About Leukemia

In this section, you or a loved one can find out more about medical treatments for leukemia. We also provide practical advice about leukemia and offer tips on how to tap into your support network. Read on and you’ll find answers to some of your questions as well as links to resources with more information. Being informed is an important first step towards becoming an active decision-maker in your care plan.

What is leukemia?


About 1 in 53 Canadian men and 1 in 72 Canadian women are expected to develop leukemia during their lifetime.

Leukemia is a cancer that originates in blood stem cells. Before going into detail about this particular type of cancer, it’s important to understand the basics: 

  • Cell – the body is made of up millions of cells. Each cell contains genes that are basically a set of instructions that tell the cell how to grow, work, reproduce and die. 
  • Stem cells – are basic “starter” cells that later become different types of cells that do different jobs. 
  • Cancer – is a disease that affects the set of instructions (genes) in certain cells; as a result, the instructions can be changed and the cells become cancer cells. In many types of cancer, cells may grow too much, form lumps or malignant tumours, and potentially spread (metastasize) to other parts of the body. Leukemia may or may not metastasize.

In leukemia, stem cells do not develop into mature blood cells and remain immature. These immature cells are called blast cells. Over time, the blast cells build up and crowd out normal blood cells so that they can't do their jobs. After leukemia is diagnosed, these blast cells may be referred to as “leukemia cells”. 

Blood cells are made in the bone marrow (the soft, spongy substance in the centre of bones). Knowing the number of blast cells in the bone marrow helps doctors identify the type of leukemia.

There are different types of leukemia. Knowing the type of leukemia you have can help you understand what is happening in your blood and how the treatment options prescribed by your doctor work. 

There are 4 main types of leukemia; these vary by the stem cell type affected and how fast the condition develops. 

Blood stem cells develop into either lymphoid stem cells or myeloid stem cells: 

  1. Myeloid stem cells are responsible for the development of red blood cells, platelets and two types of white blood cells, the granulocytes and monocytes
  2. Lymphoid stem cells are responsible for the development of lymphocyte white blood cells 

The diagram below shows how basic stems cells develop into either myeloid stem cells or lymphoid stems cells.

Normal development of Blood Cells

A leukemia that develops quickly, over days or weeks, is defined as acute, whereas, one that develops slowly, over months or years, is defined as chronic

The main types of leukemia are: 

  • Acute lymphocytic leukemia (ALL) 
  • Chronic lymphocytic leukemia (CLL)
  • Acute myelogenous leukemia (AML) 
  • Chronic myelogenous leukemia (CML)

Within these 4 types, there are many subtypes of leukemia that are differentiated by subtle variations. These subtypes will not be discussed here, for more information on the subtypes of leukemia, visit the Canadian Cancer Society website

The most common types of leukemia in adults are AML and CLL.

Finding out you have leukemia can leave you feeling devastated and overwhelmed, so it's crucial to reach out for help and information from people who are close to you and to your healthcare team. Along with obtaining the best possible medical support and treatment, it is important to make your emotional and physical wellbeing a priority, to ask for help and support when you need it, and to nurture relationships with compassionate people who enrich your life. You don't have to do it alone – there are many ways to manage your daily life with your healthcare team, family and friends, as you will see in the following sections.

Risk factors for leukemia


Leukemia is more prevalent in men than women and the risk of developing leukemia increases with age. 

Some of the factors that increase the risk of someone developing leukemia include: 

  • High doses of radiation
  • Radiation therapy given previously to treat cancer or other health issues
  • Prior chemotherapy for cancer
  • Previous radiation therapy combined with chemotherapy (the combination increases the risk more than either treatment used alone)
  • Exposure to benzene or formaldehyde
  • Genetic syndromes (leukemia is more likely in children who have these conditions)
    • Down syndrome
    • Fanconi anemia
    • Alaxia-telangiectasia
    • Bloom syndrome

About cancer stages

In order to prescribe treatment, doctors need to know the extent or “stage” of cancer in the body. For leukemia, there are different staging systems depending on the type of leukemia you have. 

