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What Happens When Leukemia Spreads To The Brain

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General Information About Adult Acute Lymphoblastic Leukemia

Why Cancers Spread to the Brain

Adult acute lymphoblastic leukemia is a type of cancer in which the bone marrow makes too many lymphocytes .

Adult acute lymphoblastic leukemia is a cancer of the blood and bone marrow. This type of cancer usually gets worse quickly if it is not treated.

Leukemia may affect red blood cells, white blood cells, and platelets.

Normally, the bone marrow makes blood stem cells that become mature blood cells over time. A blood stem cell may become a myeloidstem cell or a lymphoid stem cell.

A myeloid stem cell becomes one of three types of mature blood cells:

  • Red blood cells that carry oxygen and other substances to all tissues of the body.
  • Platelets that form blood clots to stop bleeding.
  • Granulocytes that fight infection and disease.

A lymphoid stem cell becomes a lymphoblast cell and then one of three types of lymphocytes :

  • B lymphocytes that make antibodies to help fight infection.
  • T lymphocytes that help B lymphocytes make the antibodies that help fight infection.
  • Natural killer cells that attack cancer cells and viruses.

In ALL, too many stem cells become lymphoblasts, B lymphocytes, or T lymphocytes. These cells are also called leukemia cells. These leukemia cells are not able to fight infection very well. Also, as the number of leukemia cells increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets. This may cause infection, anemia, and easy bleeding. The cancer can also spread to the central nervous system .

How Is Leukemia Treated

A pediatric will lead the medical team caring for a child with leukemia. The oncologist works with other specialists, including nurses, social workers, psychologists, and surgeons.

Chemotherapy is the main treatment for childhood leukemia. The dosages and drugs used may differ based on the child’s age and the type of leukemia.

Other treatments include:

  • radiation therapy: high-energy X-rays that kill cancer cells
  • targeted therapy: specific drugs that find and attack cancer cells without hurting normal cells
  • stem cell transplants: putting healthy stem cells into the body

Should I Consider Palliative Care

AML and its treatments can cause side effects like fatigue, pain, and nausea. Palliative care helps you feel better while you go through cancer treatment. In addition to your regular treatment, it can help with any pain you have and improve your quality of life. Itâs not the same as hospice care, which is for the final stages of cancer or another serious illness.

You can get palliative care in a hospital, outpatient clinic, or at home.

Palliative care for AML might include:

  • Blood transfusions to ease tiredness
  • Growth factors to help rebuild your bone marrow after chemotherapy
  • Antibiotic or antiviral drugs to prevent infections
  • Radiation to ease bone pain
  • Medicines for nausea or pain

You might also consider therapy, counseling, or a support group to help manage the stress of living with AML.

American Cancer Society: “If Treatment for Acute Myeloid Leukemia Stops Working,” “Stem Cell Transplant for Acute Myeloid Leukemia,” “What if Acute Myeloid Leukemia Doesn’t Respond or Comes Back After Treatment?” “Targeted Therapy for Acute Myeloid Leukemia.”

Canadian Cancer Society: “Treatments for relapsed or refractory acute myelogenous leukemia.”

Cancer.Net: “Leukemia — Acute Myeloid — AML: Treatment Options.”

Journal of Clinical Medicine: “Current Approaches in the Treatment of Relapsed and Refractory Acute Myeloid Leukemia.”

Leukaemia Care: “Relapse in Acute Myeloid Leukaemia .”

Leukemia & Lymphoma Society: “Relapsed and Refractory.”

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Common Places Leukemia Can Spread

    Leukemia is a malignant proliferation of white blood cellsthe main workforce of our immune system. As a cancer of the blood and lymphatic system, leukemia can travel and form tumors in distant parts of the body. The leukemia cells then prevent other cells in your body from behaving and functioning normally, which can have serious consequences. Some locations are more likely candidates for metastasis than others.

    Acute Lymphocytic Leukemia Diagnosis

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    Certain signs and symptoms can suggest that a person might have acute lymphocytic leukemia , but tests are needed to confirm the diagnosis.

    Medical history and physical exam

    If you have signs and symptoms that suggest you might have leukemia, the doctor will want to get a thorough medical history, including how long you have had symptoms and if you have possibly been exposed to anything considered a risk factor.

