Leukaemia

Leukaemia is a blood cancer that usually starts in your bone marrow, a spongy tissue found in the centre of your larger bones. All of your body’s blood cells including red cells, white cells and platelets are produced in the bone marrow.

Leukaemia leads to the over-production of abnormal white blood cells. White blood cells are part of your immune system and fight off infection, but incorrectly formed white blood cells cannot do this. Their abundance also crowds your red blood cells and platelets and means they cannot work properly either.

• Unexplained weight loss
• Feeling tired or weak
• Easily bruise or bleed
• Swollen lymph nodes
• Swollen stomach
• Infections
• Fever/night sweats
• Pain in bones/joints

You should see your doctor if you think you may have leukaemia symptoms. Your GP may examine you and find out more about your symptoms. If they suspect leukaemia, they will refer you to a hospital doctor called a haematologist, a specialist in blood disorders, for further tests.

Further tests might include:

• Blood tests – to check your full blood count, see if your cells are healthy, and to check how well your liver and kidneys are working.
• X-rays and scans - MRI scans, CT scans, PET scans, ultrasound scans or X-rays to create detailed pictures of the inside of your body.
• Bone marrow biopsy - a sample of bone marrow is removed and checked under a microscope.
• Genetic tests - looks for changes to the genes in your cells.
• Immunophenotyping - looks at proteins on the surface of your cells.
• Lumbar puncture - may be done if it’s suspected that acute leukaemia has spread to your nervous system.
• Lymph node biopsy - removing and examining a swollen lymph gland.

There are several different types of leukaemia. They are named according to whether the leukaemia is acute or chronic, and the type of blood cell affected.

Chronic Leukaemia - occurs when white blood cells fail to die so they accumulate in your bloodstream, bone marrow and related organs and they overcrowd your healthy blood cells. Chronic leukaemia develops more slowly and may not require immediate treatment.

There are four main types of leukaemia:

• Acute myeloid leukaemia (AML) - a rare but fast-growing condition that can develop within a few days or weeks. The myeloid blood cells start growing abnormally and in an uncontrolled way. They do not fully mature and as young cells called myeloblasts they do not have the infection-fighting properties of fully developed cells. They overcrowd your bone marrow and stop other blood cells from doing their job properly.
• Acute lymphoblastic leukaemia (ALL) – rare and most often develops in children, teenagers and young adults. Large numbers of immature white blood cells, called lymphoblasts, are released before they are ready and do not have proper infection-fighting properties. This large number of lymphoblasts results in a decrease in the number of red blood cells and platelet cells and causes symptoms of anaemia.
• Chronic myeloid leukaemia (CML) – slow-growing and most common in older adults around 60 to 65 years of age. Your bone marrow produces too many immature white blood cells, called myeloid cells, that are not fully developed and do not work properly. They also fill the bone marrow and reduce the number of normal cells in the blood.
• Chronic lymphocytic leukaemia (CLL) – slow-developing and most common form of leukaemia for adults that mainly affects people over the age of 60. The bone marrow produces too many white blood cells called lymphocytes, which are not fully developed and do not work properly. Over time, lymphocytes accumulate in your lymphatic system and may cause large and swollen lymph nodes, and fill your bone marrow that reduces the number of normal white blood cells, red blood cells and platelets that can be made.

Your treatment options will depend on the type of leukaemia you have, how developed it is, your age, and your general health. Early treatment improves the chance of achieving remission when the abnormal cells are no longer growing and dividing.

If you have acute leukaemia your treatment will usually begin immediately after diagnosis.

Types of treatment for leukaemia include:

• Watchful waiting – slower-growing chronic leukaemia may not be actively treated. You’ll be carefully monitored, and will only start treatment if and when it is needed.
• Chemotherapy – the primary treatment for leukaemia that kills the cancer cells and can be tailored to suit your type of leukaemia. It can be given through a drip into a vein, as a tablet you swallow, or by injection under the skin. You may be given chemotherapy medication at a high dose, called intensive chemotherapy, or a lower dose, known as non-intensive chemotherapy.Chemotherapy is also given in preparation for a stem cell transplant.
• Other drug therapies - used on their own or with chemotherapy. Targeted or biological therapies and immunotherapy target the protein or genetic changes your abnormal cancer cells have that normal cells do not have. They include rituximab and tyrosine kinase inhibitors (TKIs).
• Radiotherapy - high doses of controlled radiation are used to kill cancerous cells.