia (ALL)
The early signs of ALL may be similar to the flu or other common diseases. Symptoms include:
 
  • Weakness or feeling tired
  • Fever
  • Easy bruising or bleeding
  • Petechiae (flat, pinpoint spots under the skin caused by bleeding)
  • Shortness of breath
  • Weight loss or loss of appetite
  • Bone or joint pain
  • Pain or feeling of fullness below the ribs
  • Painless lumps in the neck, underarm, stomach, or groin
  • Leukemia cutis – multiple pink, red, red-brown or blue-to-violet skin lesions (papules, nodules or plaques) with a firm or rubbery consistency. These lesions form from dense infiltrates of leukemic cells into the skin. While patients with this symptom often have significant disease, leukemia cutis may be an early symptom, presenting even before the disease is detectable in blood or bone marrow.
 
Chronic Lymphocytic Leukemia (CLL)
Usually CLL does not cause any symptoms and is found during a routine blood test. Sometimes symptoms occur that may be caused by CLL or by other conditions. Symptoms include:

  • Painless swelling of the lymph nodes in the neck, underarm, stomach or groin
  • Feeling very tired
  • Pain or fullness below the ribs
  • Fever and infection; upper-respiratory tract infections, as well as outbreaks of shingles (a reactivated herpes virus), are common in CLL patients
  • Weight loss for no known reason
  • Leukemia cutis
 
Hairy Cell Leukemia
These and other symptoms may be caused by hairy cell leukemia. Other conditions may cause the same symptoms. Symptoms include:

  • Weakness or feeling tired
  • Fever or frequent infections
  • Easy bruising or bleeding
  • Shortness of breath
  • Weight loss for no known reason
  • Pain or a feeling of fullness below the ribs
  • Painess lumps in the neck, underarm, stomach or groin
  • Leukemia cutis
 
Adult T Cell Leukemia/Lymphoma (ATLL)
 
  • Weakness or feeling tired
  • Easy bruising or bleeding
  • Recurrent infections
  • Hypercalcemia (high blood calcium)
  • Unusual skin lesions or rashes (leukemia cutis)
  • Rheumatic-like symptoms
 
Acute Myeloid Leukemia (AML) and Chronic Myelogenous Leukemia (CML)
 
Possible signs of AML, CML, JMML or myelodysplastic syndromes include fever, feeling tired, and easy bleeding or bruising. Other conditions may cause the same symptoms. Symptoms include:

  • Fever with or without an infection
  • Night sweats
  • Shortness of breath
  • Weakness or feeling tired
  • Easy bruising or bleeding
  • Petechiae (flat, pinpoint spots under the skin caused by bleeding)
  • Pain in the bones or joints
  • Pain or feeling of fullness below the ribs
  • Painless lumps in the neck, underarm, stomach, groin or other parts of the body. Lumps or lesions on the skin, called leukemia cutis (see description above), may be red, blue or purple
 

Diagnosing Leukemia

It is essential to accurately diagnose a patient’s specific type of leukemia, as treatments depend on which type is involved.  City of Hope utilizes many tests to establish a leukemia diagnosis.

Tests include:
 
Complete blood count
This basic test obtains an accurate count of all the different types of blood cells. The hallmark of leukemia is an overabundance of white blood cells (leukocytes), and in some cases, this may be the first sign that alerts the doctor to the presence of leukemia. In chronic lymphocytic leukemia, characteristic cells called smudge cells (cells that rupture in the preparation of the blood smear) appear in significant numbers.
 
Bone marrow aspirate and biopsy
In this test, a needle is inserted into the hipbone or the sternum to obtain a small piece of bone and sample of bone marrow. A pathologist examines the samples under a microscope to classify the leukemia according to cell type and other parameters.
 
Lumbar puncture (spinal tap)
In some types of leukemia, doctors need to look for leukemia cells in cerebrospinal fluid surrounding the brain and spinal cord. After part of the lower back is numbed, some of the spinal cord fluid is withdrawn using a needle, and examined microscopically.
 
Cytochemistry and immunocytochemistry
Cytochemistry refers to using special stains and chemical reactions to differentiate between types of leukemia. Immunocytochemistry uses the same principle, employing antibodies to produce distinct color changes in the cell sample that allow the pathologist to identify the type of leukemia present.
 
Immunophenotyping
Immunophenotyping classifies cells according to their immunologic characteristics. This test uses monoclonal antibodies to more accurately determine the type of leukemia. The presence or absence of certain antigens, called CD antigens, cell surface markers expressed by leukocytes, is very useful in determining cell lineage (whether the leukemia derives from T cells or B cells), as well as in predicting whether the leukemia is likely to take an indolent or aggressive course. This is invaluable in devising treatment strategy.
 
