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Condition
Leukaemia
Class
Cancer
Description
Leukaemia is a form of cancer of the bone marrow (the soft, inner part of bone) which affects the blood's white cells, the body's natural defence against infections. Normally, white blood cells grow and mature in the bone marrow at a controlled rate, but in leukaemia the cells grow too quickly and do not have a chance to mature fully. The immature white cells are unable to work properly and so are less able to fight infections. Also, because there are so many immature white cells, there is very little room left in the bone marrow for the development of other cells. As a result the production of the blood's oxygen carrying cells, the red blood cells, is reduced and anaemia develops. Also, a reduction in the number of cells called platelets prevents the blood from clotting properly.

There are four main different types of leukaemia classified according to the way in which the disease progresses and the type of white blood cell affected:
  • Acute lymphocytic leukaemia (ALL)
  • Acute myeloid leukaemia (AML)
  • Chronic lymphocytic leukaemia (CLL)
  • Chronic myeloid leukaemia (CML)

Acute leukaemias and chronic leukaemias are used to describe the way the diseases develop. Acute leukaemias come on suddenly, within a matter of days or weeks. They are a very aggressive form of the disease and need to be treated immediately. Chronic leukaemias develop more slowly, over a number of months or even years. Treatment of chronic leukaemias is often delayed to a time when it is likely to be most effective.

The terms lymphocytic and myeloid are used to describe the type of white blood cell affected. In lymphocytic leukaemia there is an increase in the number of a particular type of white blood cell called a lymphocyte. In myeloid leukaemia there is an increase in the number of another type of white blood cell called a myeloid.

The most common forms of leukaemia in adults are acute myeloid leukaemia (AML) and chronic lymphocytic leukaemia (CLL), whereas in children acute lymphocytic leukaemia (ALL) is most common.
Causes
Leukaemias appear to develop as a result of a breakdown in the processes that control the normal growth and development of the white blood cells in the bone marrow. As a result of this breakdown, some cells continue to divide and multiply out of control. It is not known what causes this breakdown in the controlling process but certain factors such as exposure to high levels of radiation, to certain industrial chemicals or to viruses may be involved.

Leukaemias are not infectious and they cannot be passed on from one generation to another because of an inherited faulty gene. However, there are certain genetic disorders such as Down's Syndrome and Fanconi's anaemia that increase the chances of developing leukaemia.

Most people with chronic myeloid leukaemia are found to have an abnormal chromosome called the Philadelphia chromosome. The Philadelphia chromosome is not an inherited fault that can be passed on from one generation to the next. However, it causes the production of an enzyme called tyrosine kinase which leads to the development of chronic myeloid leukaemia.

Research has shown that the risk of developing leukaemia is not increased by exposure to electromagnetic fields or living near high-voltage electricity cables.
Symptoms
The time taken for the symptoms of acute and chronic leukaemias to appear differs. Symptoms of acute leukaemia develop suddenly, often within a few days or weeks, and the person affected tends to feel ill very quickly. Symptoms of chronic leukaemias develop more gradually over a period of months or even years and the person affected may not even be aware that anything is wrong.

The main symptoms of acute leukaemias occur when the healthy balance of blood cell production is upset, causing abnormal cells to crowd out the healthy cells and eventually spill out into the blood stream. Symptoms include:

  • Anaemia, resulting in excessive tiredness and breathlessness
  • Persistent infections caused by a lower number of properly functioning white blood cells
  • Bruising, bleeding and heavy periods due to a reduced number of platelets
  • Pain in the bones and joints due to the abundance of white blood cells
Symptoms of chronic leukaemias are similar but may begin slowly with a gradual feeling of tiredness. The spleen (an organ in the upper left abdomen) grows until it becomes huge, causing a feeling of fullness and tenderness in the upper left side of the abdomen.

Other symptoms of chronic leukaemias may include swollen glands in the armpits, groin and neck due to the presence of a large number of lymphocytes.
Treatment
The type of treatment depends on the type of leukaemia. With acute leukaemias the aim is to destroy the leukaemia cells and allow the bone marrow to start producing normal blood cells again. Chemotherapy is the main treatment used. One or more powerful drugs are given in a series of stages to kill the cancerous white blood cells. Patients may also be treated with radiotherapy, especially to the head and testicles, where leukaemia cells can evade destruction by chemotherapy. Sometimes, stem cell and bone marrow transplants are used after chemotherapy to improve the chances of curing the leukaemia. These transplants replace the damaged cells in the bone marrow and allow the person to produce healthy white blood cells, red blood cells and platelets.

In chronic leukaemias the aim is usually just to control symptoms, so in some cases treatment will only be used if symptoms begin to trouble the person affected. If treatment does become necessary, chemotherapy will usually be used.
When to consult your pharmacist
If you are worried or concerned about any aspect of your treatment talk to your pharmacist. You should also let your pharmacist know if you are continuing to take any medicines when you seek advice or treatment about other illnesses.
When to consult your doctor
If you have any of the symptoms described above you should see your doctor. These symptoms can occur with other illnesses, so it does not mean that you definitely have leukaemia. Your doctor will examine you and take a blood sample for testing. The blood sample will be analysed to look at the type and shape of the white blood cells. The number of red blood cells will be counted. The results of the blood sample tests will allow doctors to determine if you have leukaemia and, if so, what type of leukaemia it is. Sometimes further tests such as a bone marrow sample, X rays and a computerised tomography (CT scan) will be performed to confirm the diagnosis, check on the health of your internal organs and to decide the best type of treatment to use.
Living with a leukaemia
Once a particular type of leukaemia has been confirmed, your specialist doctor will talk to you about the types of treatment you or your child will receive. Your specialist will discuss with you the options available, the procedures involved, the type and length of treatment and the side effects that may be experienced. Involve your family or close friend in any discussions with your specialist to provide support and to ask any questions that you may not have considered. Keep a note of any questions as they occur to you and do not be afraid to ask the same questions again on a subsequent visit to the specialist if there is anything that you have forgotten or do not understand.

The diagnosis of a leukaemia and its treatment can be life-changing for the person affected, parents and other family members. You may experience potentially overwhelming emotional changes such as anger or guilt. The important thing to understand is that these emotions are normal and that you are not alone. There are healthcare professionals who are there to help. Talk with family and friends, join self-help groups and talk with others who are affected by leukaemia. Get as much information as you think is necessary to help you understand leukaemia and to answer any doubts or fears that you may have. See Further Information section below.

Importantly, before, during and after treatment, rely on the advice and guidance given by your specialist who is the only person to have the full facts about your or your child’s condition, medical history and treatment.
Further information
Leukaemia & Lymphoma Research Beating Blood Cancers is the only UK charity solely dedicated to research into leukaemia and other blood cancers. Its website provides patient information on all types of childhood and adult blood cancers that can be downloaded or ordered as leaflets or booklets.

www.beatbloodcancers.org
Helpline: 020 7269 9060 (Mon to Fri, 9am to 5pm)
Email: clinicalinfo@beatbloodcancers.org

Leukaemia & Lymphoma Research
39-40 Eagle Street
London
WC1R 4TH
Tel: 020 7405 0101 (Mon to Fri 9am - 5pm)
Email: info@beatbloodcancers.org


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