Diagnostic tests for all types of leukemia

The following tests are used to diagnose leukemia. The results of these tests may also help doctors identify the leukemia stage. 

Diagnostic tests

Staging and other tests

  • Medical history and physical examination
  • Complete blood count (CBC)
  • Blood chemistry tests
  • Bleeding and clotting factors
  • Cytochemistry
  • Immunophenotyping
  • Cytogenetic and molecular studies
  • Bone marrow aspiration and biopsy
  • Lumbar puncture
  • Lymph node biopsy

The method used to identify leukemia stages varies by type of leukemia


For ALL, there is no standard staging system. The disease can be described as untreated, in remission, recurrent or relapsed. 

  • Untreated
    In newly diagnosed ALL, the condition itself has not been treated; however, some signs and symptoms such as fever, bleeding or pain may have been treated. At this stage, the complete blood count is abnormal, about 25% of the bone marrow cells are blast cells and the patient may have symptoms of leukemia.
  • Remission
    The ALL has been effectively treated. At this stage, the complete blood count is normal, and blast cells account for less than 5% of bone marrow cells. There are no signs or symptoms of leukemia in the body.
    When a patient is in partial remission, less than 25% of the bone marrow cells are blast cells. 
  • Relapsed (also called recurrent)
    The ALL has come back following a period of remission. With recurrent disease, more than 25% of bone marrow cells are blast cells. 
  • Refractory
    ALL did not respond to treatment.


For AML, there is no standard staging system. The disease can be described as untreated, in remission or relapsed.

  • Untreated
    In newly diagnosed AML, the condition itself has not been treated, however, some signs and symptoms may have been treated. At this stage, blast cells may be found in the patient’s blood sample. At least 20% of bone marrow cells are blasts and the patient may have symptoms of leukemia.
  • Remission
    The AML has been treated. At this stage, the number of blood cells (neutrophils and platelets) have recovered (without blood transfusion) and blast cells account for less than 5% of bone marrow cells. There are no signs or symptoms of leukemia in the body.
    When a patient is in partial remission, less than 25% of the bone marrow cells are blast cells. 
  • Relapsed (also called recurrent)
    The AML has come back following a period of remission. With recurrent disease, more than 25% of bone marrow cells are blast cells.
  • Refractory
    AML did not respond to treatment. 


With CLL, the stage of the disease is established based on blood cell counts and amount of lymphoid tissues involved. Lymphoid tissues include cells and organs that make up the lymphatic system, which includes white blood cells (such as lymphocytes), bone marrow, thymus, spleen, and lymph nodes

Two different staging systems can be used, the Rai and the Binet. The Rai system is most commonly used in Canada.

The Rai staging system has levels 0 to IV:

  • Stage 0
    There are too many lymphocytes in the blood; however, the numbers of red blood cells and platelets are normal and the lymph nodes and spleen are not enlarged.
  • Stage I 
    There are too many lymphocytes in the blood, the numbers of red blood cells and platelets are normal and the spleen is not enlarged. The lymph nodes are enlarged.
  • Stage II
    There are too many lymphocytes in the blood; however, the numbers of red blood cells and platelets are normal. The lymph nodes may be enlarged and the spleen is enlarged.
  • Stage III
    There are too many lymphocytes in the blood, and there are fewer red blood cells than normal. The number of platelets is normal and the lymph nodes or sleep may be enlarged.
  • Stage IV
    Too many lymphocytes are in the blood but too few platelets. The number of red blood cells may be low and the lymph nodes or sleep may be enlarged.

The Binet system has 3 levels, A, B and C. Stages A and B generally correspond to Rai stages 0, I and II while stage C corresponds to Rai stages III and IV. The Binet system also includes relapsed and refractory disease and considers the risk level and number of areas of lymphatic tissue that are enlarged. The Binet system is not detailed here, for more information on the Binet system, visit the Canadian Cancer Society website.


