Leukemia

Adult Onset Leukemia

We distinguish adult onset leukemia from pediatric because the diseases and their treatments are different. Today, childhood leukemia patients have a very high rate of response and cure; while the adult forms of this disease continue to pose more difficult challenges. For that reason, we focus our testing on adult leukemia forms.

Leukemia is a group of diseases that affect the development of blood cells in the bone marrow. The type of cell affected and the rate of cell growth determine the leukemia type.

Types of Leukemia

Acute Lymphocytic (Lymphoblastic) Leukemia (ALL) is the most common type of leukemia in children, but it also occurs in adults. ALL is caused by an overproduction of immature lymphocytes. In adults, the risk of developing this disease increases after age 50.

Acute Myelogenous (Myelocytic, Myeloblastic, Myeloid or granulocysts) Leukemia (AML) affects the granulocytes in the bone marrow. In AML, these cells do not mature normally. The bone marrow becomes filled with blasts, which inhibit the production of normal cells. This is the most common form of adult onset leukemia.

Chronic Lymphocytic (Lymphoblastic) Leukemia (CLL) is the second most common type of adult onset leukemia and is found most often after age 50. This type occurs when the bone marrow and lymph organs produce too many mature lymphocytes. Their overabundant production crowds out other cells and can collect in the blood, bone marrow, spleen and lymph node tissue. CLL typically progresses slowly and can take years to display any symptoms.

Hairy Cell Leukemia (HCL) is a rare subtype of CLL.

Chronic Myelogenous (Myelocytic, Myeloblastic, Myeloid or Granulocytic) Leukemia (CML) occurs in people with an acquired genetic abnormality that causes a portion of one chromosome to break off and re-attach to another chromosome. This exchange, called a translocation is known as the Philadelphia chromosome.

This mutation is found only in blood-forming cells and is not inherited. The resulting transformation prohibits normal growth of myeloid cells, which causes the bone marrow to accumulate too many white blood cells and platelets, but may decrease the amount of red blood cells. The disease presents in a slow growing form known as chronic phase but then progresses to accelerated and blastic stages over time.

Common Treatments for Leukemia

The first-line of treatment for ALL and AML is chemotherapy and for recurrent cases, some oncologists recommend bone marrow transplants. With CLL, chemotherapy and radiation therapies are also employed, with some professionals recommending blood and bone marrow transplantation.

Interferon oral Hydrea (hydroxyurea) and oral Myleran (busulfan) were the first treatments for CML. But with the cause of CML now known, researchers have developed a targeted therapy called Gleevec (imatinib), which focuses on the aberrant protein. This therapy must be taken continuously in order to be effective. Some physicians recommend transplantation for younger patients with this disease.

Leukemias are among the most chemo-responsive forms of cancer. While the specific drug combinations vary by disease type, the anthracyclines (doxorubicin, daunorubicin and idarubicin) plus cytarabine are widely used in both AML and ALL, while methotrexate, L-asparaginase, prednisone and vincristine are widely used only in ALL. In CLL, fludarabine, rituxan and alkylating agents like cytoxan and chlorambucil are mainstays of therapy.

These protocols, developed over years of clinical trials, assign patients to the drugs for which they have the greatest statistical probability of response. The fact that all patients with leukemia have an equal likelihood of response to a drug does not mean they will respond equally.

Nagourney Cancer Institute exposes living cancer cells, obtained from your blood sample, to a variety of chemotherapy drugs and novel compounds. A treatment regimen is recommended based on actual observed patterns of cell death.

Leukemia Patient Story

After enduring six occurrences and treatments for Hairy Cell Leukemia, Glenn found Dr. Nagourney and Rational Therapeutics (now Nagourney Cancer Institute) while searching the Internet in 2014.

"The idea of testing your own cancer cells and coming up with drug choices which would be most effective with my stubborn cancer seemed amazing and sensible. 

I finally realized that no matter who my oncologist was, they were all just guessing on what might work for me.  I was tired of all these guesses.  

Meeting with Dr. Nagourney was different than other oncologists I had worked with.  He took his time and spent over one hour with me.  I learned more about possible treatment options for my cancer than I had ever heard of working with other oncologists over the years.   I became optimistic!

Well, I didn’t have to wait long for my leukemia to come rushing back.  In November 2015, I found my chance to have Dr. Nagourney test my leukemia cells."

CLICK HERE TO READ MORE OF GLENN'S STORY 

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How We Test Your Cancer

Currently, hundreds of drugs, drug combinations and targeted agents are used to treat cancer patients. With so many choices, how does your oncologist decide which ones are right for you?