Cytogenetics (chromosome analysis)
Since some leukemias, such as chronic myelogenous leukemia and acute myeloid leukemia, are caused by chromosomal translocations, getting a complete chromosome analysis may provide important diagnostic information.
 
Molecular testing, including polymerase chain reaction testing
This test examines genes in the leukemia cell. The presence of certain genes, called oncogenes, can help diagnose precisely what form of leukemia is present. For example, in chronic myelogenous leukemia, an oncogene called bcr-abl is often the determining factor in making a diagnosis.
 

Our Treatment Approach

Patients with acute leukemia usually require induction treatment to reduce symptoms and return blood counts and bone marrow to normal. Once remission is achieved, additional treatment is given to help prevent recurrence of the disease.

Patients with chronic types of leukemia may receive treatment, or they and their City of Hope leukemia team may decide to wait until symptoms appear before taking action.
 
 

Chemotherapy

Chemotherapy is the main treatment for all forms of leukemia. Because leukemia is a cancer of the blood, surgery is not an option as it is with solid tumors. As a result, chemotherapy uses powerful drugs to kill leukemic cells. The drugs target fast-dividing cells by disrupting critical parts of the cell cycle. Because cancer cells divide faster than normal cells, more cancer cells than normal cells are killed; however, a significant number of normal cells are damaged, which causes the many familiar side effects of chemotherapy. Chemotherapy may be given orally, intravenously through an IV or catheter, or into the cerebrospinal fluid. Most often, combinations of chemotherapy drugs are used to achieve the optimal therapeutic outcome.
 
City of Hope’s New Drug Development Program is actively developing and testing novel drugs and drug combinations designed to improve outcomes for all types of leukemia. Chemotherapy is usually given in cycles, sometimes starting with intensive induction treatment, which takes several days. This is followed by a few weeks without treatment, allowing the patient to recover from side effects, mostly related to lower blood counts. The sequence is then repeated.  Patients who achieve initial remission require additional treatment, usually given over a period of months (in chronic lymphocytic leukemia and acute myeloid leukemia) or years (in acute lymphoblastic leukemia and chronic myelogenous leukemia) in order to prevent recurrence.

Chemotherapy for Acute Leukemia

Treatment for acute leukemia is intensive and usually requires hospitalization.

Chemotherapy for Acute Lymphocytic Leukemia (ALL)

Induction chemotherapy for ALL usually involves a number of agents. The following is a common combination protocol:
 
  • L-asparaginase (Elspar) or PEG-L-asparaginase (pegaspargase, Oncaspar)
  • Daunorubicin, also known as daunomycin (Cerubidine)
  • Vincristine (Oncovin)
  • Prednisone (numerous brand names)
     
Post-remission therapy is determined by the patient’s adverse risk factors and will be determined via cytogenic and other genetic markers. If the patient’s leukemia falls in a low-risk group, Cytarabine consolidation therapy may be used. If the patient falls into a high-risk group, we would then recommend a stem cell transplant.

Chemotherapy for Acute Myelogenous Leukemia (AML)

Induction chemotherapy for AML usually involves a combination of two or three different anticancer drugs. One often-used combination is the following:
 
  • Daunorubicin, also known as daunomycin (Cerubidine) or idarubicin (Idamycin)
  • Cytarabine, also known as cytosine arabinoside or ara-C (Cytosar)
     
Post-remission therapy is determined by the patient’s adverse risk factors and will be determined via cytogenic and other genetic markers. If the patient’s leukemia falls in a low-risk group, Cytarabine consolidation therapy may be used. If the patient falls into a high-risk group, we would then recommend a stem cell transplant.

Chemotherapy for Chronic Leukemia

For patients with chronic leukemia, such as chronic myeloid leukemia (CML) or chronic lymphocytic leukemia (CLL), oral or intravenous drugs may often be given in an outpatient setting.

Chemotherapy for CML

First-line treatment for CML is either Nilotinib or Dasatinib.  Gleevac was the first recommended treatment for CML and works by targeting tyrosine kinase, the protein produced by a gene on the abnormal Philadelphia chromosome, which is a hallmark of CML. Recent studies have shown that Dasatinib and Nilotinib have improved the response rate and are now recommended as upfront therapy.
 
Follow-up care requires close monitoring of the VCR-ABLE response to treatment and making sure that certain landmarks are achieved. Patients are monitored to ensure they are not developing any mutations that might require a different therapy. If these treatments fail to work for a patient, he or she would be a candidate for a stem cell transplant.
 

