Leukaemia

Leukaemia is a group of cancers that affect the blood. They start in the bone marrow, where blood cells are made.

Leukaemia can affect both adults and children. Different types are more common in different age groups.

What are the types of leukaemia?

There are many types of leukaemia. The types of leukaemia are named according to:

• the type of white blood cells affected ('lymphoid' or 'myeloid')
• whether the cancer is acute or chronic

In acute leukaemia, the bone marrow makes too many abnormal 'blast' (immature) cells. These cells build up and interfere with the production of normal blood cells.

In chronic leukaemia, abnormal mature white blood cells slowly build up in your bloodstream, bone marrow and other organs.

The main types of leukaemia are:

• acute lymphoblastic leukaemia (ALL), also called acute lymphocytic leukaemia — this is the most common type of childhood leukaemia. It can also affect adults.
• acute myeloid leukaemia (AML), sometimes called acute myelocytic, myelogenous or granulocytic leukaemia — it can occur at any age, but more often affects older people
• acute promyelocytic leukaemia (APML) — this is thought to be caused by damage to your genes
• chronic lymphocytic leukaemia (CLL) — this is the most common type of leukaemia in adults. CLL tends to be slow-growing and may have little impact on your health for months or even years.
• chronic myeloid leukaemia (CML) — this tends to progress over weeks or months. CML mostly affects adults aged over 40 years.

Rare types of leukaemia include hairy cell leukaemia (more common in middle-aged males) and biphenotypic leukaemia (which involves both abnormal myeloid and lymphoid cells).

Different types of leukaemia cause different symptoms. Many people with leukaemia have no symptoms.

The main symptoms of leukaemia are:

• tiredness
• anaemia — leading to pale skin and tiredness
• repeated infections — such as mouth sores and urinary tract infections
• fevers and sweats
• increased bruising and bleeding

Less common symptoms of leukaemia include:

• bone pain
• swollen, tender gums
• skin rashes
• headaches or vision problems
• vomiting
• enlarged lymph nodes
• pain or discomfort in your abdomen (tummy) or chest

Acute leukaemia symptoms tend to be more severe and develop more quickly than chronic leukaemia symptoms.

The symptoms of chronic leukaemia can develop over months or years. It grows so slowly that many people with chronic leukaemia don't know they have the condition.

Some people with chronic leukaemia only find out they have it through a routine blood test.

Although the exact causes of leukaemia are unclear, some things are known to increase your chance of getting leukaemia. Some of these risk factors are:

• contact with intense radiation
• exposure to certain chemicals, such as benzene
• some viral infections, for example human T-cell leukaemia virus
• changes in certain genes (gene mutations)
• a family history of leukaemia

Different risk factors are linked to getting different types of leukaemia.

Many common conditions can cause symptoms similar to leukaemia. If you notice any symptoms of leukaemia, it's a good idea to see your doctor for a check-up.

To make a diagnosis of leukaemia, your doctor will give you a physical examination and arrange blood tests.

Depending on the results of your blood tests, you may need additional tests to confirm a diagnosis of leukaemia and to work out which type it is and how far it has spread.

These tests may include:

• bone marrow biopsy — a needle is used to take a sample of bone marrow from your hip bone
• lumbar puncture (spinal tap) — a needle is used to take fluid from around the spinal cord in your lower back
• CT scan or PET scan

Your doctor may also look for genetic changes using a blood test.

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

Treatment for leukaemia depends on:

• the type of leukaemia you have
• the stage of your disease
• how severe your symptoms are
• your age
• your general health
• your choices

Treatments for acute leukaemia

There are several 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 often given as a liquid injected into your veins (intravenous infusion). You may have low-dose chemotherapy injected under the skin or given as tablets.
• 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.
• targeted therapy — medicines that attack cancer cells without harming healthy cells
• leukapheresis — passing the blood through a special machine to remove white blood cells
• immunotherapy — medicines that boost the body's own immune system to fight cancer

Treatments for chronic leukaemia

Treatments for chronic leukaemia can be similar to those used for acute leukaemia. Other treatments may include:

• active monitoring — having regular check-ups and blood tests, delaying treatment until it's needed
• surgery to remove your spleen

Palliative care

Palliative care aims to help manage your symptoms and improve your quality of life.

It is sometimes given at the same time as you are receiving other treatments. Some people may be offered palliative care from the time of diagnosis. It doesn't mean that your medical team has given up on other treatments.

What are the side effects of treatment?

Leukaemia treatments can cause unwanted side effects. For example, chemotherapy can also affect your healthy cells, causing:

• heavy bleeding and easy bruising
• infections
• tiredness
• nausea (feeling sick) and vomiting
• hair loss

Some types of chemotherapy and radiotherapy may cause fertility problems. It's important to talk through any questions you might have about fertility with your doctor.

Treatments are available for most of these side effects.

Living with leukaemia can affect many parts of your life, but support and treatment can help you manage the condition. Some people may need regular hospital visits for treatment or monitoring, while others may go long periods without needing active care. Your experience will depend on the type of leukaemia you have, how it responds to treatment and your overall health.

You might feel tired more often, be more prone to infections or need to be careful to avoid bleeding. It's important to follow your doctor's advice, attend regular check-ups and let your healthcare team know about any new symptoms.

Many people with leukaemia continue working, studying or caring for others. You may need to adjust your routine or ask for extra support. Talking to family, friends or a counsellor can help you cope with the emotional side of living with cancer.

Support groups, financial assistance and practical help are available. Your doctor or cancer care team can connect you with services that suit your needs.

Leukaemia cells can suddenly break down and release chemicals into your blood. This is called tumour lysis syndrome. It can damage your kidneys and other organs. It can also happen after starting chemotherapy.

Some types of leukaemia can affect your brain or lungs, causing headaches, confusion or breathing problems.

These complications can be serious, but many can be treated or managed with the right care.

There is no known way to prevent leukaemia.

However, you can lower your chance of getting any cancer by:

• eating well
• exercising regularly
• quitting smoking
• cutting back on alcohol

For more information and support, try these resources:

• Visit the Leukaemia Foundation (Opens in new tab) for a wide range of information about leukaemia, including practical and emotional support and referral services. Call 1800 620 420 to talk to a Blood Cancer Support Coordinator.
• Visit the Cancer Council (Opens in new tab) for information about leukaemia symptoms, diagnosis and treatment. Call the Cancer Council on 13 11 20 for information about leukaemia and support.
• You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.

Languages other than English

• The Leukaemia Foundation has fact sheets on blood cancers (Opens in new tab) for people from a range of cultural and language backgrounds.
• Cancer Australia has a range of resources about cancer (Opens in new tab), which have been translated into other languages.

Information for Aboriginal and/or Torres Strait Islander peoples

• The Leukaemia Foundation has information about blood cancers (Opens in new tab) for Aboriginal and/or Torres Strait Islander peoples.
• Read all about cancer for Aboriginal and Torres Strait Islander peoples (Opens in new tab) at Cancer NSW.
• Find resources for people with cancer (Opens in new tab), their families and communities.