CML is grouped into phases based on blood cell counts and symptoms, instead of stages. There are 3 phases: chronic, accelerated and blastic. 

  • Chronic Phase
    Less than 5% of the cells in the blood and bone marrow are blast cells. The patient has either no symptoms or very mild symptoms.
  • Accelerated Phase
    10% to 19% of the cells in the blood and bone marrow are blast cells. Symptoms include fever, poor appetite, weight loss, and enlarged spleen. When CML is in the accelerated phase, it can quickly go to the blastic phase. This is referred to as a blastic crisis.
  • Blastic Phase
    20% or more of the cells in the blood and bone marrow are blast cells. The leukemia has spread to tissues and organs outside the bone marrow. Symptoms include fever, malaise, an enlarged spleen, poor appetite, weight loss, fatigue, shortness of breath, abdominal pain and bone pain. The white blood cell counts and platelet counts become abnormal which can lead to bleeding and infection.

For more information on CML disease phases, visit the Canadian Cancer Society website.

In addition to the phases mentioned above, CML can also be in remission (blood counts return to normal), relapsed (number of blast cells in the blood and bone marrow increase following treatment and remission) or refractory (the leukemia does not respond to treatment).

Leukemia: factors influencing disease outcomes


A prognosis is the doctor’s best estimate of how disease will affect a person and how that person will likely respond to treatment. The prognosis for people with leukemia varies with the type of leukemia and other factors.

Examples of factors which affect the prognosis include age, chromosome changes, white blood cell count, response to chemotherapy and early relapse.

You may have come across survival statistics regarding leukemia. Keep in mind that survival statistics are general estimates and must be interpreted carefully. These statistics are based on the experience of groups of people and; therefore, cannot be used to predict an individual’s specific chances of survival. When certain types of leukemia are diagnosed and treated early, the likelihood of successful treatment is better. 

Your doctor can explain the statistics for leukemia and what they may mean for you. 

Signs and symptoms will vary depending on the type of leukemia. With chronic leukemia (for example CLL and CML), patients often say that they do not feel well in general and frequently the diagnosis is confirmed during routine blood tests. When a patient has acute leukemia (such as ALL and AML) leukemia symptoms may suddenly arise over a period of days or weeks.

Common symptoms of leukemia include: 

  • Fever 
  • Chills
  • Persistent fatigue 
  • Weakness
  • Frequent or severe infections
  • Losing weight without dieting
  • Swollen lymph nodes, enlarged spleen or liver
  • Easy bleeding and/or bruising
  • Recurrent nosebleeds
  • Tiny red spots in your skin (known as petechiae)
  • Excessive sweating (especially at night)
  • Bone pain or tenderness

Repeated infections can occur in patients with leukemia. Kidney failure or impaired kidney function, as well as a decreasing number of neutrophils (a type of white blood cell), are also known complications. Leukemia treatments can have serious side effects. 

Support means everything


When you have cancer, you may need different types of support at different times.

Although you may find it hard to ask for help, the fact is that having help often makes it easier to cope with leukemia. Keep in mind that your family and friends, even co-workers, may really want to help but they aren’t sure what to do. Knowing that you need something done (for example walking your dog) allows your loved ones to feel useful. Keep in mind that receiving and giving help are both gifts. 

Other sources of support are people who have gone through what you’re going through. These people understand how you feel, they can tell you what to expect, how they coped, and give you hope for the future. You can get in touch with people in your situation through organized support programs. If you’re interested in an organized support program ask your doctor or other member of your healthcare team for more information. Contacting the Canadian Cancer Society or the Leukemia & Lymphoma Society of Canada can also give you access to people and resources.

Your healthcare team is also a key source of support for you. Although the people on your team are all professionals, they are also human beings so it’s important to build a good relationship with them with open honest communication. 

