Blood cells, which include red cells, white cells and platelets, are made in your bone marrow. White blood cells play a vital role in your immune system and help defend your body against infection. If you have leukaemia, your white blood cells grow in an uncontrolled way, and these abnormal cells can’t defend your body. They also stop your other blood cells from working properly.
We have two main types of immature white blood cells – myeloid and lymphoid. Leukaemia is classed as myeloid or lymphoid depending on which cells are affected. Leukaemia can also be either acute or chronic. Acute leukaemias develop quickly over weeks and chronic leukaemias develop slowly over months and years.
There are four main types of leukaemia.
- Acute myeloid leukaemia. This is most common in adults over 60.
- Chronic myeloid leukaemia. This is most common in adults around the age of 50. Children can get this type of leukaemia too, but less often.
- Acute lymphoblastic leukaemia. This is most common in children under six. Although adults can develop this type of leukaemia too, it’s rare.
- Chronic lymphocytic leukaemia. This is the most common type of leukaemia in adults, especially in people over 65.
The symptoms of leukaemia vary depending on which type you have, and how advanced it is. It’s also possible not to get any symptoms at all.
If you do have symptoms of leukaemia, they may include:
- feeling tired
- feeling breathless
- feeling dizzy
- a fever and night sweats
- red bumps on your skin
- pain in your bones and joints
- swollen lymph nodes, which are glands in your body that are part of your immune system
- a swelling or tender lump on your abdomen (tummy)
- pale skin
- losing weight
- getting lots of infections
- bleeding or bruising easily
These symptoms aren't always caused by leukaemia, but if you have them, contact your GP.
Your GP will ask you about your symptoms and examine you. They’ll ask about your medical history too.
Your GP may give you (or arrange for you to have) a blood test to see if there is anything unusual. If there are any abnormalities, or your GP has concerns, they may refer you to see a haematologist. This is a doctor who specialises in blood conditions.
You might need to have some more tests, such as those below.
- Bone marrow aspiration or biopsy. An aspiration involves a doctor removing a small sample of bone marrow fluid. A biopsy is when they take a small sample of bone and marrow tissue, which will be tested.
- Cytogenetics. This involves checking the genetic information of your blood or bone marrow cells. With some types of leukaemia, you can get abnormalities in genetic tests.
- Immunophenotyping. This checks your blood or bone marrow cells for certain proteins found on leukaemia cells to see if they are myeloid or lymphoid.
Your treatment options will depend on the type of leukaemia you have, and how far your condition has progressed. Ask your doctor to talk you through these. They may include the following.
- Chemotherapy. This uses medicines to destroy cancer cells. How you have this treatment will depend on the type of leukaemia you have.
- Targeted therapy. This is a medicine that can block the growth and spread of cancer. It does this by interfering with how cancer cells grow. Targeted therapy medicines include imatinib.
- A bone marrow or stem cell transplant. Bone marrow or stem cells will be taken from a healthy donor and put into your body. You’ll usually have chemotherapy or radiotherapy before you have a transplant.
- Monoclonal antibodies. These are medicines that can recognise and target cancer cells. Monoclonal antibodies for leukaemia include ofatumumab, imatinib and dasatinib. They work for different types of leukaemia. Ask your doctor for advice on what medicines can treat your type of leukaemia.
It’s important to have what’s called supportive care too. This may include having antibiotics to prevent getting infections, or blood transfusions to help if you have anaemia. It might also include having injections of a medicine called granulocyte-colony stimulating factor (G-CSF) to help boost your white blood cell count.
Doctors don’t know the exact reasons why people develop leukaemia yet. But some things make you more likely to develop it. These include the following.
- Your age. Your risk of developing acute myeloid leukaemia and chronic lymphocytic leukaemia increases as you get older.
- Your gender. Slightly more men than women get leukaemia.
- Family history. Your risk of getting some types of leukaemia is higher if you have a brother, sister or parent with the condition.
- Exposure to radiation or chemicals, such as benzene.
- Genetic conditions, such as Down’s syndrome.
- Chemotherapy. Your risk of developing blood changes that could lead to leukaemia slightly increases if you’ve already had treatment with some chemotherapy medicines.
It can be a very difficult time for both you and your family when you find out you have leukaemia. It’s natural to feel anxious and overwhelmed about it. You may find it helpful to talk to someone about how you're feeling, maybe a friend or family member. Or you might find it helps to contact a support group to talk to people who are going through a similar experience to you.
Once your treatment is over, make sure you give yourself enough time to recover. You may feel very tired even months after your treatment. You may find it helps to plan ahead with school or work. Perhaps go back part-time at first and build the time up. Once you feel ready, try some gentle exercise, such as walking. And eat a healthy, balanced diet. See Related information for more tips on a healthy lifestyle during and after cancer.
Acute leukaemia often goes into remission. This is when there’s no sign of the disease, and your condition is under control. But this doesn’t mean that leukaemia is cured. But if acute leukaemia hasn’t come back within five years of having completed your treatment, doctors consider it cured. In some people, the disease returns after a remission and this is called a relapse.
If you have advanced cancer, you’ll be offered support known as palliative care. This aims to reduce the severity of your symptoms or slow down the cancer’s progression, rather than provide a cure. For more information, speak to your doctor, nurse or healthcare professional.
Not all chemotherapy medicines make you feel sick, and there are medicines that can help to ease it if this does happen.
Chemotherapy affects everyone in different ways, so it’s difficult to predict how you will respond to treatment. It can depend on lots of things, such as the medicines you’re taking and the dose. If you do feel sick, 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. They’ll usually be able to offer you a different type of medicine to ease your symptoms.
It depends on the type of treatment you have, but chemotherapy can sometimes make your hair fall out. Ask your doctor or specialist cancer nurse to explain the side-effects of your leukaemia treatment.
One treatment for leukaemia is chemotherapy, which uses medicines to destroy cancer cells. One of the side-effects of some, but not all, chemotherapy medicines is hair loss. Certain chemotherapy medicines 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 your medicine is likely to cause you to lose your hair, you might want to consider having your hair cut short before your treatment starts. Or you could think about getting a wig – your nurse should be able to help you with this.
If your hair does fall out, it will usually grow back after your treatment has finished. But it may be a slightly different colour, softer or curlier than it was before.
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- Dasatinib, nilotinib and standard-dose imatinib for the first-line treatment of chronic myeloid leukaemia. National Institute for Health and Care Excellence (NICE), 25 April 2012. www.nice.org.uk
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Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, June 2016.
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