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Leukaemia - a general overview

Leukaemia is cancer of the white blood cells. There are several different types of leukaemia, which can either develop quickly over weeks (acute) or slowly over months and years (chronic).

Healthy blood cells, which include red cells, white cells and platelets, are made in your bone marrow. Usually, white blood cells are part of your immune system and help defend your body against infection. Leukaemia occurs when immature white blood cells grow in an uncontrolled way. These abnormal cells can’t defend your body against infection.

There are two main types of immature white blood cells – myeloid and lymphoid. Leukaemia can therefore be classed as myeloid or lymphoid. The condition is also said to be either acute or chronic. Acute leukaemias develop quickly over weeks and chronic leukaemias develop slowly over months and years.

The four main types of leukaemia are listed below.

  • Acute myeloid leukaemia – most common in adults aged about 60.
  • Chronic myeloid leukaemia –most common in adults aged about 50. Children can get this type of leukaemia too, but this is rare.
  • Acute lymphoblastic leukaemia – most common in children aged between two and 10. Adults can also develop this type of leukaemia, but this is rare.
  • Chronic lymphocytic leukaemia –most common in adults, especially older people aged around 70.

In the UK, around 8,600 people are diagnosed with a type of leukaemia each year. It’s generally more common in men than women.

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Details

  • Symptoms Symptoms of leukaemia

    The symptoms vary depending on the exact type of leukaemia you have and how advanced it is. You can also have leukaemia but have no symptoms at all.

    Symptoms of leukaemia can include:

    • tiredness
    • breathlessness
    • pale skin
    • fever and night sweats
    • weight loss
    • frequent infections
    • unusual bleeding or bruising
    • red bumps on your skin
    • pain in your bones and joints
    • swollen lymph nodes (glands in your body that are part of your immune system)
    • a swelling or tender lump on the left side of your abdomen (tummy) because of an enlarged spleen

    These symptoms aren't always caused by leukaemia, but if you have them, see your GP.

  • Diagnosis Diagnosis of leukaemia

    Your GP will ask you about your symptoms and examine you.

    If he or she suspects you may have leukaemia, you will be advised to have a blood test. Your sample will be sent to a laboratory to find out which types of cell are present in your blood.

    If the diagnosis is confirmed, or strongly suspected after your blood test, your GP will refer you to a haematologist. This is a doctor who specialises in conditions of the blood. Your doctor may advise you to have some further tests, which may include the following.

    • Bone marrow aspiration or biopsy. An aspiration involves having a small sample of bone marrow fluid removed. A biopsy is where a small sample of bone and marrow tissue is taken for testing. This allows your bone marrow cells to be studied more closely.
    • CT scan, MRI scan or chest X-rays.
    • Cytogenetics. This involves checking your blood or bone marrow cells for any abnormalities in your genes.
    • Immunophenotyping. This checks your blood or bone marrow cells for certain proteins found on the leukaemia cells and will determine whether they are myeloid or lymphoid.
    • Tissue typing. This involves having a set of blood tests. You and your siblings may be offered this if stem cell transplantation is a possible treatment option in the future.
  • Treatment Treatment of leukaemia

    Your treatment options will depend on the type of leukaemia you have and how far your condition has progressed. Ask your doctor about your options. These may include the following.

    • Chemotherapy. You may be offered medicines to destroy the cancer cells.
    • Radiotherapy. With certain types of leukaemia, you may be offered treatment using high-energy rays to target cancer cells. However, it’s worth bearing in mind that radiotherapy isn’t commonly recommended as a treatment for leukaemia.
    • Targeted therapy. You may be offered medicines such as imatinib, which are directed at a specific protein in leukaemia cells.
    • A bone marrow or stem cell transplant. This is when bone marrow or stem cells from a healthy donor are put into your body. You will usually be offered high-dose chemotherapy or radiotherapy before you have your transplant.
    • Monoclonal antibodies. An antibody is a type of protein which is attracted to certain cells in your body. Monoclonal antibodies have lots of copies of one particular antibody. These are used to stimulate your body into attacking or controlling the growth of cancer cells. Your doctor may suggest that you take a monoclonal antibody together with your chemotherapy. For example, if you have chronic lymphocytic leukaemia, you may be offered a medicine called rituximab.

    Good supportive care is also very important. This may include having antibiotics or, blood transfusions. Make sure you get the emotional support you need too.

