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What is leukaemia?

Leukaemias (or leukemias - U.S. spelling) are cancers of the white blood cells, which begin in the bone marrow. 

Leukaemias are grouped in two ways: the type of white blood cell affected - lymphoid or myeloid; and how quickly the disease develops and gets worse. Acute leukaemia appears suddenly and grows quickly while chronic leukaemia appears gradually and develops slowly over months to years. 

This information refers to four types of leukaemia; acute lymphoblastic leukaemia (ALL), chronic lymphoblastic leukaemia (CLL), acute myeloid leukaemia (AML) and chronic myeloid leukaemia (CML). 

In 2016, 4225 people in Australia were diagnosed with leukaemia. Chronic lymphocytic leukaemia is the most common type of leukaemia in Australia. 

In 2018, there were 1887 deaths due to these four cancer types. 

The five year survival rate is 62%. 



Leukaemia symptoms

Many people with leukaemia have no symptoms. The symptoms tend to be mild at first and worsen slowly. 

The main symptoms include: 

  • tiredness and/or anaemia (pale complexion, weakness and breathlessness) 

  • repeated infections (mouth sores, sore throat, fevers, sweats, coughing, frequent passing of urine with irritation, infected cuts and scratches, and boils) 

  • increased bruising and bleeding.

Other less common symptoms include: 

  • bone pain 
  • swollen, tender gums 
  • skin rashes 
  • headaches 
  • vision problems 
  • vomiting 
  • enlarged lymph glands 
  • enlarged spleen that may cause pain or discomfort 
  • chest pains. 


Causes of leukaemia

The cause of acute leukaemia is unknown, but factors that put some people at higher risk are: 

  • exposure to intense radiation

  • exposure to certain chemicals, such as benzene

  • viruses like the Human T-Cell leukaemia virus.

Most people diagnosed with chronic myeloid leukaemia have an abnormal chromosome called the Philadelphia chromosome. It has also been linked to exposure to high levels of radiation. 



Diagnosis of leukaemia

If your doctor suspects you may have a form of leukaemia, you will have one or more of the following tests to help diagnose, and determine the type of leukaemia: 

Blood tests

An initial blood test will show if leukaemia cells are present in the blood or if the levels of blood cells are different to what would be expected in a healthy person. 

Bone marrow biopsy

A small amount of bone marrow is removed from the hip bone (pelvic bone) using a long needle. As the procedure can be uncomfortable and even painful, a local anaesthetic will be used to numb the area and you may be given some pain-killers. It is common for children to have a general anaesthetic. 

Chest x-ray

A chest x-ray is taken to check the heart and lungs, and to see whether there are enlarged lymph nodes in the chest. 

Lumbar puncture

This test shows if any leukaemia cells have travelled to the fluid around your spine. 

Fluid is removed with a thin needle from a space between the bones in the lower back. This takes a few minutes, but as it can be uncomfortable, your doctor will use a local anaesthetic to numb the area. 



Treatment of leukaemia

Treatment depends on the type of leukaemia. Acute leukaemias develop quickly and need to be treated urgently, typically within 24 hours of diagnosis. 

Staging

Chest x-ray, CT scan and lumbar puncture determine if the leukaemia has spread. Cytogenetic analysis also may be used, to look for chromosomal changes. 

For acute myeloid leukaemia and acute lymphoblastic leukaemia there is no standard staging system; the disease is described as untreated, in remission, or recurrent. 

Staging of chronic myelogenous leukaemia is described in three phases: 

  • chronic - a few blast cells are found in the blood and bone marrow 
  • accelerated - after a few years the leukaemia may suddenly change and grow quicker 
  • blast - the number of blast cells increases, causing symptoms to worsen. Blast cells often spread to other organs. 

Chronic myelogenous leukaemia is described as stage 0 to IV, determined by the lymphocytes in the blood, size of lymph nodes and organs such as liver and spleen (larger = higher stage) and impact on red blood cells and platelets (fewer = higher stage). 

Common treatment options are:

Acute lymphoblastic leukaemia 

Acute myeloid leukaemia 

  • chemotherapy 
  • peripheral blood stem cell and bone marrow transplantation 
  • radiation therapy to the head. 

Chronic lymphoblastic leukaemia 

  • watchful waiting 
  • radiation therapy 
  • chemotherapy (chemotherapy with stem cell transplant is being tested in clinical trials) 
  • surgery (removal of spleen) 
  • monoclonal antibody therapy. 

Chronic myeloid leukaemia 

  • tyrosine kinase inhibitory therapy 
  • chemotherapy 
  • biologic therapy 
  • high-dose chemotherapy with stem cell transplant 
  • donor lymphocyte infusion 
  • surgery (removal of spleen). 

Palliative care

In some cases of leukaemia, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer. 

As well as slowing the spread of leukaemia, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies. 

Treatment Team

Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:
  • GP (General Practitioner)- looks after your general health and works with your specialiststo coordinate treatment.
  • Haematologist- specialises in diagnosing and treating diseases of the blood and lymphatic system.
  • Radiation oncologist- prescribes and coordinates radiation therapy treatment.
  • Cancer nurses- assist with treatment and provide information and support throughout your treatment.
  • Cancer care coordinators- coordinate your care, liaise with the multidisciplinary team and support you and your family throughout treatment.
  • Other allied health professionals- such as social workers, pharmacists and counsellors.


Screening for leukaemia

There is currently no national screening program for leukaemia available in Australia. 



Preventing leukaemia

There are no proven measures to prevent leukaemia. 



Prognosis for leukaemia

It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person's individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of leukaemia you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history. 

For most children and many adults who achieve remission, the leukaemia may be cured with peripheral blood stem cell or bone marrow transplantation and chemotherapy. 



Sources

Understanding Acute Leukaemia, Cancer Council NSW, © 2018. Last medical review of source booklet: November 2018. 

Understanding Chronic Leukaemia, Cancer Council NSW, © 2020. Last medical review of source booklet: March 2020. 

Australian Institute of Health and Welfare. ACIM (Australian Cancer Incidence and Mortality) Books. Canberra: AIHW. 

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