    During the physical exam, the doctor will probably focus on any enlarged lymph nodes, areas of bleeding or bruising, or possible signs of infection. The eyes, mouth, and skin will be looked at carefully, and a thorough nervous system exam may be done. Your abdomen will be felt for spleen or liver enlargement.

    If there is reason to think low levels of blood cells might be causing your symptoms , the doctor will most likely order blood tests to check your blood cell counts. You might also be referred to a hematologist, a doctor who specializes in diseases of the blood .

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    Treatment For Adult Acute Lymphoblastic Leukemia May Cause Side Effects

    For information about side effects that begin during treatment for cancer, see our Side Effects page.

    Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Late effects of treatment for ALL may include the risk of second cancers . Regular follow-up exams are very important for long-term survivors.

    Additional Diagnostics Before Treatment Begins

    To prepare the patient for the intensive treatment, several organ functions must be checked, since certain anticancer agents have specific side effects that can damage different organs. To have an initial assessment later helps to detect and appropriately interprete potential functional changes. These preparatory diagnostics usually include various tests of the heart function and echocardiography) and the brain function as well as a variety of different blood tests that will give information on how well liver, bone marrow, and kidneys are working. Furthermore, the patients blood group will be defined, which is essential in case a blood transfusion may be necessary during the course of treatment.

    Good to know: Not all the tests listed above need to be done for every patient. Contrariwise, the patients individual situation may require additional diagnostic procedures that have not been mentioned in this chapter. Therefore, you should always ask your doctor, based on the information above, which test your child needs and why.

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    What Kind Of Treatment Will I Need

    AML often grows quickly, so its important to start treatment as soon as possible after it is found.

    The most common treatment for AML is chemotherapy . Other treatments are used less often.

    The treatment plan that is best for you will depend on:

    • The type of AML
    • The chance that a type of treatment will cure the leukemia or help in some way
    • Your age and overall health
    • If the AML cells have changes in certain genes
    • Whether a matched stem cell donor can be found
    • Your feelings about the treatment and the side effects that possibly come with it

    Adult Acute Lymphoblastic Leukemia In Remission

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    Standard treatment of adult ALL during the post-remission phase includes the following:

    • Chemotherapy.
    • Tyrosine kinase inhibitortherapy.
    • Chemotherapy with stem cell transplant.
    • CNS prophylaxis therapy including chemotherapy with or without radiation therapy to the brain.

    Check for U.S. clinical trials from NCI’s list of cancer clinical trials that are now accepting patients with adult acute lymphoblastic leukemia in remission. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

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    Who Is At Risk For Acute Lymphocytic Leukemia

    The factors that raise your risk of ALL include

    • Being male
    • Targeted therapy, which uses drugs or other substances that attack specific cancer cells with less harm to normal cells

    Treatment is usually done in two phases:

    • The goal of the first phase is to kill the leukemia cells in the blood and bone marrow. This treatment puts the leukemia into remission. Remission means that the signs and symptoms of cancer are reduced or have disappeared.
    • The second phase is known as post-remission therapy. Its goal is to prevent a relapse of the cancer. It involves killing any remaining leukemia cells that may not be active but could begin to regrow.

    Treatment during both phases also usually includes central nervous system prophylaxis therapy. This therapy helps prevent the spread of leukemia cells to the brain and spinal cord. It may be high dose chemotherapy or chemotherapy injected into the spinal cord. It also sometimes includes radiation therapy.

    NIH: National Cancer Institute

    What Is The Prognosis For Adults Who Have Acute Myeloid Leukemia

    Approximately 2 out of 3 adults with AML go into remission after getting chemotherapy. Remission means you dont have disease symptoms. There are no detectable cancer cells in the bone marrow and the normal healthy cells are growing again.

    Because AML often comes back, you may continue to get chemotherapy to destroy any remaining cancer cells and keep them away. Your healthcare provider may call this step post-remission chemotherapy. Up to half of people who get this treatment go into long-term remission. AML accounts for fewer than 2% of all cancer-related deaths.

    If cancer comes back within 12 months of treatment, your provider may recommend a stem cell transplant if you are healthy enough to tolerate it. If youve relapsed, a bone marrow transplant is often the only chance for cure once the leukemia has gone back into remission.

