Signs and Symptoms

Signs and symptoms of leukemia include:

• Fatigue
• Fever
• Abnormal paleness
• Weight loss
• Shortness of breath
• Easy bruising
• Bleeding
• Repeated infections
• Bone pain
• Abdominal pain
• Skin irritations or rashes
• Irritability

What Causes It?

Most causes of leukemia are not known. Several genetic and environmental factors are associated with childhood leukemia. The disease has also been linked to:

• Exposure to large amounts of high energy radiation (from nuclear bombs)
• Occupational exposure to the chemical benzene
• Viral infections
• Chemicals from cigarettes

Who Is Most At Risk?

Leukemia is linked to the following risk factors:

• Males are at greater risk than females
• Increasing age
• Genetic diseases, such as Fanconi anemia or Down syndrome
• Acquired diseases, such as Hodgkin disease
• First degree relative with leukemia
• Excessive exposure to ionizing radiation
• Chemical exposure (benzene)
• Certain drugs
• Chromosomal abnormalities
• Cigarette smoking

What to Expect at Your Doctor's Office

If you or your child has symptoms associated with leukemia, see your child's doctor. Your child's doctor can make a diagnosis and help you determine which treatment or combination of therapies will work best.

Your child's doctor will do a physical examination, checking for swelling in the liver, the spleen, and the lymph nodes, and will order certain laboratory tests. Scientists will examine the bone marrow for leukemia cells or to determine the type of leukemia. A lumbar puncture ("spinal tap") checks for leukemia cells in the fluid around the brain and spinal cord. Chest x-rays can reveal signs of the disease in the chest.

Treatment Options

Prevention

Some leukemias can be prevented by avoiding exposure to benzene, nicotine, or radiation.

Treatment Plan

Leukemia is an extremely complex disease. Treatment depends on the type of leukemia, certain features of the leukemic cells, the extent of the disease, and whether the leukemia has been treated before. Whenever possible, a patient with leukemia should be treated at a medical center that specializes in the disease.

Drug Therapies

Some of the drug therapies used to treat leukemia include the following:

• Radiation therapy. The use of high energy rays to kill cancer cells and prevent them from growing.
• Chemotherapy. The use of drugs to kill cancer cells.
• Steroids. To suppress muscle inflammation and reduce the activity of the immune system.
• Bone marrow transplantation. A procedure in which cancerous bone marrow is destroyed with high doses of anticancer drugs or radiation, then replaced with healthy bone marrow.
• Biological therapy. Stimulates or restores the immune system's ability to fight infection and disease. May also help reduce side effects caused by other treatments.

Surgical and Other Procedures

Surgeries may include:

• Lumbar puncture
• Bone marrow transplant
• Splenectomy (removal of the spleen)
• Stem cell transplant

Complementary and Alternative Therapies

A comprehensive treatment plan for leukemia may include a range of complementary and alternative therapies (CAM). Individuals should educate themselves and keep all medical providers fully informed regarding any and all CAM therapies they are using, including prescribed drugs and dietary supplements. While supplements and herbal therapies may be an important component of a comprehensive cancer care program, some supplements and herbs may interfere with conventional cancer care, and new research about these interactions is emerging every day. Work with a knowledgeable physician and inform all of your health care providers about any herbs and supplements you are using or considering using.

Following these nutritional tips may help reduce symptoms:

• Try to eliminate potential food allergens, including dairy (milk, cheese, and butter), wheat (gluten), corn, soy, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
• Eat antioxidant rich foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as kale, spinach, and bell peppers).
• Avoid refined foods, such as white breads, pasta, and sugar.
• Eat healthy protein favoring free-range, organic sources.
• Use healthy oils in cooking, such as coconut oil. Be sure to cook olive oil under medium to low heat to prevent carcinogens from forming.
• Reduce or eliminate trans fatty acids found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 to 8 glasses of filtered water daily.
• Exercise lightly, if possible. Speak with your doctor about a regimen that is right for you.