Family and friends want to be there for you. Some people know what to do and say without you saying anything. Others want to help but aren’t sure how. In these cases, you can take the first step by starting the conversation and tell the other person exactly what you need help with. You shouldn't assume that the other person will know how to help. In other cases, someone may say, “Let me know if I can do anything.” You can answer by saying specifically what you need help with. 

Here are some tips and helpful insights we’ve learned from patients:

  • Ask those closest to you to learn about your condition. This will help them understand your symptoms better and how you feel about them. It may give them new ideas about how to make things easier for you in your day-to-day life. This awareness alone will make you all more comfortable dealing with leukemia. Mutual understanding often arises from education – friends and relatives can read this or other websites, look up reliable sources of information in libraries, or go with you to some of your appointments. Websites for the Canadian Cancer Society and the Leukemia & Lymphoma Society of Canada are excellent sources of information.
  • Let them know you need their support. This could be just their listening when you need to talk – even about things not directly related to your leukemia. Nourish your important personal relationships – share how you are feeling physically and emotionally. There will be times when you experience more pain and limitations, and are frustrated. 
  • Always be open and honest about your needs. It’s best to give others a very clear idea of how they can help you. Here are some examples of what you may ask of your friends and family:
    • Help with housework such as cooking, cleaning, shopping and yard work 
    • Water your house plants and garden 
    • Mow the lawn 
    • Bring in your mail 
    • Take care of your pets 
    • Drive you to your medical appointments or treatments 
    • Drive a child to or from school or other activities 
    • Pick up a prescription at the pharmacy 
    • Look up information about your condition or other topics 
    • Be the contact person who keeps others updated on your condition

People with cancer can experience a range of emotions. Although some of these feelings are difficult to deal with, there are positive feelings as well. Some cancer patients find that they begin to appreciate life in a new way. 

Leukemia is different for every patient, with treatment tailored to each individual case. The key is to closely follow your healthcare team’s instructions for the steps and medications to take. Be persistent in following your treatment. Keep notes and communicate regularly with your doctor about the effects of your treatment. If you feel there’s a problem with your treatment, or are experiencing any side effects, talk to your doctor right away about these concerns. Don’t hold back from asking questions. Be pro-active and involved in the decision-making about your health. 

Here are some tips on how to get the most out of your appointment with people on your healthcare team:

  • Be open and honest about how you’re feeling 
  • If you want a loved one to talk with your healthcare team either with you or on your behalf, it helps to choose one person to play this role. This will help avoid having many people asking your healthcare team the same questions 
  • Write down any questions you have and bring the list with you 
  • Take notes 
  • Ask who you should call if something happens between scheduled appointments 
  • Try not to become hostile or angry during your appointment, this can affect how your healthcare team communicates with you

Lifestyle options


For most people, regardless of having cancer or not, exercise, healthy eating and good sleep habits are recommended. A healthy lifestyle can lead to enhanced quality of life for most people. 

Talk to your doctor before making any lifestyle changes. 

Many doctors encourage physical activity during cancer treatment and recovery. 

Benefits of exercise after cancer treatment can include: 

  • Increased energy level
  • Less fatigue, anxiety and depression
  • Reduction of stress
  • Improvement in cardiovascular fitness
  • Better self-esteem
  • Improved quality of life

Even though adding regular exercise to your life may be challenging, it’s important to remember that exercise can also help maintain your endurance as well as strength and flexibility. Make sure to discuss any plans for new physical activities with your healthcare team. If you experience any health problems while exercising, be sure to seek medical attention.

