1. Leukemia
Cancer of the Blood

2. What is Leukemia?
Leukemia is a type of cancer that starts in the blood- forming tissue, such as the bone marrow, and causes large numbers of blood cells to be produced and enter the blood stream very quickly. Leukemia usually starts in the white blood cells; the bone marrow starts to make a lot of abnormal white blood cells, called leukemia cells. Your white blood cells are potent infection fighters — they normally grow and divide in an orderly way, as your body needs them. But in people with leukemia, the bone marrow produces abnormal white blood cells, which don't function properly. Leukemia cells can crowd out the normal blood cells and can lead to anemia, bleeding, and infections; also, leukemia can spread to the lymph nodes or other organs and cause swelling or pain.
(Sources 1,2,3,6)

3. What are white blood cells?
White blood cells, also known as leukocytes, help fight infections and, in general, help the immune system. There are two basic types of leukocytes: granulocytes which process granules, and granulocytes which lack granules. White blood cells are formed from undifferentiated stem cells called hematopoietic stem cells. The hematopoietic stem cells are self-generating and renew themselves throughout your life. They produce extraordinary quantities of blood cells. White blood cells are your primary defense against infection and tissue damage. They are called effector cells and not only kill unwanted organisms, but also act like scavengers to get rid of damaged cells. The leukocytes (white blood cells) get around by what is called ameboid movement and can penetrate tissue to control problems and then later return to the blood stream. (Source 12)

4. What is Bone Marrow?
Bone marrow is the soft, spongy, inner part of bones, such as your hip and thigh bones. All of the different types of blood cells are made in the bone marrow. Bone marrow includes blood-forming cells, fat cells and tissues that aid the growth of blood cells. It is the place where new blood cells are produced. it contains immature cells, called stem cells. The stem cells can develop into the red blood cells that carry oxygen through your body, the white blood cells that fight infections, and the platelets that help with blood clotting. When you are healthy, your bone marrow makes: White blood cells, which help your body fight infection. Red blood cells, which carry oxygen to all parts of your body. Platelets, which help your blood clot. When you have leukemia, the bone marrow starts to make a lot of abnormal white blood cells, called leukemia cells. (sources 1, 6, 9)

5. What is the lymphatic system?
The lymphatic system is an extensive drainage network that helps keep bodily fluid levels in balance and defends the body against infections. (source 10)

6. How do you get/prevent leukemia?
No one knows the cause of leukemia, but there are a few risks that can increase your odds of getting it.
Previous cancer treatments
genetic disorders (such as Down syndrome)
Smoking
Radiation
drugs with alkalating agents (common in chemotherapy)
exposure to chemicals
family history of leukemia
(source 1,2,6)

7. How do you Classify Different types of Leukemia?
Doctors classify leukemia based on its speed of progression and the type of cells involved. There are several different types of leukemia. In general, leukemia is grouped by how fast it gets worse and what kind of white blood cell it affects.
It may be acute or chronic. Acute leukemia gets worse very fast and may make you feel sick right away. Chronic leukemia gets worse slowly and may not cause symptoms for years.
It may be lymphocytic or myelogenous. Lymphocytic (or lymphoblastic) leukemia affects white blood cells called lymphocytes. Myelogenous leukemia affects white blood cells called myelocytes.
Chronic Lymphocytic Leukemia most often occurs in those older than age 55 and almost never in children
Chronic Myeloid Leukemia affects mainly adults
Acute Lymphocytic Leukemia most common type of leukemia in young children but also may affect adults
Acute Myeloid Leukemia occurs in both adults and children
(source 1, 2, 6)

8. What are symptoms of leukemia?
Symptoms may depend on what type of leukemia you have, but common symptoms include:
Fever and night sweats.
Persistent fatigue, weakness
Headaches.
Bruising or bleeding easily. (bleeding gums, purplish patches in the skin or tiny red spots under the skin)
Bone or joint pain.
Swollen lymph nodes in the armpit, neck, spleen, liver, or groin.
A swollen or painful belly from an enlarged spleen.
Getting a lot of infections.
Feeling very tired or weak.
Losing weight and not feeling hungry.
Tiny red spots in your skin (petechiae) (source 1, 2, 6)