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    What Happens When Cancer Spreads To The Brain

      If you or a loved one have been diagnosed with cancer, youve probably heard the term metastasis. This refers to when cancer develops in one part of the body and then spreads to another part of the body . This generally happens when cancer cells detach from the main tumor , travel through the bloodstream or lymphatic system and then settle in another part of the body and begin growing there, as well . The metastatic tumors are usually composed of the same type of cancer cells as the primary tumor, although they might develop new mutations.

      When cancer spreads from a different part of the body to the brain, the metastatic tumors are referred to as brain metastases. The brain is a relatively common location for metastasis to occur. In fact, one in four cancer patients experience brain metastasis. And, brain metastases are the most common type of brain tumor diagnosed among adults. Although any type of cancer can spread to the brain, brain metastases most often originate from cancer in the lungs, breasts, kidneys or colon.

      Causes And Risk Factors

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      Although the exact causes of CNS lymphoma are not known, there are several factors that may increase a person’s risk for developing the disease, such as having a compromised immune system due to acquired immunodeficiency syndrome , other disorders of the immune system, or chronic immunosuppression  as a result of organ transplantation.

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      Expert Review And References

      • Nater A, Vincent F, Fehlings MG. Spinal column tumors. Bernstein M and Berger MS . Neuro-oncology: The Essentials. 3rd ed. New York: Thieme; 2015: 40: 474-492.
      • National Cancer Institute. Adult Central Nervous System Tumors Treatment for Health Professionals . 2016: .
      • Patel AJ, Lang F, Sawaya R. Metastatic brain tumors. Bernstein M and Berger MS . Neuro-oncology: The Essentials. 3rd ed. New York: Thieme; 2015: 38: 451-461.
      • US National Library of Medicine. MedlinePlus Medical Encyclopedia: Metastatic Brain Tumor. 2014: .

      What Makes Yale Medicine’s Approach To Treating Metastatic Brain Tumors Unique

      Yale Medicine is leading the way nationally in the use of the newer chemotherapy agents, including immunotherapy and targeted therapies.

      For example, Yale Medicine offers a unique clinical trial evaluating the use of immunotherapy alone, and deferring radiation, to treat brain metastases. Data showing preliminary success was recently published in Lancet Oncology.

      Yale Medicine is the only multidisciplinary consortium providing comprehensive brain cancer care in southern New England. This gives patients access to the full range of treatment options, from medical therapy to cutting-edge radiosurgery.

      At Yale Medicine, treatment is not suggested based on the technology we own, but rather is personalized to the patient’s needs and evidence-based, acquired through national research and experience. Discussion of challenging cases, both from within our Yale Cancer Centeras well as referred to Yale Medicine from other centers around the state, occurs at a weekly tumor board. Recommendations from the Tumor Board are then communicated back to the involved physicians to ensure seamless coordination of care.

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      Spread To Other Organs

      Less often, ALL spreads to other organs:

      • If ALL spreads to the brain and spinal cord it can cause headaches, weakness, seizures, vomiting, trouble with balance, facial muscle weakness or numbness, or blurred vision.
      • ALL may spread inside the chest, where it can cause fluid buildup and trouble breathing.
      • Rarely, ALL may spread to the skin, eyes, testicles, ovaries, kidneys, or other organs.

      Acute Lymphocytic Leukemia Subtypes And Prognostic Factors

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      For most types of cancer, determining the stage of the cancer is very important. The stage is based on the size of the tumor and how far the cancer has spread. This can be helpful in predicting a persons outlook and deciding on treatment.

      Acute lymphocytic leukemia , on the other hand, does not usually form tumors. It generally affects all of the bone marrow in the body and, in some cases, has already spread to other organs, such as the liver, spleen, and lymph nodes, by the time it is found. Therefore acute lymphoblastic leukemia is not staged like most other cancers. The outlook for a person with acute lymphoblastic leukemia depends on other information, such as the subtype of acute lymphoblastic leukemia , the patients age, and other lab test results.

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      Complications Of Acute Lymphoblastic Leukaemia

      If a cure for acute lymphoblastic leukaemia is not possible, there’s a risk that the lack of healthy blood cells can make the person:

      • extremely vulnerable to life-threatening infections
      • prone to uncontrolled and serious bleeding

      These two complications, and others, are discussed further in complications of acute lymphoblastic leukaemia.

      What Causes Leukemia

      Doctors don’t know exactly what causes leukemia. But most cases happen when there is a change in a gene that happens spontaneously. This means that the genetic mutation was not passed down from a parent.

