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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 lymphocytic leukaemia (CLL), acute myeloid leukaemia (AML) and chronic myeloid leukaemia (CML). 

It is estimated that 4903 new cases of leukaemia will be diagnosed in Australia in 2021.

The chance of surviving at least five years is 63%. 



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. 

After a diagnosis of leukaemia 

After a diagnosis of leukaemia it is normal to experience a range of emotions such as anxiety, distress, uncertainty, sadness and confusion. At the same time treatment decisions will need to be made.  

Your doctor should discuss the different treatment options with you including the likely outcomes, timeframes, potential side effects and risks and benefits. It is up to you how involved you want to be in decisions about your treatment so get as much information as you need.  



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 lympocytic leukaemia in Australia generally uses the Binet system. There are three stages: 

  • Stage A – a high number of white blood cells but less than three enlarged areas of lymph tissue 
  • Stage B – a high number of white blood cells and three or more enlarged areas of lymph tissue 
  • Stage C – a high number of white blood cells with a low number of red blood cells and/or platelets and enlarged spleen or lymph nodes.  

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 lymphocytic leukaemia 

  • active monitoring
  • radiation therapy 
  • chemotherapy (chemotherapy with stem cell transplant is being tested in clinical trials) 
  • surgery (removal of spleen).

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. 

Managing side effects 

Treatment for leukaemia and even the cancer itself, can cause side effects. The types and severity of any side effects you may experience will depend on the type of treatment you have and may vary from person to person.  

Chemotherapy drugs affect cancer cells but also healthy fast-dividing cells. This can cause side effects such as fatiguehair loss and nausea. Side effects will vary depending on the drugs prescribed but most are temporary and there are ways to reduce or prevent them.  

Outlined below are some of the side effects you may experience.  

Heavy bleeding or easy bruising 

Chemotherapy can lower the number of platelets in your blood (thrombocytopenia) which means you will bruise and bleed more easily. While platelets are low, women who are menstruating will be given drugs to stop monthly periods. In some instances your doctor may recommend a platelet transfusion.  

Risk of infection 

The combination of chemotherapy drugs, as well as the leukaemia, will lower the levels of white blood cells. This is called neutropenia and can increase your risk of getting infections such as colds or infected cuts.  

Feeling tired (fatigue) 

The level of red blood cell may drop. This is called anaemia and can make you feel breathless and tired. This can be treated with blood transfusions but some people may feel fatigued for weeks or months after cancer treatment. Exercise can help reduce fatigue and improve your mood.  

Feeling sick or vomiting 

Chemotherapy can make you feel sick (nauseated) or even make you vomit. Not everyone will feel sick during and after treatment but often the best way to manage nausea is to prevent it starting. Anti-nausea (antiemetic) medicine helps most people although it may take time to find the right one.  

Hair loss 

Hair loss is a common side effect of chemotherapy and can also be a side effect of radiation therapy. This is due to the fact that any treatment which acts on growing cancer cells can also affect other fast-growing cells like hair roots. Talk to your doctor before treatment begins, about the possibility of hair loss and the level you can expect.  

You may not have all the above side effects or any at all and There are other side effects you may experience such as changes to bowel habits, mouth problems, nerve and muscle effects (peripheral neuropathy) or changes to thinking and memory. It is important to talk to your health care team about any changes you experience during and after treatment.  

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 specialists to 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, © 2020. Last medical review of source booklet: December 2020. 
  • 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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