Chemotherapy for CLL

Chemotherapy for chronic lymphocytic leukemia (CLL) is used when the course of the disease appears aggressive rather than indolent, based on factors such as blood counts, cytogenetics / fluorescence in situ hybridization (FISH) testing and symptoms.

New Approaches to CLL

Current upfront therapies and new approaches to CLL include:
 
 
  • Monoclonal antibody-targeted therapy monoclonal antibodies are increasingly being used in the treatment of CLL, including Rituximab(Rituxan), and a combination of fludarabine, cyclophosphamide and rituximab (FCR), or ritoxin and dendeamustine.

For recurrent diseases, we have numerous  clinical trials, including the use of Bruton’s tyrosine kinase inhibitors.

Beyond Chemotherapy: Advances in Treating Leukemia

City of Hope utilizes  stem cell transplantation and pioneering approaches such as radioimmunotherapy and adoptive T cell therapy in treating leukemia patients. These methods augment the effectiveness of chemotherapy.  In fact, for many patients, a stem cell transplant offers a real chance at curing leukemia rather than just achieving remission.
 
City of Hope’s acclaimed leadership in stem cell transplantation ensures that patients receive the latest treatment protocols designed to maximize successful transplant engraftment, while minimizing rejection and debilitating side effects.
 

Stem Cell Transplantation

Hematopoietic cell transplantation (HCT) and peripheral blood stem cell transplantation are therapeutic treatments that use stem cells (immature blood cells) to treat a patient's malignancy or repair diseased or defective bone marrow. Transplants are sometimes performed early in the course of treatment to improve outcomes. In some patients, they are utilized when other treatments are not working.
These transplant procedures include intensive chemotherapy, with or without radiation therapy, to destroy the cancerous cells. This is followed by an infusion of healthy new stem cells, which have the ability to grow back into the bone marrow and begin making normal blood cells again.

If a patient receives stem cells from a matched donor (using related, unrelated or cord blood), the transplant is called allogeneic. Like other tissue transplants, allogeneic stem cell transplants require a genetic match between the donor and recipient.

In allogeneic transplants, the donor is preferably a sibling. Alternatively, a matched unrelated donor who has a similar genetic type may be used. In fact, 45 percent of allogeneic transplants at City of Hope come from volunteer donors unrelated to the patient.
New alternative donor sources include cord stem cells obtained from a cord stem cell bank. These are cells that are cryopreserved and obtained from the umbilical cords of newborn babies.  Another option is a 50 percent match from the patient’s mother or father.

In some cases, a patient’s own stem cells may be used. This is called an autologous (self) transplant. First, stem cells are removed from the blood or bone marrow of the patient and stored. When the intensive chemotherapy and/or radiation are completed, the stem cells are then infused back into the patient. As these new stem cells grow, they restore the body's own blood cells.

In the transplant process, intensive chemotherapy also causes weakening of the immune system (immunosuppression). This helps to prevent the body’s rejection of the newly transplanted stem cells from a related or unrelated donor. In contrast, with autologous transplants, there is little risk of rejection of a patient's own stem cells.
 

Non-Myeloablative HCT

A new transplant procedure has been developed to treat patients with leukemia and myelodysplasia who are older or have underlying medical problems. Non-myeloablative HCT, also called “mini-HCT or “mini transplant,” involves less intensive chemotherapy and radiation treatments.

Researchers now understand that the immune cells created by the transplanted donor stem cells may recognize any remaining cancer cells in the patient as “foreign” and kill them, helping to fight the cancer. This mini-HCT strategy is showing great promise for leukemia and many other cancers and is being used to treat patients into their 80s. Chronic lymphocytic leukemia (CLL), as an example, cannot be cured without a successful stem cell transplant. Because CLL patients are often older than 70, mini-HCT has provided a viable and powerful treatment option in patients with aggressive or late-stage disease.

Radioimmunotherapy

City of Hope has developed novel ways of delivering radiation utilizing monoclonal antibodies. These antibodies (part of the immune system) can be combined with small amounts of radioactive substances. When administered to the patient, they seek out cancer sites and deliver high-dose radiation directly, while minimizing damage to normal tissues and toxicity to the patient.

Adoptive T Cell Therapy

T-cells are a powerful part of the immune system. A new approach being studied at City of Hope involves redirecting T cells to recognize leukemia cells and destroy them. By targeting microscopic traces of disease, treatment with adoptive T cells may help prevent a relapse. Trials with T cells to treat acute lymphoblastic leukemia are ongoing at City of Hope.