      Kids have a greater chance of developing leukemia if they have:

      • an identical twin who had leukemia at a young age
      • a non-identical twin or other siblings with leukemia
      • had radiation therapy or chemotherapy for other types of cancer
      • taken medicines to suppress their immune system after an organ transplant 
      • a genetic health problem, such as:
      • Li-Fraumeni syndrome
      • Fanconi anemia

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      How Is All Diagnosed

      Many people with ALL dont have any symptoms when its diagnosed its typically found when a doctor orders blood tests for something completely unrelated or during a routine checkup.

      Some people may be at higher risk of ALL because they have certain blood disorders, such as myelodysplastic syndrome, or inherited disorders, such as Down syndrome, or because they were treated with certain chemotherapy drugs or radiation. Doctors typically recommend these people have regular checkups.

      If you have signs or symptoms of ALL, or if a physical examination indicted you may have leukemia, the doctor will need to take samples of your blood and bone marrow to have it tested to be sure. The blood will be drawn from a vein in the arm, in most cases, but the bone marrow will be extracted in two ways: through an aspiration and a biopsy.

      Other Not Common But Possible Areas

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      It is possible for leukemia to spread to other parts of the body, even though it is pretty rare.

      • Your gums. Some forms of acute myeloid leukemia can spread to your gums, causing , bleeding and swelling.

      • Your spleen. A particular subtype of leukemia called hairy cell leukemia has been shown to metastasize to the spleen. Its very rare, but it can happen.

      • Your skin. When leukemia shows up in your skin, its called leukemia cutis, and it usually looks like a series of plum-colored lesions, nodules or plaques. It is associated with many different types of leukemia, including both myeloid and lymphoid forms. The types of most associated with this particular manifestation are adult T-cell leukemia/lymphoma and . And unfortunately, when it shows up, its a harbinger of bad news; usually, the development of leukemia cutis means that you either have systemic leukemia or your previously treated systemic leukemia has relapsed and returned. It can also signify that your leukemia is progressing very aggressively.

      • Other organs. Acute myeloid leukemia can also occasionally spread to the testicles, kidneys and even your eyes.

      Knowing and understanding the particular type of leukemia you have can help you know where the cancer is most likely to spread. Your doctor may want to monitor you for certain symptoms, and you may want to learn more about what to watch for, too. The type of treatment that your doctor will recommend could change if your leukemia has spread to another location.

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      What Causes Acute Myeloid Leukemia

      The blood stem cells make up a small part of bone marrow. These stem cells develop into blood-forming cells and into white blood cells, red blood cells and platelets. The white blood cells include types of cells, including lymphocytes and myeloid cells.

      The stem cell can develop a red blood cell that carries oxygen. The stem cell can become a white blood cell or it may become a platelet, which helps form blood clots and/or stop bleeding events.

      In people with AML, the myeloid cells dont develop normally into healthy cells due to a mutation or damage. Instead, in the case of AML, the cells turn into immature white blood cells called myeloid blasts . These cells continue to grow rapidly and in an uncontrolled manner, disturbing the normal production of healthy cells. The uncontrolled growth can also cause damage by increasing your risk of bleeding and or other disorders if the leukemia goes on unnoticed.

      Leukemia cells can build up in bone marrow, crowding out healthy cells. These diseased cells quickly move into your blood and other parts of your body.

      Risk Factors For Acute Lymphoblastic Leukemia

      A risk factor is something that increases your chance of getting a disease such as cancer. But having a risk factor, or even several risk factors, does not mean that you will definitely get the disease. And many people who get the disease may have few or no known risk factors.

      There are only a handful of known risk factors for acute lymphocytic leukemia .

      Factors that may increase the risk of acute lymphocytic leukemia include:

      • Age: Acute lymphocytic leukemia is more likely to occur in children and in adults over the age of 50.
      • Previous cancer treatment. Children and adults whove had certain types of chemotherapy and radiation therapy for other kinds of cancer may have an increased risk of developing acute lymphocytic leukemia.
      • Genetic disorders. Acute lymphocytic leukemia itself doesnt appear to have a strong inherited component. That is, it doesnt seem to run in families, so a persons risk is not increased if a family member has the disease. But there are some genetic syndromes that seem to raise the risk of acute lymphocytic leukemia. These include:
      • Down syndrome
      • Neurofibromatosis
      • Li-Fraumeni syndrome
      • Having a brother or sister with acute lymphocytic leukemia. People who have a sibling, including a twin, with acute lymphocytic leukemia have an increased risk of acute lymphocytic leukemia.
      • Being very overweight some studies have shown that people who are very overweight have a slightly higher risk of developing leukemia than those who are a normal weight.