  • Prompt access to quality care

    From treatment through to aftercare, with Bupa health insurance we aim to get you the help you need, as quickly as possible. Find out more today.

  • Causes Causes of leukaemia

    The exact reasons why you may develop leukaemia aren't fully understood at the moment. However, certain factors may increase your risk of developing the condition.

    • Your age. Your risk of developing acute myeloid leukaemia increases as you get older.
    • Gender. Slightly more men than women are affected by leukaemia.
    • Family history. For example, your risk of getting chronic lymphocytic leukaemia is up to nine times higher if you have a brother, sister or parent with the condition.
    • Exposure to radiation or chemicals, such as benzene.
    • A weakened immune system. For example, if you have HIV/AIDS, or you’re taking medicines that suppress your immune system.
    • Certain blood disorders, such as aplastic anaemia. Or genetic conditions, such as Down’s syndrome.
    • Chemotherapy. Your risk of developing blood changes that could lead to acute myeloid leukaemia slightly increases if you’ve already had treatment with certain chemotherapy medicines. However, this is very rare.
  • Living with leukaemia Living with leukaemia

    You may feel anxious and overwhelmed when you find out you have leukaemia. It can be a very difficult time for both you and your family. You may find it helpful to talk to someone about how you're feeling, maybe a friend or family member. Alternatively, you may wish to contact support groups to talk to people who are going through the same experiences as you.

    Once your treatment is over, you may feel frustrated that you can't immediately get back to life as it was before. For example, you may feel very tired even months after your treatment. Make sure you give yourself enough time to recover. You may find it helpful to plan ahead with school or work, perhaps going back part-time at first.

    Once you feel ready, you may decide to try some gentle exercise, such as walking. Try to eat a healthy, balanced diet with at least five portions of fruit and vegetables a day.

    Acute leukaemia often goes into remission. This is when there’s no sign of the disease, and your condition is under control. However, this doesn’t mean that your condition is cured. For many people with acute leukaemia, the disease returns after a remission – this is called a relapse.

    For more advanced cancer, you will be offered support known as palliative care. This treatment will aim to reduce the severity of your symptoms or slow disease progression, rather than providing a cure. For more information, speak to your doctor, nurse or healthcare professional.

  • FAQs FAQs

    Could I pass leukaemia on to my children?

    Answer

    It’s extremely rare, but occasionally leukaemia can be passed on to an unborn baby from his or her mother.

    Explanation

    In 2009, scientists found that cancer cells can be transferred from a mother to her unborn baby. They discovered, using tests known as genetic fingerprinting, that a pregnant woman had passed leukaemia cells on to her baby. However, this is extremely rare and very unlikely to happen to most mothers and babies.

    Some genetic conditions that are passed from parent to child can increase the risk of certain types of leukaemia. However, they don't directly cause the disease. These conditions include Down's syndrome and Fanconi's anaemia. Speak to your doctor if you would like more information about this.

    Will I be sick if I have chemotherapy for leukaemia?

    Answer

    Not all chemotherapy medicines make you feel sick. However, if you do feel unwell, there are medicines which can help to ease your sickness.

    Explanation

    Chemotherapy affects everyone in different ways. It’s difficult to predict how someone will respond to treatment. It can depend on many things, such as the medicines you’re taking and the dose.

    You may find that chemotherapy doesn’t make you feel sick. If you do feel sick, this may start immediately or it may not come on until several hours after your treatment. You may continue to feel sick the day after your treatment.

    Your doctor may give you anti-sickness injections or tablets. These medicines can work better in some people than others. If they don't work for you, let your doctor know. He or she will usually be able to offer you a different type of medicine to ease your symptoms.

    Will treatment for leukaemia make my hair fall out?

    Answer

    It depends on the type of treatment you have. Chemotherapy can sometimes make your hair fall out. Ask your doctor or specialist cancer nurse to explain the side-effects of your leukaemia treatment.

    Explanation

    One type of treatment you may have for leukaemia is chemotherapy, which uses medicines to destroy cancer cells. One of the side-effects of some chemotherapy medicines is hair loss. However, not all chemotherapy medicines cause hair loss and may only lead to some mild hair thinning. Ask your doctor or specialist nurse whether hair loss is a possible side-effect of your treatment.

    If complete hair loss is a possible side-effect of your treatment, you may want to consider having your hair cut short before your treatment starts. You may also want to think about getting a wig. If you would like to get a wig, speak to your nurse for more information.

