Key Facts
Leukaemia is a form of cancer that develops from white blood cells.
Overall, leukaemia is the eighth most common form of cancer in Europe with about 81,000 new cases diagnosed each year.
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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Key Figures
Overall the incidence for all leukaemias in Europe is:
- 10 per 100,000 per year (Men: 12 per 100,000; Women: 8 per 100,000)
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Cancer Types
There are four basic types of leukaemia:
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Causes of Leukaemia
Acute Lymphoblastic Leukaemia (ALL)
ALL is not usually hereditary. Some sufferers with syndromes such as Down’s syndrome and Fanconi’s syndrome have an increased risk of developing leukaemia. Evidence of specific genetic abnormalities in various types of leukaemia is accumulating.
Acute Myeloid Leukaemia (AML)
Previous chemotherapy or radiotherapy treatments are known risk factors for AML. Exposure to benzene and other industrial solvents is also associated with a higher incidence of this malignancy.
Chronic Lymphatic Leukaemia (CLL)
It is not known what causes the damage which leads to abnormal lymphocytes developing into CLL.
Chronic Myeloid Leukaemia (CML)
Many patients affected by 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. Another risk for developing CML is exposure to high doses of radiation.
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Prevention
There are no practical preventive measures which individuals can take to avoid being at risk of developing leukaemia.
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Common Symptoms
There are often no symptoms in the early stages of leukaemia. However, symptoms when they do occur may include:
- 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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Diagnostic Tests
Diagnostic tests for leukaemia include:
- a standard blood test will usually show a high number of white blood cells in the blood sample, and in some types of leukaemia these will look abnormal, and indicate the likelihood of leukaemia.
- bone marrow biopsy. A bone marrow biopsy is normally taken to confirm a diagnosis of acute leukaemia. The sample is usually taken from the iliac crest, and can be painful despite the use of local anaesthetic. Different leukaemias are distinguished using immunological and enzyme markers.
- cytogenetic testing. This identifies the genetic makeup of the leukaemia cells, which can show important implications for treatment.
- lymph node biopsy. If enlarged lymph nodes are found on clinical examination further biopsies are taken to check for involvement of the lymph nodes.
- CT Scans. A CT scan to check other organs including the heart and lungs.
- lumbar puncture. If there is a risk that acute leukaemia has spread to the central nervous system, a lumbar puncture may be undertaken. Cerebrospinal fluid is examined for the presence of abnormal white cells.
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Treatment
Different treatments will be recommended according to:
- the type of leukaemia
- the phase of the disease
- the age and general health of the patient
Acute Lymphoblastic Leukaemia (ALL)
Chemotherapy (the use of drugs to destroy abnormal cells) is the main treatment for ALL and is given in a series of treatment blocks.
Radiotherapy is sometimes given to the brain notably if there is CNS involvement or to prevent relapse where it can be difficult to achieve optimal concentration of drugs.
Acute Myeloid Leukaemia (AML)
AML is mainly treated with chemotherapy.
Allogeneic stem cell (bone marrow) transplantation from a matched donor is also used in some cases. Before a transplant is carried out, high-dose chemotherapy and/or whole-body radiotherapy are 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 will have a normal life expectancy without any treatment. Radiotherapy can occasionally be used to treat painful lymph nodes.
Chronic Myeloid Leukaemia (CML)
Treatment for patients with CML depends on which phase of the disease they are experiencing 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 often effective. Imatinib is a monoclonal antibody 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. However, there is no guarantee that it will work. Before a transplant, high-dose chemotherapy with or without radiotherapy is used to destroy the patient’s own bone marrow. Transplants work best in the chronic stage of the disease.
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Key Trends
The significant recent development has been the introduction of tyrosine kinase inhibitors, notably in the treatment of chronic myeloid leukaemia (imatinib).
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Current Developments
The main recent development has been the introduction of tyrosine kinase inhibitors, notably in the treatment of chronic myeloid leukaemia (using imatinib).
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Important Research Areas
Further use of tyrosine kinase inhibitors in the treatment of the other leukaemias.
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