You may address nutritional deficiencies with the following supplements:

• Probiotic supplement (containing Lactobacillus acidophilus). For maintenance of gastrointestinal and immune health. Some probiotic supplements may need refrigeration. Check the label carefully. Probiotics may not be appropriate for people who are severely immune compromised. Speak with your doctor.
• Omega-3 fatty acids. Such as fish oil, to help reduce inflammation. Fish oils may increase bleeding in sensitive individuals, such as those taking blood-thinning mediations (including aspirin).

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of gastritis symptoms (such as nausea and vomiting) based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for an individual.

Homeopathy may help reduce symptoms and strengthen overall constitution and may help lessen the side effects of chemotherapy.

• Radium bromatum. Is specific for radiation poisoning, especially followed by arthritic complaints.

Acupuncture may alleviate symptoms. Acupuncture may help to enhance immune function, normalize digestion, and address disease conditions. For many patients and physicians, acupuncture has become one of the most widely used alternative interventions in cancer therapy support.

Prognosis/Possible Complications

Repeated infections complicate most cases of leukemia. Kidney failure or impaired function, and a decreasing number of neutrophils (a type of white blood cell), are also common complications. Treatments for leukemia can have serious side effects.

The prognosis for people with leukemia varies by the type of leukemia. ALL patients have the best prognosis, with a 5-year survival rate of 80%.

Following Up

Patients with leukemia undergo extensive follow up care, including daily exams to check for infections and bleeding, weekly bone marrow biopsies after chemotherapy has begun, post remission chemotherapy, treatment for central nervous system conditions, and monitoring of urinary function.

Supporting Research

Ajrouche R, Rudant J, Orsi L, et al. Maternal reproductive history, fertility treatments and folic acid supplementation in the risk of childhood acute leukemia: the ESTELLE study. Cancer Causes Control. 2014;25(10):1283-1293.

Benchimol EI, Mack DR. Probiotics in relapsing and chronic diarrhea. J Pediatr Hematol Oncol. 2004;26(8):515-517.

Boros LG, Nichelatti M, Schoenfeld Y. Fermented wheat germ extract (Avemar) in the treatment of cancer and autoimmune diseases. Ann N Y Acad Sci. 2005;1051:529-542.

Brauner EV, Andersen CE, Anderson HP, et al. Is there any interaction between domestic radon exposure and air pollution from traffic in relation to childhood leukemia risk? Cancer Causes Control. 2010;21(11):1961-1964.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Carlos-Wallace FM, Zhang L, Smith MT, Rader G, Steinmaus C. Parental, in utero, and early-life exposure to benzene and the risk of childhood leukemia: A Meta-Analysis. Am J Epidemiol. 2016;183(1):1-14.

Cheng TO. Can green tea protect against not only sunburn but also melanoma? Chin Med J (Engl). 2006;119(12):1056.

Das M, Sur P, Gomes A, Vedasiromoni JR, Ganguly DK. Inhibition of tumor growth and inflammation by consumption of tea. Phytother Res. 2002;16 Suppl 1:S40-S44.

Dorchies OM, Wagner S, Vuadens O, et al. Green tea extract and its major polyphenol (-)-epigallocatechin gallate improve muscle function in a mouse model for Duchenne muscular dystrophy. Am J Physiol Cell Physiol. 2006;290(2):C616-C625.

Eschenauer G, Sweet BV. Pharmacology and therapeutic uses of theanine. Am J Health Syst Pharm. 2006;63(1):26, 28-30.

Hollender A, Bjoro T, Otto Karlsen K, et al. Vitamin D deficiency in patients operated on for gastric lymphoma. Scand J Gastroenterol. 2006;41(6):673-681.

Jamieson K. Chronic leukemias. In: Bope ET, Kellerman RD, eds. Conn's Current Therapy 2016. 1st ed. Philadelphia, PA: Elsevier; 2016:chap 12;838-842.

