Leukemia
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Evolution of Treatment for a Rare Type of Leukemia
Medical Author: Michael Lill,
MD
Medical Editor: Leslie
J. Schoenfield, MD, PhD
Medical Revising Editor: Melissa Conrad Stöppler, MD
 One
of my more vivid memories from the early days of my training in hematology
in Perth, Australia, is of the tragedy of a young girl with
acute promyelocytic leukemia (APL). This disease is a very serious, rare type of acute leukemia (cancer of the white blood cells). I admitted her to our
oncology floor in the hospital. A
teenager, she had been completely well
until one Sunday when she developed unusually
heavy menstrual bleeding. She saw her doctor in her small country town on
Monday, had a blood count done on Tuesday, and was flown up to us in Perth on Wednesday
with a diagnosis of acute (rapid
onset) leukemia. The next day, we performed a biopsy of the bone marrow that enabled us to confirm the
diagnosis. We immediately started chemotherapy but
that night she bled into her brain. Despite intensive medical efforts, including
brain surgery, she died the next morning.
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What is leukemia?
Leukemia is cancer that starts in the tissue that forms blood. To understand cancer, it helps to know how normal blood cells form.
Normal Blood Cells
Most blood cells develop from cells in the bone marrow called stem cells.
Bone marrow is the soft material in the center of most bones.
Stem cells mature into different kinds of blood cells. Each kind has a
special job:
White
blood cells help fight infection. There are several types of white blood cells.
Red
blood cells carry oxygen to tissues throughout the body.
Platelets help form
blood clots that control bleeding.
White blood cells, red blood cells, and platelets are made from stem cells as
the body needs them. When cells grow old or get damaged, they die, and new cells
take their place.
The picture below shows how stem cells can mature into different types of
white blood cells. First, a stem cell matures into either a myeloid stem cell or
a lymphoid stem cell:
- A myeloid stem cell matures into a myeloid blast. The blast can form a red
blood cell, platelets, or one of several types of white blood cells.
- A lymphoid stem cell matures into a lymphoid blast. The blast can form one of
several types of white blood cells, such as B cells or T cells.
The white blood
cells that form from myeloid blasts are different from the white blood cells
that form from lymphoid blasts.
Leukemia Cells
In a person with leukemia, the bone marrow makes abnormal white blood cells.
The abnormal cells are leukemia cells.
Unlike normal blood cells, leukemia cells don't die when they should. They
may crowd out normal white blood cells, red blood cells, and platelets. This
makes it hard for normal blood cells to do their work.
Next: What are the types of leukemia? »
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