    If your hair does fall out, it will usually grow back after your treatment has finished. However, your hair may be a slightly different colour, softer or curlier than it was before.

  • Resources Resources

    Further information

    Sources

    • Leukaemias. Medscape. www.emedicine.medscape.com, published 1 April 2014
    • Overview of leukaemia. The Merck Manuals. www.merckmanuals.com, published July 2012
    • Simon C Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press 2010:674−7
    • Sherwood L. Human Physiology: From cells to systems. 8th ed. USA: Brooks/Cole; 2013:394−404
    • Overview of leukaemia. BMJ Best Practice. www. bestpractice.bmj.com, published 24 May 2013
    • Singer CRJ, Baglin T, Doka I. Oxford handbook of clinical haematology. 3rd ed. Oxford: Oxford University Press 2009:120 −50
    • Eichhorst B, Dreyling M, Robak T et al. Chronic lymphocytic leukemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011; 22 (suppl 6):vi50-vi54. doi: 10.1093/annonc/mdr377
    • Acute myeloid leukaemia risks and causes. Cancer Research UK. www.cancerresearchuk.org, published 22 February 2014
    • Leukaemia incidence statistics. Cancer Research UK. www.cancerresearchuk.org, accessed 6 March 2014
    • Dasatinib, nilotinib and standard-dose imatinib for the first-line treatment of chronic myeloid leukaemia. National Institute for Health and Care Excellence (NICE), 2012. www.nice.org.uk
    • Acute Leukemia. The Merck Manuals. www.merckmanuals.com, published July 2012
    • Chronic lymphocytic leukaemia (CLL) risks and causes. Cancer Research UK. www.cancerresearchuk.org, published 15 January 2014
    • Chemotherapy for breast cancer. American Cancer Society. www.cancer.org, published 11 September 2013
    • Acute myeloid leukaemia tests. Cancer Research UK. www.cancerresearchuk.org, accessed 26 February 2014
    • Acute myelogenous leukaemia. BMJ Best Practice. www.bestpractice.bmj.com, published 9 August 2013
    • Acute lymphocytic leukaemia. BMJ Best Practice. www.bestpractice.bmj.com, accessed 30 August 2013
    • Further tests for acute myeloid leukaemia. Cancer Research UK. www.cancerresearchuk.org, published 11 February 2014
    • Radiotherapy for acute myeloid leukaemia. Cancer Research UK. www.cancerresearchuk.org, accessed reviewed 16 May 2014
    • Radiotherapy for chronic lymphocytic leukaemia (CLL). Cancer Research UK. www.cancerresearchuk.org, published 17 July 2013
    • Chronic myelogenous leukaemia. BMJ Best Practice. www.bestpractice.bmj.com, published 1 November 2013
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 5 March 2014 (online version)
    • Hematopoietic stem cell transplantation. Medscape. www.emedicine.medscape.com, published 31 March 2014
    • Hematopoietic stem cell transplantation. The Merck Manuals. www.merckmanuals.com, published August 2013
    • Bone marrow or stem cell transplants for ALL. Cancer Research UK. www.cancerresearchuk.org, published 19 August 2013
    • Biological therapy for chronic lymphocytic leukaemia (CLL). Cancer Research UK. www.cancerresearchuk.org, published 17 July 2013
    • Rituximab for the first-line treatment of chronic lymphocytic leukaemia. National Institute for Health and Care Excellence (NICE), 2010. www.nice.org.uk
    • Worry, anxiety and panic attacks. Macmillan cancer support. www.macmillan.org.uk, reviewed 1 May 2012
    • How you can help yourself. Macmillan cancer support. www.macmillan.org.uk, reviewed 1 May 2012
    • Coping with acute myeloid leukaemia. Cancer Research UK. www.cancerresearchuk.org, published 26 February 2012
    • Diet and exercise after acute myeloid leukaemia. Cancer Research UK. www.cancerresearchuk.org, published 24 February 2014
    • Hair loss, hair thinning and cancer drugs. Cancer Research UK. www.cancerresearchuk.org, published 31 January 2014
    • Sickness (nausea) and cancer drugs. Cancer Research UK. www.cancerresearchuk.org, published 31 January 2014
    • Isoda T, Ford AM, Tomizawa D et al. Immunologically silent cancer clone transmission from mother to offspring. PNAS 2009; 106(12):17882-85. doi:10.1073/pnas.0904658106
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    Reviewed by Hemali Parekh, Bupa Health Information Team, June 2014.

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