Jiang J, Slivova V, Sliva D. Ganoderma lucidum inhibits proliferation of human breast cancer cells by down-regulation of estrogen receptor and NF-kappaB signaling. Int J Oncol. 2006;29(3):695-703.

Kelemen LE, Cerhan JR, Lim U, et al. Vegetables, fruit, and antioxidant-related nutrients and risk of non-Hodgkin lymphoma: a National Cancer Institute-Surveillance, Epidemiology, and End Results population-based case-control study. Am J Clin Nutr. 2006;83(6):1401-1410.

Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016.

Kormosh N, Laktionov K, Antoshechkina M. Effect of a combination of extract from several plants on cell-mediated and humoral immunity of patients with advanced ovarian cancer. Phytother Res. 2006;20(5):424-425.

Laviano A, Muscaritoli M, Rossi-Fanelli F. Phase II study of high-dose fish oil capsules for patients with cancer-related cachexia: a Cancer and Leukemia Group B study. Cancer. 2005;103(3):651-652.

MacLean CH, Newberry SJ, Mojica WA, et al. Effects of omega-3 fatty acids on cancer risk: a systematic review. JAMA. 2006;295(4):403-415.

McCarty MF, Block KI. Toward a core nutraceutical program for cancer management. Integr Cancer Ther. 2006;5(2):150-171.

Miller MF, Bellizzi KM, Sufian M, et al. Dietary supplement use in individuals living with cancer and other chronic conditions: a population-based study. J Am Diet Assoc. 2008;108(3):483-494.

Nabhan C, Rosen ST. Chronic lymphocytic leukemia: a clinical review. JAMA. 2014; 312(21):2265-2276.

Ouillette P, Saiya-Cork K, Seymour E, Li C, Shedden K, Malek SN. Clonal evolution, genomic drivers, and effects of therapy in chronic lymphocytic leukemia. Clin Cancer Res. 2013;19(11):2893-2904.

Polesel J, Talamini R, Montella M, et al. Linoleic acid, vitamin D and other nutrient intakes in the risk of non-Hodgkin lymphoma: an Italian case-control study. Ann Oncol. 2006;17(4):713-718.

Rubnitz JE, Gibson B, Smith FO. Acute myeloid leukemia. Hematol Oncol Clin North Am. 2010;24(1):35-63.

Rubnitz JE, Onciu M, Pounds S, et al. Acute mixed lineage leukemia in children: the experience of St. Jude Children's Research Hospital. Blood. 2009;113(21):5083-5089.

Shanshal M, Haddad R. Chronic lymphocytic leukemia. Dis Mon. 2012;58(4):153-167.

Slater ME, Linabery AM, Spector LG, et al. Maternal exposure to household chemicals and risk of infant leukemia: a report from the Children's Oncology Group. Cancer Causes Control. 2011;22(8):1197-1204.

Thomas X. Novel approaches to pediatric leukemia treatment. Expert Rev Anticancer Ther. 2015;15(7):811-828.

Wan XS, Ware JH, Zhou Z, Donahue JJ, Guan J, Kennedy AR. Protection against radiation-induced oxidative stress in cultured human epithelial cells by treatment with antioxidant agents. Int J Radiat Oncol Biol Phys. 2006;64(5):1475-1481.

Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs. 2000;9(9):2103-2119.

Wayne A, Baird K, Egeler R. Hematopoietic Stem Cell Transplantation for Leukemia. Pediatr Clin North Am. 2010;57(1):1-25.

Velicer CM, Ulrich CM. Vitamin and mineral supplement use among US adults after cancer diagnosis: a systematic review. J Clin Oncol. 2008;26(4):665-673.

Zajac-Spychata O, Wachowiak J. Late sequelae of central nervous system prophylaxis in children with acute lymphoblastic leukemia: high doses of intravenous methotrexate versus radiotherapy of the central nervous system--review of literature. Med Wieku Rozwoj .2012;16(2):128-137.