Introduction
Leukaemia is a form of cancer affecting the white blood cells which are part of the body’s defence system against infections. Overall, leukaemia is the eighth most common form of cancer in Europe with about 81,000 new cases diagnosed each year.
There are four basic types of leukaemia:
The acute forms of leukaemia develop more quickly than the chronic or slowly growing types.
Effective treatments are available for all forms of leukaemia producing good results for the majority of patients.
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The Blood and White Blood Cells
The blood has two main types of cells – red cells which carry oxygen to the lungs and to all other areas of the body, and white cells which combat infection. In addition, there are blood platelets which are important in blood clotting. The rest of the blood is made up of plasma, a watery solution of various chemicals and proteins essential for our wellbeing.
Blood cells are produced in the bone marrow and other sites. In leukaemia, larger numbers of abnormal white cells, which do not function properly, build up in the blood interfering with normal processes. In chronic leukaemia this build up is very slow, often over years, but in acute leukaemia these changes can happen over days or weeks with a sudden onset of symptoms.
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Different Forms of Leukaemia
Acute Lymphoblastic Leukaemia
Acute Lymphoblastic Leukaemia (ALL) affects white blood cells called lymphocytes. An overproduction of immature lymphocytes clogs up the bone marrow stopping the production of normal blood cells and platelets and so producing symptoms due to a lack of these two important blood elements.
Acute lymphoblastic leukaemia is rare but it is the most common form of cancer in children and can also affect teenagers and adults.
Acute Myeloid Leukaemia
Acute Myeloid Leukaemia (AML) affects the other type of white blood cells, the granulocytes. Granulocytes contain granules which are enzymes capable of digesting particles, including bacteria and other tiny pieces of debris, which the cells clean up around the body. In acute myeloid leukaemia, overproduction of granulocytes fills up the bone marrow and so prevents production of normal cells with the abnormal cells spilling over into the blood stream. The patient also suffers from associated anaemia due to a lack of red blood cells, and bruising and bleeding due to a lack of platelets.
Chronic Lymphatic Leukaemia
Chronic Lymphatic Leukaemia (CLL) is the most common form of leukaemia affecting the lymphocytes. The lymphocytes multiply too quickly resulting in too many being present in the blood. Although CLL cells look normal under the microscope, they do not work properly and over time, usually many months or years, replace the normal cells in the bone marrow so reducing production of normal blood cells and platelets resulting in anaemia due to a lack of red blood cells, and bruising and bleeding due to a lack of platelets.
Chronic Myeloid Leukaemia
Chronic Myeloid Leukaemia (CML) affects white granulocytes which fail to mature or work properly and gradually fill up the bone marrow reducing the numbers of normal cells and platelets produced.
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Leukaemia Risk Factors
Risk factors are things which make it more likely that you will develop a particular disease.
Acute Lymphoblastic Leukaemia (ALL)
ALL is not usually genetic but some syndromes like Down's syndrome and Fanconi’s syndrome are associated with an increased risk of developing leukaemia.
Benzene and other industrial solvents are also associated with a higher incidence of acute lymphoblastic leukaemia.
Acute Myeloid Leukaemia (AML)
Apart from previous radiotherapy treatment, there are no known risk factors for acute myeloid leukaemia.
Chronic Lymphatic Leukaemia (CLL)
CLL generally affects people over the age of 60 and is rare under the age of 40. It is not known what causes the damage which leads to abnormal lymphocytes developing into CLL.
Chronic Myeloid Leukaemia (CML)
Exposure to benzene and other industrial solvents is associated with a higher incidence.
Many patients with CML will have the Philadelphia chromosome. This is not an inherited gene but an abnormal chromosome which produces an enzyme, tyrosine kinase, which leads to the development of CML.
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Preventing Leukaemia
There are no practical preventive measures which individuals can take to avoid being at risk of leukaemia.
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Symptoms of Leukaemia
There are no specific symptoms of leukaemia and in the early stages of the chronic forms there may be no symptoms at all.