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      Radiation Therapy For Metastatic Brain Tumors

      Radiation therapy treats metastatic brain tumors by using X-rays and other forms of radiation to destroy cancer cells or prevent a tumor from growing. It is also called radiotherapy.

      These painless treatments involve passing beams of radiation through the brain, which can treat cancers in areas that are difficult to reach through surgery. Procedures may include any one or a combination of the following:

      • External beam radiation therapy delivers radiation from a machine and through the body to reach metastatic tumors.
      • Whole-brain radiation targets the entire brain to hit multiple tumors or any metastatic disease that hides from an MRI scan.
      • Stereotactic radiosurgery  directs a high dose of radiation targeted to the specific shape of the tumor, sparing surrounding healthy tissue from unnecessary radiation exposure.
      • Proton therapy uses protons to treat metastatic brain tumors. Like stereotactic radiosurgery, proton therapy minimizes harm to healthy tissue surrounding a tumor.
    • Brachytherapy is radioactive material implanted within a tumor to prevent further growth.
    • These procedures may be performed after surgery to prevent tumors from recurring at the surgical site and growing into other brain tissue.

      Because radiation therapy has been so successful in treating brain metastases and because many live long lives after treatment studies are now looking at how to manage the long-term effects of treatment.

      Immunotherapy For Metastatic Brain Tumors

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      Cancer immunotherapy is a fast-growing field of research that seeks to develop drugs, vaccines and other therapies that trigger the immune systems natural abilities to fight cancer. Many immunotherapy drugs for metastatic brain tumors act as checkpoint inhibitors. Normally, tumor cells can evade attack by activating certain proteins that disarm your immune system. Checkpoint inhibitors prevent tumor cells from exploiting this process.

      Immunotherapy drugs to treat metastatic brain tumors include:

      • Atezolizumab
      • Nivolumab

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      How Do Physicians Diagnose Leukemia

      Hematologists are specialist physicians who diagnose and treat blood diseases, including leukemia; hematologist-oncologists treat blood diseases like leukemia, as well as other types of cancers.

      In addition to a medical history and a physical exam to look for signs of leukemia , the diagnosis of leukemia typically involves laboratory studies of a blood sample. Abnormal numbers of blood cells may suggest a diagnosis of leukemia, and the blood sample may also be examined under the microscope to see if the cells appear abnormal. A sample of the bone marrow may also be obtained to establish the diagnosis. For a bone marrow aspirate, a long, thin needle is used to withdraw a sample of bone marrow from the hip bone, under local anesthesia. A bone marrow biopsy involves insertion of a thick, hollow needle into the hip bone to remove a sample of the bone marrow, using local anesthesia.

      Cells from the blood and bone marrow are further tested if leukemia cells are present. These additional tests look for genetic alterations and expression of certain cell surface markers by the cancer cells . The results of these tests are used to help determine the precise classification of the leukemia and to decide on optimal treatment.

      Imaging tests such as MRI and CT scanning can also be useful for some patients to determine the extent of disease.

      What Is Acute Lymphocytic Leukemia

      Acute lymphocytic leukemia, also called acute lymphoblastic leukemia, is a type of cancer in which there are too many lymphocytes, the early phase of the white blood cell, in your bone marrow. Leukemia is different from other types of cancers in that it starts in the blood and bone marrow and can spread to other parts of the body. Other cancers can eventually spread to the bone marrow, but they dont become leukemia.

      A cancer that is considered acute can progress quickly and, if not treated, become fatal in just a few months. Acute leukemia differs from chronic leukemia in that with acute leukemia, the bone marrow cells dont mature the way theyre supposed to. Immature leukemia cells continue to reproduce and build up. In chronic leukemia, the cells mature partially, but not completely, and they dont fight infection as well as normal white blood cells do. Chronic leukemias tend to progress over time and most people can live for several years, although these kinds of leukemias are more difficult to treat.

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