9. How does your doctor know if you have Leukemia?
Make an appointment with your doctor if you have any persistent signs or symptoms that worry you. Leukemia symptoms are often vague and not specific. You may overlook early leukemia symptoms because they may resemble symptoms of the flu and other common illnesses. Rarely, leukemia may be discovered during blood tests for some other condition.
To find out if you have leukemia, a doctor will:
Ask questions about your past health and symptoms.
Do a physical exam. The doctor will look for swollen lymph nodes and check to see if your spleen or liver is enlarged.
Order blood tests. Leukemia causes a high level of white blood cells and low levels of other types of blood cells.
If your blood tests are not normal, the doctor may want to do a bone marrow biopsy. This test lets the doctor look at cells from inside your bone. This can give key information about what type of leukemia it is so you can get the right treatment.
(source 1, 2)

10. How do you treat leukemia?
What type of treatment you need will depend on many things, including: what kind of leukemia you have, how far along it is, and your age and overall health.
If you have acute leukemia, you will need quick treatment to stop the rapid growth of leukemia cells. In many cases, treatment makes acute leukemia go into remission. Some doctors prefer the term "remission" to "cure," because there is a chance the cancer could come back.
Chronic leukemia can rarely be cured, but treatment can help control the disease. If you have chronic lymphocytic leukemia, you may not need to be treated until you have symptoms. But chronic myelogenous leukemia will probably be treated right away. (source 1, 2)

11. Common treatments used to fight leukemia:
Chemotherapy
Biological Therapy
Targeted therapy
Radiation therapy
Stem cell transplant
Clinical Trials
(source 1, 2)

12. Chemotherapy
Chemotherapy is the major form of treatment for leukemia. This drug treatment uses chemicals to kill leukemia cells. Depending on the type of leukemia you have, you may receive a single drug or a combination of drugs. These drugs may come in a pill form, or they may be injected directly into a vein.
(source 1, 2)

13. Biological therapy
Biological therapy works by helping your immune system recognize and attack leukemia cells.
(source 1, 2)

14. Targeted Therapy
Targeted therapy uses drugs that attack specific vulnerabilities within your cancer cells. For example, the drug imatinib (Gleevec) stops the action of a protein within the leukemia cells of people with chronic myelogenous leukemia. This can help control the disease.
(source 1, 2)

15. Radiation Therapy
Radiation therapy uses X-rays or other high- energy beams to damage leukemia cells and stop their growth. During radiation therapy, you lie on a table while a large machine moves around you, directing the radiation to precise points on your body. You may receive radiation in one specific area of your body where there is a collection of leukemia cells, or you may receive radiation over your whole body. Radiation therapy may be used to prepare for a stem cell transplant.
(source 1, 2)

16. Stem Cell Transplant
A stem cell transplant is a procedure to replace your diseased bone marrow with healthy bone marrow. Before a stem cell transplant, you receive high doses of chemotherapy or radiation therapy to destroy your diseased bone marrow. Then you receive an infusion of blood-forming stem cells that help to rebuild your bone marrow. You may receive stem cells from a donor, or in some cases you may be able to use your own stem cells. A stem cell transplant is very similar to a bone marrow transplant.
(source 1, 2)

17. Clinical Trials
For some people, clinical trials are a treatment option. Clinical trials are research projects to test new medicines and other treatments. Often people with leukemia take part in these studies.
(source 1, 2)

18. Jonny’s Diagnosis
My brother Jonny was diagnosed with Acute Lymphocytic Leukemia on July 3rd, 1995.
“What were Jonny’s symptoms that made you take him to the doctor?”
“To be completely honest, I was positive that he had an ear infection. We had just moved from Brooklyn to New Providence about a month earlier and we didn’t even have a pediatrician in New Jersey. It was Friday, June 30 (my wedding anniversary!) and I decided to take Jonny to the doctor because he had been running a low-grade fever for two days and seemed a little out of sorts and paler than usual. We were going into the 4th of July weekend and I felt that if I didn’t get someone to see him that afternoon, he probably would not have been seen by anyone until the middle of the following week and my thought was that he probably just needed an antibiotic.” – Jamie D’Amico (mother)

19. Jonny was taken to the New Providence Pediatrics
Jonny was taken to the New Providence Pediatrics. The doctor was, luckily, very familiar with pediatric cancer.
She examined Jonny and determined no sign of infection but because he was so pale, decided he might be anemic. She did a simple CBC (complete blood count test) in her office.

