Leukaemias (or leukemias – U.S. spelling) are cancers of the white blood cells, which begin in the bone marrow.
Leukaemias are grouped in two ways: the type of white blood cell affected – lymphoid or myeloid; and how quickly the disease develops and gets worse. Acute leukaemia appears suddenly and grows quickly while chronic leukaemia appears gradually and develops slowly over months to years.
This information refers to four types of leukaemia; acute lymphocytic leukaemia (ALL), chronic lymphocytic leukaemia (CLL), acute myeloid leukaemia (AML) and chronic myeloid leukaemia (CML).
In 2013, 2850 people in Australia were diagnosed with leukaemia. Chronic lymphocytic leukaemia is the most common type of leukaemia in Australia.
In 2014, there were 1438 deaths due to these four cancer types. Acute myeloid leukaemia caused the most deaths, with 911 deaths. Chronic lymphocytic leukaemia caused 341 deaths, chronic myeloid leukaemia caused 89 deaths and acute lymphocytic leukaemia caused 97 deaths.
In Australia, the five-year survival rate for chronic lymphocytic leukaemia is around 79%, for acute myeloid leukaemia it is 27%.
Many people with leukaemia have no symptoms. The symptoms tend to be mild at first and worsen slowly.
The main symptoms include:
- tiredness and/or anaemia (pale complexion, weakness and breathlessness)
- repeated infections (mouth sores, sore throat, fevers, sweats, coughing, frequent passing of urine with irritation, infected cuts and scratches, and boils)
- increased bruising and bleeding.
Other less common symptoms include:
- bone pain
- swollen tender gums
- skin rashes
- vision problems
- enlarged lymph glands
- enlarged spleen that may cause pain or discomfort
- chest pains.
The cause of acute leukaemia is unknown, but factors that put some people at higher risk are:
- exposure to intense radiation
- exposure to certain chemicals, such as benzene
- viruses like the Human T-Cell leukaemia virus.
Most people diagnosed with chronic myeloid leukaemia have an abnormal chromosone called the Philadelphia chromosone. It has also been linked to exposure to high levels of radiation.
If your doctor suspects you may have a form of leukaemia, you will have one or more of the following tests to help diagnose, and determine the type of leukaemia:
An initial blood test will show if leukaemia cells are present in the blood or if the levels of blood cells are different to what would be expected in a healthy person.
Bone marrow biopsy
A small amount of bone marrow is removed from the hip bone (pelvic bone) using a long needle. As the procedure can be uncomfortable and even painful, a local anaesthetic will be used to numb the area andy ou may be given some pain-killers. It is common for children to have a general anaesthetic.
A chest X-ray is taken to check the heart and lungs, and to see whether there are enlarged lymph nodes in the chest.
This test shows if any leukaemia cells have travelled to the fluid around your spine.
Fluid is removed with a thin needle from a space between the bones in the lower back. This takes a few minutes, but as it can be uncomfortable, your doctor will use a local anaesthetic to numb the area.
Treatment depends on the type of leukaemia. Acute leukaemias develop quickly and need to be treated urgently, typically within 24 hours of diagnosis.
Chest X-ray, CT scan and lumbar puncture determine if the leukaemia has spread. Cytogenetic analysis also may be used, to look for chromosomal changes.
For acute myeloid leukaemia and acute lymphoblastic leukaemia there is no standard staging system; the disease is described as untreated, in remission, or recurrent.
Staging of chronic myelogenous leukaemia is described in three phases:
- chronic – a few blast cells are found in the blood and bone marrow
- accelerated – after a few years the leukaemia may suddenly change and grow quicker
- blast – the number of blast cells increases, causing symptoms to worsen. Blast cells often spread to other organs.
Chronic myelogenous leukaemia is described as stage 0 to IV, determined by the lymphocytes in the blood, size of lymph nodes and organs such as liver and spleen (larger = higher stage) and impact on red blood cells and platelets (fewer = higher stage).
Common treatment options are:
Acute lymphoblastic leukaemia
- peripheral blood stem cell and bone marrow transplantation
- radiotherapy to the head
- steroid therapy.
Acute myeloid leukaemia
- peripheral blood stem cell and bone marrow transplantation
- radiotherapy to the head.
Chronic lymphoblastic leukaemia
- watchful waiting
- radiation therapy
- chemotherapy (chemotherapy with stem cell transplant is being tested in clinical trials)
- surgery (removal of spleen)
- monoclonal antibody therapy.
Chronic myeloid leukaemia
- tyrosine kinase inhibitory therapy
- biologic therapy
- high-dose chemotherapy with stem cell transplant
- donor lymphocyte infusion
- surgery (removal of spleen).
Apart from a GP, who will usually arrange the first tests, your treatment team may consist of a number of different specialist staff, such as:
- a haematologist
- radiation oncologist
- a cancer care coordinator
- other allied health professionals, such as counsellor and dietitian.
In some cases of leukaemia, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.
As well as slowing the spread of leukaemia, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.
There is currently no screening test for leukaemia available in Australia.
It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person’s individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of leukaemia you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.
For most children and many adults who achieve remission, the leukaemia may be cured with peripheral blood stem cell or bone marrow transplantation and chemotherapy.
There are no proven measures to prevent leukaemia.
Australian Institute of Health and Welfare. ACIM (Australian Cancer Incidence and Mortality) Books. Canberra: AIHW.
Australian Institute of Health and Welfare (AIHW) 2017. Cancer in Australia 2017. Cancer series no. 101. Cat. no. CAN 100. Canberra: AIHW.