Radiation Therapy

Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells. Our Department of Radiation Oncology was the first in the western United States to offer the Helical TomoTherapy Hi-Art System, one of the first radiation therapy systems of its kind to incorporate not only radiation therapy, but also tumor imaging capabilities comparable to a diagnostic computed tomography (CT) scan.
 
Two types of technology are integrated – spiral CT scanning and intensity modulated radiation therapy (IMRT) – producing hundreds of pencil beams of radiation (each varying in intensity) that rotate spirally around a tumor. The high-dose region of radiation can be shaped or sculpted to fit the exact shape of each patient’s tumor, resulting in more effective and potentially curative doses to the cancer. This also reduces damage to normal tissues and results in fewer complications.

Leukemia Resources

All of our leukemia patients have access to the Sheri & Les Biller Patient and Family Resource Center , which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.

Additional Resources

The Leukemia & Lymphoma Society
800-955-4572
The Leukemia & Lymphoma Society is the world's largest voluntary health organization dedicated to funding blood cancer research, education and patient services. The society's mission: cure leukemia, lymphoma, Hodgkin's disease and myeloma, and improve the quality of life of patients and their families.

American Cancer Society
800-ACS-2345
866-228-4327 for TYY
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.
 
National Bone Marrow Transplant Link
248-358-1886

National Comprehensive Cancer Network (NCCN)
888-909-NCCN (6226)
The National Comprehensive Cancer Network, an alliance of 21 of the world's leading cancer centers, is an authoritative source of information to help patients and health professionals make informed decisions about cancer care.

National Cancer Institute (NCI)
800-4-CANCER
The National Cancer Institute is the federal government's principal agency for cancer research and training.
 
U.S. Dept. of Health & Human Services National Institutes of Health (NIH)
301-496-4000
301-402-9612 for TYY
The National Institutes of Health (NIH) is one of the world's foremost medical research centers, and the federal focal point for medical research in the United States. The NIH, comprising 27 separate institutes and centers, is one of eight health agencies of the Public Health Service, which, in turn, is part of the U.S. Department of Health & Human Services.

 

 

Research/Clinical Trials

  • City of Hope is a leader in leukemia research, committed to bringing the latest scientific findings into clinical practice as quickly as possible. With our extensive number of clinical trials, patients here have access to novel treatments available only at City of Hope.
 
  • Our current focus in leukemia research is a better understanding of leukemia stem cells in order to develop cures for leukemia and other hematologic malignancies. Because recent studies have demonstrated that leukemia stem cells cause leukemia, the objective must now be to eradicate leukemia stem cells, rather than just the mature leukemia cells addressed by current therapies. Eradication of the leukemia stem cells may actually produce cures.

Learn more about our clinical trials program and our leukemia clinical trials.
 

Leukemia Team

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.


For more information on supporting this specific program, please contact us below.

Dr. Tina Pakfar
Vice President
Direct: 213-241-7216
Email: tpakfar@coh.org

 
 
Meet our doctors: Hematologist Leslie Popplewell on clinicaltrials

Meet our doctors: Hematologist Leslie Popplewell on clinical trials

Research studies known as clinical trials have led to countless advances in the diagnosis, treatment and prevention of cancer. These studies test the effectiveness of new medical approaches that can l...

March 2, 2014

 
New CMV vaccine targets virus affecting third of transplantpatients

New CMV vaccine targets virus affecting third of transplant patients

In most healthy adults, the immune system wages a winning battle against a virus that infects up to 80 percent of the population by age 40. Most never even know they have cytomegalovirus, or CMV....

February 3, 2014

 
‘My cancer diagnosis: What I wish I’d known’ – Bishop J. JonBruno

‘My cancer diagnosis: What I wish I’d known’ – Bishop J. Jon Bruno

Bishop J. Jon Bruno will be one of 11 former City of Hope patients riding atop our float on New Year’s Day. Read other riders’ stories and learn more about the float, “Turning Hope and Dream...

December 23, 2013

 
Exploring cognitive decline after hematopoietic celltransplant

Exploring cognitive decline after hematopoietic cell transplant

Hematopoietic cell transplant patients who undergo what’s known as myeloablative conditioning (that is, high-intensity chemotherapy and radiation) – and who have shorter telomeres (chromosome “en...

December 17, 2013

 
Leukemia diagnosis made Bishop J. Jon Bruno see his trueimpact

Leukemia diagnosis made Bishop J. Jon Bruno see his true impact

Bishop J. Jon Bruno will be one of 11 former City of Hope patients riding atop our float on New Year’s Day. Read other riders’ stories and learn more about the float, “Turning Hope and Dreams into Rea...