20. White Blood Cell Count
Hemoglobin
Platelets
Jonny’s Results
22,000
4.9
17,000
Normal Range
5,000-10,000
12-16
150,000

21. Because of the drastic abnormalities in Jonny’s CBC results, the pediatrician contacted Dr. Steven Halpern, Pediatric Hematologist/ Oncologist at Overlook Hospital to let him know that Jonny was on his way over to the hospital to ensure the CBC results were accurate.
After 45 minutes, we were informed of the news, Jonny had cancer. While it was fairly certain Jonny had leukemia, it would not be determined what type until he had a Bone Marrow Aspiration – where they do a pathological report of the bone marrow. They also had to do a spinal tap, which is where they remove fluid from a part of the spine to see if there are cancer cells. The spinal tap would determine if Jonny also needed radiation therapy as part of his treatment, luckily, he didn’t.
Jonny was diagnosed on July 3rd, 1995 with Acute Lymphocytic Leukemia; he was 3 years and 8 months. Thankfully, this is the most common/treatable cancer in children.

22. Jonny’s Treatment
Jonny was given a specific treatment that was administered over years. There were 4 phases of the treatment.
Induction
Consolidation
Delayed Intensification
Maintenance

23. One of the choices given to my family by the doctor was to have Jonny put into a randomized clinical trial where he would receive all of the same medication, but some might be administered differently.
For example, 6M was a medication many patients took in pill form, Jonny however had it administered over a 10 hour period through an IV.
My parents opted to have Jonny as part of the clinical trial.
Jonny, within the first few days, was also given transfusion of platelets and red blood cells and had a portacath surgically implanted to administer his medication

24. Chemotherapy: Vincristine Dexamethasone L- asparaginase
6- mercaptopurone
Methotrexate
Cytoxan
Adriamycin
6- thioguanune
Ara-C
Intrathecal Methitrexate

25. (Most) Other Medication:
Vincristine
Decadron
Colace
Zantac
Bactrim
Nystatin
Allopurinol
Cyterabine (ARAC)
Dexorubicin
Cyclophamide
Cytoxan
Tioguanine
Given Everyday Unless Otherwise Noted

26. Response to the Medication
Jonny responded well to the medication. The changes in his blood count was almost immediate. Unfortunately, he developed infections and other problems that forced our family to put his treatment on hold on numerous occasions

27. His treatment started on July 5th, 1995
His treatment ended on August 28th, 1998

28. Cancer Free, Now What?
Just like everyone else, Jonny has to eat right and exercise to stay healthy; unlike everyone else, there are a few things he has to do now that he is cancer free. Per his doctor, recommendations for follow-up are as follows:
History and physical yearly
CBC, chemistry profile, urinalysis yearly
Echocardiogram (EKG) every 5 years
DEXA scan beginning at age 30 (measures bone density)

29. Jonny on the first day he was taken to the doctor

30. This is Jonny and you can clearly see he has gained weight and had the portacath put in.

31. These photos are from when Jonny was first in the hospital

32. Compared to the last photo of Jonny in a hospital bed, he looks much heavier here because of his steroids.

33. Jonny was put on steroids on day 1, before they were even sure of what type of cancer he had. When on heavy steroids, it is common to be very hungry and eat a lot, because of this, Jonny gained a lot of weight. Jonny was able to eat an entire pizza for lunch and then ask 5 minutes later what was for dinner.

34. Over time, Jonny’s cancer was in remission and then gone
Over time, Jonny’s cancer was in remission and then gone. He is now healthier than ever!
I am so thankful that Jonny was able to get better. Because of the advances in medication and treatment facilities, I know my brother. I was so young when he was diagnosed, I would have never known him had things been different. Jonny is one of my best friends and can’t imagine a world without him. I can thank the hospitals and doctors who kept him alive for giving me my brother back. 34

35. With Cancer and on Chemo
Today! 35

36. Citation http://www.webmd.com/cancer/tc/leukemia-topic-overview?page=1
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