Planning your exercise program

After being diagnosed, check with your doctor before starting an exercise program, some programs may not be appropriate for you. General safety precautions include:

  • Don’t exercise if you have anemia or other blood problems (for example, abnormal sodium or potassium levels).
  • Avoid public places, such as gyms, if you have low white blood cell counts or a weakened immune system.
  • Avoid uneven surfaces or any weight-bearing exercises that could cause falls or injury.
  • If you have osteoporosis, arthritis, nerve damage or cancer that has spread to the bone, do not use heavy weights or exercise that puts too much stress on the bones.
  • Avoid swimming pools if you are receiving radiation therapy as chlorine can irritate skin in the treatment area.

For general information about exercise, you can go to the Public Health Agency of Canada Physical Activity’s webpage

Going through cancer therapy can take its toll on your body. After your treatment, living a healthy lifestyle is a good way to regain strength and endurance, manage stress, deal with fatigue, sleep problems and solve weight issues. 

Managing fatigue

Patients may describe fatigue as feeling tired, weak, worn-out, heavy, slow, or no energy. Fatigue can be symptom of a low red blood cell count (anemia). Red blood cell counts may be lower when the bone marrow is affected by leukemia or its treatments. Fatigue can also occur due to poor nutrition, sleep problems, anxiety or depression.

Make sure to discuss your fatigue with your healthcare team. They may suggest or prescribe one or more treatments such as nutritional supplements, blood transfusion, iron pills or other medications. 

Cancer-related fatigue may not be completely relieved by sleep and rest. This type of fatigue generally diminishes after cancer treatment ends but patients may continue to experience it months and even years later. 

Here are some approaches to coping with fatigue. Make sure to discuss any changes to your lifestyle with your doctor:  

  • Exercise can help patients with cancer feel better and have more energy. Refer to our section on exercise
  • A schedule of activity, rest and proper sleep time. Changes in daily routine makes the body use more energy so keeping to a regular schedule can improve sleep and increase day-time energy levels
  • Talk to a counselor about how you feel. Bottled up feelings and emotions can make fatigue worse 

For people with cancer, along with everyone else, a good diet is important for your body to regain its strength. Patients can consult Canada’s Food guide for help in making healthy food choices after having received cancer treatment.

A dietician can also help you make a meal plan that fits with your health needs and food preferences. 


The best way to get the vitamins and minerals you need is by eating a healthy, well-balanced diet, which should provide the amounts needed to stay healthy. However, taking regular-strength multivitamins and/or mineral supplements tailored appropriate for your age group and condition may be helpful, but you should check with your doctor before taking any supplements. 

Both prior to and after your leukemia treatment, you’ll likely experience overwhelming emotions such as feelings of anxiety or depression 

Ways of coping with these emotions include physical activity, good nutrition, balancing being active with rest and communicating honestly regarding your fears and concerns. 

Getting support from other people can help you manage your emotional health. Family, friends, religious or spiritual groups, cancer support groups, on-line support forums and counselors are all options. Which people or group(s) are best suited to you is a personal decision. Your level of comfort with the support setting is very important. If you prefer talking with one person at a time, a counselor or trusted friend might be the best choice. If you prefer talking with other leukemia patients who are experiencing the same thing you are experiencing, then a peer-support group run by a local clinic or local branch of the Canadian Cancer Society (www.cancer.ca – see the community services locator for your province) may be the best option for you. 

Complimentary therapy options for cancer


During your interactions with family and friends, and perhaps support groups, you may hear about various complementary and alternative therapies for cancer. These therapies, used for cancer in general, may include vitamins, herbs, special diets, and acupuncture among other things. 

If you are considering any complimentary or alternative therapies, talk to your doctor first. The decision to use a complementary or alternative therapy is a personal choice; however, it’s important that your doctor knows about these therapies because they could have some effects on the treatment prescribed by your doctor(s). 

Here are some examples of complementary therapies: 

Medical treatments


Content update in progress.


Please note that the information on this Web site should not be used as a substitute for seeking medical advice or treatment from a physician. You should not use this information to diagnose or treat a medical condition or health problem. Speak to your healthcare provider if you have any questions about your medical condition, symptoms or treatment options.