What is leukaemia?

Leukaemia is cancer that affects the white blood cells (lymphocytes). It affects the blood and bone marrow, where blood cells are made. Leukaemia may be acute, appearing fast and growing quickly, or chronic, appearing gradually and growing slowly.

Although the cause of leukaemia is not known in most cases, there are treatments that can help manage the disease. Acute leukaemia can be cured. There is no cure for chronic leukaemia, but it can often be managed by lifelong treatments.

What are the types of leukaemia?

The types of leukaemia are named according to the:

• type of white blood cells affected (‘lymphoid’ if from the lymphatic system, or ‘myeloid’ if from the bone marrow)
• how quickly the cancer cells grow (‘acute’ if fast; ‘chronic’ if slow)

The 4 main types of leukaemia are:

• Acute lymphoblastic leukaemia (ALL), also called acute lymphocytic leukaemia — the most common type of leukaemia in children, and can also affect adults.
• Acute myeloid leukaemia (AML), sometimes called acute myelocytic, myelogenous or granulocytic leukaemia — can occur at any age, although it tends to affect older people.
• Chronic lymphocytic leukaemia (CLL) — the most common type of leukaemia in adults. CLL tends to be slow-growing and may have little impact on a person’s health for months or even years.
• Chronic myeloid leukaemia (CML) — tends to progress over weeks or months. CML mostly affects adults over 40 and is rare in children.

What are the symptoms of leukaemia?

The symptoms of leukaemia depend on how many abnormal white blood cells are in the body and where they collect.

In cases of acute leukaemia, abnormal white blood cells multiply rapidly and spill out from the bone marrow into the bloodstream, crowding out healthy blood cells, which can no longer do their job properly.

In chronic leukaemia, abnormal white blood cells fail to die, and slowly build up in the bloodstream, bone marrow and other organs.

A lack of healthy blood cells can lead to a range of problems.

Symptoms of acute leukaemia

Some of the more common symptoms of acute leukaemia include:

• anaemia, causing paleness, weakness, breathlessness and tiredness
• repeated infections, for example mouth sores, infected cuts and scratches
• unexplained bruising and bleeding
• bone or joint pain

Less common symptoms of acute leukaemia include:

• chest pain
• painful or swollen gums
• skin rashes
• headaches or eyesight problems
• vomiting

Symptoms of chronic leukaemia

The symptoms of chronic leukaemia can develop over months or years. It develops so slowly that many people with chronic leukaemia don’t know they have the condition, especially in the early stages. Some people with chronic leukaemia only find out they have the disease when they have a routine blood test.

The symptoms of chronic leukaemia are similar to that of acute leukaemia, as well as:

• pain or discomfort under the ribs on the left side, due to an enlarged spleen
• painless swelling of the lymph glands
• excessive sweating at night
• unintentional weight loss

What causes leukaemia?

Doctors are not sure what causes leukaemia. It is likely that abnormal genes play a part. CML is often caused by an abnormal chromosome. It is also likely that a person's chances of getting leukaemia are affected by where they live, where they work, what they eat and more.

In ALL, it's thought that the response of the immune system to certain infections may cause the condition to develop in some people.

When should I see my doctor?

The symptoms of leukaemia are similar to that of some other common conditions. If you notice any of these symptoms, it doesn't mean you have leukaemia, but it's a good idea to see your doctor for a check-up.

What are the risk factors for leukaemia?

Although the exact causes of leukaemia are unclear, some things are known to increase the risk of developing leukaemia. These are called 'risk factors' and include:

• smoking tobacco
• exposure to certain chemicals, such as benzene
• previous cancer treatment with chemotherapy or radiotherapy
• having certain genetic disorders, for example Down syndrome
• certain viral infections, for example human T-cell leukaemia virus
• a personal history of blood disorders, for example myelodysplastic syndrome
• having someone with leukaemia in the family

How is leukaemia diagnosed?

Many symptoms of leukaemia are quite general and can be caused by a range of illnesses. To make a definite diagnosis of leukaemia, a number of tests need to be done.

Your doctor will most likely give you a physical examination and take a sample of your blood so it can be examined under a microscope. If the blood test shows large numbers of abnormal white blood cells, and low numbers of healthy blood cells, more tests will be done to confirm the diagnosis.

Tests to find leukaemia

Several tests can be done to confirm a diagnosis of leukaemia, and to work out which type it is:

• Bone marrow biopsy — a syringe is used to take a sample of bone marrow, usually from your hip bone, for examination under the microscope and genetic testing.
• Lumbar puncture — this is sometimes called a spinal tap. A needle is put into the space between the bones of your lower back and fluid from around the spinal cord is removed for examination under the microscope to look for abnormal white blood cells.
• Lymph node biopsy — if you have swollen or tender lymph nodes, a sample may be removed for examination under the microscope.

