Leukaemia - a general overview

Expert reviewer, Dr Prem Mahendra, Consultant Haematologist
Next review due September 2021

Leukaemia is cancer that starts in the tissue that makes your blood cells – usually your bone marrow. There are different types of leukaemia. The most common type in adults is called chronic lymphocytic leukaemia, and the most common in children is acute lymphoblastic leukaemia. In the UK, around 10,000 people are diagnosed with leukaemia each year.

About blood cells

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, some of your white blood cells grow in an uncontrolled way, and these abnormal cells can’t defend your body.

Types of leukaemia

There are four main types of leukaemia. They are named according to the speed at which the condition develops and the type of immature white blood cell involved.

Leukaemia can be either acute or chronic. Acute leukaemia develops quickly over weeks and chronic leukaemia develops slowly over months and years.

We have two main types of immature white blood cells – myeloid and lymphoid. Leukaemia is classed as myeloid or lymphoid depending on which type of white blood cell is affected.

These are the four main types of leukaemia.

  • Acute lymphoblastic leukaemia (ALL). This is most common in children. Although adults can develop this type of leukaemia, it’s far less common.
  • Chronic lymphocytic leukaemia (CLL). This is the most common type of leukaemia in adults, particularly in people over 60.
  • Acute myeloid leukaemia (AML). This is most common in older adults over 60.
  • Chronic myeloid leukaemia (CML). This is most common in adults around the age of 50. Children can get this type of leukaemia, but it happens less often.

There are also other, less common, types of leukaemia, such as hairy cell leukaemia. Your doctor can give you detailed information about which type you have.

Symptoms of leukaemia

Leukaemia symptoms can vary depending on which type you have, and how advanced it is. It’s also possible not to have any symptoms at all.

If you do have symptoms of leukaemia, they may include:

  • feeling tired
  • bleeding or bruising easily
  • getting lots of infections
  • pale skin
  • feeling short of breath
  • feeling dizzy
  • a fever and night sweats
  • red bumps on your skin
  • pain in your bones and joints
  • swollen lymph nodes – these are glands in your body that are part of your immune system
  • a swollen or tender tummy (abdomen), or discomfort or pain on the left side of your tummy
  • losing weight
  • feeling your heart racing

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

Diagnosis of leukaemia

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 and molecular analysis. This involves checking the genetic information of your blood or bone marrow cells. With some types of leukaemia, you can get abnormalities in these 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.

Treatment of leukaemia

Leukaemia treatment options depend on the type of leukaemia you have, and how far your condition has progressed. Ask your doctor to talk you through your options. 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 stem cell transplant or bone marrow transplant. You’ll usually have chemotherapy or chemotherapy and radiotherapy before you have a transplant.
  • Immunotherapy. This is a treatment that stimulates or suppresses your immune system to help your body fight cancer. Examples of immunotherapy to treat leukaemia include rituximab, ofatumumab and blinatumomab. You might have immunotherapy in combination with chemotherapy.

Different treatments work for different types of leukaemia; some aim to cure leukaemia while others aim to keep it under control. Ask your doctor for advice on which medicines can treat your type of leukaemia.

As well as medicines, it’s important to have supportive care. This may include antibiotics to prevent getting infections, or blood and platelet transfusions to boost your red blood cell and platelet count. It might also include having injections of a medicine called granulocyte-colony stimulating factor (G-CSF) to help boost your white blood cell count.

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Causes of leukaemia

Doctors don’t yet know the exact reasons why people develop leukaemia. But some things make you more likely to develop some types of leukaemia. These include the following.

  • Your age. Your risk of developing acute myeloid leukaemia and chronic lymphocytic leukaemia increases as you get older.
  • Your sex. Your risk of getting either acute lymphocytic leukaemia or chronic lymphocytic leukaemia is higher if you are male.
  • 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.
  • Family history. Your risk of getting chronic lymphocytic leukaemia may be higher if you have a brother, sister or parent with the condition.

Living with leukaemia

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 life 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 your leukaemia is cured. Sometimes acute leukaemia returns after a remission – this is called a relapse. If this happens to you, you may be able to have further treatment, such as chemotherapy or a stem cell transplant. However, if acute leukaemia hasn’t come back within a few years of having completed your treatment, it’s unlikely to return.

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 to provide a cure. For more information, speak to your doctor, nurse or healthcare professional.

Frequently asked questions

  • 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 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 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.

  • One of the side-effects of some, but not all, chemotherapy medicines is hair loss. Some chemotherapy medicines cause only 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 or softer or curlier than it was before.

  • This depends on what type of leukaemia you have, how soon you were diagnosed and how you responded to treatment. It also depends on your age.

    Chronic lymphocytic leukaemia (CLL)

    CLL often can’t be cured, but most people live with the disease for many years. The cancer is then in what’s called remission. This means that the symptoms of cancer go away but the cancer is still in your body. So treatment may control the cancer but not cure it.

    Chronic myeloid leukaemia (CML)

    The outlook for CML is reasonably good. While treatment for most people won’t cure the cancer, it will keep the cancer under control for a number of years. You’ll usually be treated with a tablet form of chemotherapy but if you don’t respond to this, your doctor may recommend a stem cell transplant. If a stem cell transplant is an option for you, it may offer a cure.

    Acute lymphoblastic leukaemia (ALL)

    Around 30% of adults with ALL are cured with treatment. Children with ALL seem to do well – about eight in every 10 children are cured after treatment.

    Acute myeloid leukaemia (AML)

    About a third of people between 18 and 60 with AML are cured with treatment. Children with AML are more likely to do well than older people but it depends on your individual circumstances.

    Your team of healthcare professionals looking after you will discuss your treatment with you and what to expect. They’ll talk you through the different options available to you, and you can talk to them about your chances of surviving leukaemia. You’ll be monitored regularly to check for any signs of relapse. This means the cancer has returned, or you get symptoms of leukaemia after a period of improvement. If you get any new symptoms, it's important to let your healthcare team know.

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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, September 2018
    Expert reviewer, Dr Prem Mahendra, Consultant Haematologist
    Next review due September 2021