December 16, 2013

 
Videos
 
Watch patient stories and other videos highlighting City of Hope's Leukemia Program, treatments and research.
Refer a Patient
Physicians can choose a number of options to refer a patient:

  • Call 800-826-HOPE (4673) to speak with a patient referral specialist.
  • Fax the patient face sheet to 626-301-8432
  • Complete an online callback request form
 
Hematologic Cancers Support Groups
City of Hope is committed to making the process of becoming a patient here as easy as possible. Call 800-826-HOPE (4673) or complete the Schedule a Callback form.
The focus of the Division of Hematopoietic Stem Cell and Leukemia Research is to improve the understanding of leukemia stem cells in order to develop cures for leukemia and other hematologic malignancies.
NEWS & UPDATES
  • Cancer cells may be known for their uncontrollable growth and spread, but they also differ from normal tissue in another manner: how they produce energy. In healthy cells, energy is derived primarily from aerobic respiration, an oxygen-requiring process that extracts the maximum possible energy from glucose, or...
  • Clinical trials are expensive and complex, but they’re essential for bringing new therapies to patients. Edward Newman, Ph.D., associate professor of molecular pharmacology, just boosted City of Hope’s ability to conduct those studies with a five-year, $4.2 million grant from the National Cancer Institute...
  • Meet City of Hope’s new chair of the Department of Surgery – esteemed pancreatic and hepatobiliary surgeon, researcher and author Yuman Fong, M.D. As one of today’s most respected and recognizable physicians in the treatment of cancers of the liver, bile duct, gallbladder and pancreas, Fong has pioneered and en...
  • For most of her life, Southern California teenager Kayla Saikaly described herself as healthy, even very healthy. She played basketball. She never missed school with as much as a fever. Her worst childhood illness was nothing more than a cold. Then, when she was 13, her nose started bleeding after a basketball ...
  • Neuroblastoma is one of the deadliest childhood cancers, accounting for 15 percent of pediatric cancer deaths. For patients with high-risk neuroblastomas, the five-year survival rate is 40 to 50 percent even with the most rigorous treatments available today. But those odds may improve soon, thanks to a new comp...
  • For breast cancer survivors, a common worry is a recurrence of their cancer. Currently, these patients are screened with regular mammograms, but there’s no way to tell who is more likely to have a recurrence and who is fully cleared of her cancer. A new blood test – reported in Cancer Research, a journal of the...
  • Metastasis — the spreading of cancer cells from a primary tumor site to other parts of the body — generally leads to poorer outcomes for patients, so oncologists and researchers are constantly seeking new ways to detect and thwart this malicious process. Now City of Hope researchers may have identified a substa...
  • Deodorant, plastic bottles, grilled foods, artificial sweeteners, soy products … Do any of these products really cause cancer? With so many cancer myths and urban legends out there, why not ask the experts? They can debunk cancer myths while sharing cancer facts that matter, such as risk factors, preventi...
  • Cancer risk varies by ethnicity, as does the risk of cancer-related death. But the size of those differences can be surprising, highlighting the health disparities that exist among various ethnic groups in the United States. Both cancer incidence and death rates for men are highest among African-Americans, acco...
  • George Winston, known worldwide for his impressionistic, genre-defying music, considers music to be his first language, and admits he often stumbles over words – especially when he attempts languages other than English. There’s one German phrase he’s determined to perfect, however: danke schön. Winston thinks h...
  • Few decisions are more important than those involving health care, and few decisions can have such lasting impact, not only on oneself but on relatives and loved ones. Those choices, especially, should be made in advance – carefully, deliberately, free of pain and stress, and with much weighing of values and pr...
  • Using a card game to make decisions about health care, especially as those decisions relate to the end of life, would seem to be a poor idea. It isn’t. The GoWish Game makes those overwhelming, but all-important decisions not just easy, but natural. On each card of the 36-card deck is listed what seriously ill,...
  • Young adults and adolescents with cancer face unique challenges both during their treatment and afterward. Not only are therapies for children and older adults not always appropriate for them, they also must come to terms with the disease and treatment’s impact on their relationships, finances, school or ...
  • Breast cancer is the most common cancer, other than skin cancer, among women in the United States. It’s also the second-leading cause of cancer death, behind lung cancer. In the past several years, various task force recommendations and studies have questioned the benefits of broad screening guidelines fo...
  • Paternal age and the health effects it has on potential offspring have been the focus of many studies, but few have examined the effect parental age has on the risk of adult-onset hormone-related cancers (breast cancer, ovarian cancer and endometrial cancer). A team of City of Hope researchers, lead by Yani Lu,...