In acute leukaemia, and in the later stages of chronic leukaemia, reduced production of normal cells in the bone marrow results in a range of non-specific symptoms including:
- generalised weakness and fatigue, which might be due to anaemia
- infections, due to the reduced numbers of normal white cells in the blood
- weight loss
- bruising and bleeding, due to the reduced numbers of platelets in the blood
- bone and joint pain, usually due to bleeding into the joints
- breathlessness, due to anaemia and the reduced oxygen carrying capacity of the blood
- enlarged lymph nodes
- an enlarged spleen – the spleen cannot normally be felt as it is under the ribs on the left side of the abdomen. However, if it is enlarged its lower edge will be below the ribs and can be felt
- discomfort in the abdomen, which may be due to the spleen being enlarged
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Treating Leukaemia
Treatment varies according to the type of leukaemia and the individual patient.
Acute Lymphoblastic Leukaemia (ALL)
Chemotherapy (drugs used to destroy abnormal cells) is the main treatment for ALL (given in a series of treatment blocks).
Radiotherapy is sometimes given to the brain if leukaemia cells are found in the fluid around the spine, as leukaemia cells can survive there even after chemotherapy.
Acute Myeloid Leukaemia (AML)
AML is treated mainly with chemotherapy, but radiotherapy and biological therapy can be used in certain situations.
Treatment of acute myeloid leukaemia is usually divided into two phases:
Stem cell (bone marrow) transplantation is also used in some cases. Before a transplant, high dose chemotherapy and/or radiotherapy is used to destroy the patient’s existing bone marrow.
Chronic Lymphatic Leukaemia (CLL)
CLL is a slowly progressive disease. Treatment with conventional doses of chemotherapy is not curative and is frequently unnecessary in the early stages of the disease as some patients have a normal life expectancy without any treatment.
Chronic Myeloid Leukaemia (CML)
Treatment for patients with CML depends on which phase of their disease they are in, and to some extent their age, as well as the availability of a suitable stem cell donor with matching tissue type.
In the chronic phase treatment with imatinib is the norm. Imatinib is an example of a new type of drug called monoclonal antibodies, which works by blocking an abnormal enzyme found in CML.
For patients in the blast phase, a stem cell (bone marrow) transplant is the best treatment, but there is no guarantee that it will work. Before a transplant, high dose chemotherapy and/or radiotherapy is used to destroy the patient’s existing bone marrow. Transplants work best in the chronic stage of the disease.
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Looking after Yourself
Radiotherapy is highly effective as part of the treatment of many forms of leukaemia, but all treatments can cause some side effects. Some patients will not experience any side effects, whilst others may find several troublesome. Fortunately, many of these side effects disappear soon after the treatment ends and the symptoms can usually be treated, so if you do experience any problems it is important to mention them to your doctor or nurse, so they can give you the treatment you need.
Many patients will experience hair loss following chemotherapy or radiotherapy, usually this is temporary and the hair grows back after the treatment finishes. Wigs are one way of dealing with this problem, although many patients find it easier just to wear a scarf or hat until their hair regrows.
Not having much energy is a common side effect that can last for several weeks following treatment, so you have to be realistic about how much you can do during this time.
Loss of appetite and feeling sick can also occur, but are rarely a major problem.
Whatever the problem, do not assume that nothing can be done about it – ask your doctor or nurse: do not just grin and bear it.
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Questions for your Doctor
Before making up your mind about the best treatment option for you, you will need information about your cancer, the treatments available in your area and what they will involve, what to expect from the treatment, what side effects you might experience and how these may change over time as well as what your doctors believe would be most effective in combating your cancer.
For different patients the answers will be different, so it is important to discuss all these issues with your doctor so that you are able to make the right choice for you.
You will have your own questions but some issues you might want to raise are:
- What does the treatment involve?
- What are the benefits I might get?
- How good are my chances of getting those benefits?
- Could having treatment make me feel worse? If so, in what way?
- Are there other treatments?
- What are the risks of the treatment?
- Are the risks minor or serious? How likely are they to happen?
- What care will I need after treatment?
- What happens if something goes wrong?
- What may happen if I don’t have the treatment?
- How will treatment affect my quality of life during and after treatment?
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Conclusion
There are several different types of leukaemia, and the treatment varies from type to type. For clinical and personal reasons particular treatments will be recommended for some patients rather than others. Patients, therefore, need comprehensive information so that they are able to make the right decision for them.
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