Leukemia – T-Cell

Overview

Leukemia is a cancer of the blood cells. Leukemia begins when normal blood cells change and grow uncontrollably. Blood cells (including red cells that carry oxygen, white cells that fight infection, and platelets that cause blood to clot) are produced in the bone marrow, the spongy tissue inside the larger bones in the body. Abnormalities in the bone marrow cells can cause the overproduction or underproduction of certain blood cells.

Subtypes of T-cell leukemia

Large granular lymphocytic leukemia (LGLL). LGLL is a slow-growing leukemia of the T cells and is more common in women than in men. The cause of LGLL is unknown, although approximately 30% of people with LGLL also have rheumatoid arthritis (a chronic, progressive disease in which inflammatory changes occur throughout the connective tissues of the body, mostly in the joints of the hands, feet, wrists, knees, hips, or shoulders).
T-cell prolymphocytic leukemia (T-PLL). T-PLL is an aggressive subtype of CLL that has only been defined recently. It occurs more often in older men, but women may also be affected. It can affect the skin, but in a different way than Sezary syndrome (see below).
Adult T-cell leukemia/lymphoma (ATLL). ATLL has four clinical subtypes. Depending on the clinical features, it is subclassified as smoldering, chronic, acute, or adult T-cell lymphoma (cancer of the lymph system). The acute and the adult T-cell lymphoma subtypes are rapidly progressing diseases. ATLL is caused by a retrovirus called the human T-cell leukemia virus (HTLV1).
Sezary syndrome. Sezary syndrome is a form of mycosis fungoides, a T-cell lymphoma that occurs in the skin. Sezary syndrome is usually slow-growing and takes years to develop from mycosis fungoides, which is limited to the skin. Sezary syndrome is generally diagnosed when large numbers of the lymphoma cells are found in the blood, often in association with erythroderma (reddening of the skin)

Risk Factors

A risk factor is anything that increases a person’s chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health-care choices.

Symptoms

People with T-cell leukemia may experience the following symptoms. Sometimes, people with T-cell leukemia do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor.

• Recurrent infections, due to low numbers of neutrophils (infection-fighting white blood cells)
• Bleeding or bruising easily
• Unexplained tiredness (fatigue)
• Persistent, unexplained abdominal pain on the left side, due to an enlarged spleen (LGLL, T-PLL)

Treatment

The treatment of T-cell leukemia depends on the symptoms produced by the disease, whether the cancer has spread, and the person’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan.

Active surveillance/watch and wait

This approach means that the doctor is closely monitoring the disease, and active treatment begins only when the leukemia shows signs of advancing. It may also be called active surveillance or watchful waiting. Patients are monitored using blood and other tests at regularly scheduled checkups, to track blood cell counts and look for other symptoms that the leukemia is progressing.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication, or a hematologist, a doctor who specializes in treating blood disorders. Some people may receive chemotherapy in their doctor’s office; others may go to the hospital. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific time.