Staging and further tests

The 'stage' of leukaemia describes how far the cancer has spread. Doctors conduct staging with a chest x-ray, CT scan or lumbar puncture. They may also look for chromosomal changes in your blood.

For acute leukaemia, the disease is described as untreated, in remission or recurrent (returned).

The stages of CLL are:

• Stage A (0), which refers to early disease where most people don’t have symptoms and don’t need treatment.
• Stage B (I-II) & C (III-IV), which refer to more advanced disease, which usually requires treatment.

CML may be described according to its phase:

• chronic (when there are only a few abnormal white blood cells or blasts)
• accelerated (when the leukaemia growth suddenly changes)
• blast (when there are a lot of immature white blood cells, causing symptoms to worsen)

How is leukaemia treated?

Treatment for leukaemia is usually provided by a team of different types of health professionals. The treatment depends on the type of leukaemia, the stage or phase of the disease, the severity of your symptoms, your age and health, and your wishes.

Most people with acute leukaemia need treatment straight away, while people with chronic leukaemia may not need treatment for years.

Treatments for acute leukaemia

There are a lot of new, effective treatments for leukaemia. Treatments for acute leukaemia include:

• Chemotherapy — a combination of medicines that kill cancer cells or slow their growth. It is most commonly given as a liquid injected into the veins (intravenous infusion). Some people may have low-dose chemotherapy injected under the skin or given as tablets.
• Targeted therapy — medicines that attack specific features of cancer cells without harming normal cells, leading to fewer side effects than chemotherapy.
• Stem cell or bone marrow transplant — putting healthy stem cells into the body after high-dose chemotherapy.
• Radiotherapy — using radiation to kill or damage cancer cells so they can’t grow or multiply. It may be used before a stem cell transplant.
• Retinoic acid — a form of vitamin A, usually given as tablets to treat a type of leukaemia called acute promyelocytic leukaemia.
• Leukapheresis — passing the blood through a special machine to remove white blood cells.
• Immunotherapy, which uses the body’s own immune system to fight cancer.

Treatments for chronic leukaemia

Treatments for chronic leukaemia can include those for acute leukaemia, as well as:

• actively monitoring the disease, with regular check-ups and blood tests, and delaying treatment until it's needed
• surgery to remove the spleen, if affected
• biological therapy, such as interferon, a protein with anti-cancer effects

On rare occasions, a stem cell transplant might be used. This is usually only an option in young people with aggressive CLL, because of the risks associated with this type of treatment.

What are the side effects of treatment?

Leukaemia treatments can cause unwanted side effects. For example, chemotherapy can cause nausea and vomiting, tiredness, hair loss, diarrhoea, constipation and a sore mouth.

Interferon can cause flu-like symptoms and other effects like loss of appetite and muscle pain, while retinoic acid can cause headaches, dry skin, dry mouth and bone pain.

Stem cell transplants can also cause unwanted effects, ranging from easy bruising and bleeding, to weakness and mouth infections.

Treatments can be given to reduce the impact of most of these side effects.

Palliative care

Palliative care aims to help control your symptoms and improve your quality of life. It does not mean that your medical team has given up on other treatments. Also known as supportive care, palliative care is sometimes given at the same time as you are receiving other treatments, such as chemotherapy, and in some cases it may be offered from the time of diagnosis.

Can leukaemia be prevented?

You can lower your risk of getting any cancer by eating well, exercising regularly, giving up smoking and cutting back on alcohol. But in many cases, there is no known way to prevent leukaemia.

Are there complications of leukaemia treatment?

A potential complication of chemotherapy for leukaemia is tumour lysis syndrome, which occurs when the large number of leukaemia cells break open and release their contents into the bloodstream.

This can overwhelm the kidneys, leading to a number of serious problems. Extra fluids and certain medicines may be given to avoid this syndrome.

Some types of chemotherapy may cause a temporary or permanent reduction in fertility. It is important to discuss any questions you might have about fertility with your doctor.

Resources and support

For more information and support, try these resources:

• Visit the Leukaemia Foundation’s website for a wide range of information about leukaemia, including about practical and emotional support and referral services.
• Call 1800 620 420 to arrange to talk to a Blood Cancer Support Coordinator at the Leukaemia Foundation.
• Call the Cancer Council on 13 11 20 for information about leukaemia and support.
• Visit the Cancer Council’s website for information about leukaemia symptoms, diagnosis and treatment.