- Acute myeloid leukaemia
- The facts on leukaemia: symptoms, treatment and more
- Leukaemia symptoms
- Causes of leukaemia
- Diagnosis for leukaemia
- Blood tests
- Bone marrow biopsy
- Chest X-ray
- Lumbar puncture
- Treatment for leukaemia
- Common treatment options are:
- Treatment team
- Palliative care
- Screening for leukaemia
- Prognosis for leukaemia
- Preventing leukaemia
- Leukemia Treatment, Diagnosis, Causes, Symptoms & Prognosis
- Biological therapy
- Targeted therapy
- Radiation therapy
- Stem cell transplant
- Chimeric antigen receptor (CAR) T-cell treatment
- Supportive treatments
- Leukaemia Foundation
- Types of leukaemia
- » Acute myeloid leukaemia (AML) » Acute lymphoblastic leukaemia (ALL) » Acute promyelocytic leukaemia (APML)
- » Blood cancer resources » Leukaemia videos » Our publications and newsletters » Support, information and advice
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- What is acute lymphoblastic leukaemia (ALL)
- How common is ALL?
- What happens in ALL
- Blood cells and ALL
- How leukaemia can affect you
- Leukaemia – What is leukaemia?
Acute myeloid leukaemia
Leukaemia is cancer of the white blood cells. Acute leukaemia means it progresses quickly and aggressively, and usually requires immediate treatment.
Acute leukaemia is classified according to the type of white blood cells affected.
The 2 main types of white blood cells are:
- lymphocytes – which fight viral infections
- myeloid cells – which do different things, such as fighting bacterial infections, defending the body against parasites and preventing the spread of tissue damage
This topic focuses on acute myeloid leukaemia (AML), which is an aggressive cancer of the myeloid cells.
The following types of leukaemia are covered separately:
The symptoms of AML usually develop over a few weeks and become worse over time.
Symptoms can include:
- looking pale or “washed out”
- feeling tired or weak
- frequent infections
- unusual and frequent bruising or bleeding, such as bleeding gums or nosebleeds
- losing weight without trying to
Speak to a GP if you or your child have possible symptoms of AML.
Although it's highly unly that leukaemia is the cause, these symptoms should be investigated.
If your GP thinks you may have leukaemia, they'll arrange blood tests to check your blood cell production.
If the tests suggest there's a problem, you'll be urgently referred to a specialist in treating blood conditions (haematologist) for further tests and treatment.
Find out more about diagnosing AML
It's not clear exactly what causes AML and, in most cases, there's no identifiable cause.
But some things can increase your risk of getting AML, including:
- previous chemotherapy or radiotherapy
- exposure to very high levels of radiation (including previous radiotherapy treatment)
- smoking and other exposure to benzene, a chemical used in manufacturing that's also found in cigarette smoke
- having a blood disorder or some genetic conditions, such as Down's syndrome
Find out more about the causes of AML
AML is a rare type of cancer, with around 3,100 people diagnosed with it each year in the UK.
The risk of developing AML increases with age. It's most common in people over 75.
Treatment for AML needs to begin as soon as possible, as it can develop quickly.
Chemotherapy is the main treatment for AML. It's used to kill as many leukaemia cells in your body as possible and reduce the risk of the condition coming back (relapsing).
In some cases, intensive chemotherapy and radiotherapy may be needed, in combination with a bone marrow or stem cell transplant.
Find out more about treating AML
There are organisations that offer information, advice and support if you or a family member has been diagnosed with AML.
The facts on leukaemia: symptoms, treatment and more
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 lymphoblastic leukaemia (ALL), chronic lymphoblastic leukaemia (CLL), acute myeloid leukaemia (AML) and chronic myeloid leukaemia (CML).
In 2015, 3905 people in Australia were diagnosed with leukaemia. Chronic lymphocytic leukaemia is the most common type of leukaemia in Australia.
In 2016, there were 1823 deaths due to these four cancer types.
The five year survival rate is 61%.
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.Top
Causes of leukaemia
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 the Human T-Cell leukaemia virus.
Most people diagnosed with chronic myeloid leukaemia have an abnormal chromosome called the Philadelphia chromosome. It has also been linked to exposure to high levels of radiation.
Diagnosis for leukaemia
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 and you 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.Top
Treatment for leukaemia
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.
Screening for leukaemia
There is currently no screening test for leukaemia available in Australia.
Prognosis for leukaemia
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 ly outcome of the disease, 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.
This page was last updated on: Wednesday, November 13, 2019
- What Is Leukemia?
- Diagnosis & Treatment
- Childhood Leukemia
Leukemia is a blood cancer caused by a rise in the number of white blood cells in your body.
Those white blood cells crowd out the red blood cells and platelets that your body needs to be healthy. The extra white blood cells don’t work right.
Different types of leukemia can cause different problems. You might not notice any signs in the early stages of some forms. When you do have symptoms, they may include:
No one knows exactly what causes leukemia. People who have it have certain unusual chromosomes, but the chromosomes don’t cause leukemia.
You can’t prevent leukemia, but certain things may trigger it. You might have a higher risk if you:
How does leukemia happen?
Blood has three types of cells: white blood cells that fight infection, red blood cells that carry oxygen, and platelets that help blood clot.
Every day, your bone marrow makes billions of new blood cells, and most of them are red cells. When you have leukemia, your body makes more white cells than it needs.
These leukemia cells can’t fight infection the way normal white blood cells do. And because there are so many of them, they start to affect the way your organs work. Over time, you may not have enough red blood cells to supply oxygen, enough platelets to clot your blood, or enough normal white blood cells to fight infection.
Leukemia is grouped by how fast it develops and gets worse, and by which type of blood cell is involved.
The first group, how fast it develops, is divided into acute and chronic leukemia.
- Acute leukemia happens when most of the abnormal blood cells don’t mature and can’t carry out normal functions. It can get bad very fast.
- Chronic leukemia happens when there are some immature cells, but others are normal and can work the way they should. It gets bad more slowly than acute forms do.
The second group, what type of cell is involved, is divided into lymphocytic and myelogenous leukemia.
- Lymphocytic (or lymphoblastic) leukemia involves bone marrow cells that become lymphocytes, a kind of white blood cell.
- Myelogenous (or myeloid) leukemia involves the marrow cells that create red blood cells, platelets, and other kinds of white blood cells.
Types of leukemia
The four main types of leukemia are:
Your doctor will need to check for signs of leukemia in your blood or bone marrow. They might do tests including:
- Blood tests. A complete blood count (CBC) looks at the number and maturity of different types of blood cells. A blood smear looks for unusual or immature cells.
- Bone marrow biopsy. This test involves marrow taken from your pelvic bone with a long needle. It can tell your doctor what kind of leukemia you have and how severe it is.
- Spinal tap. This involves fluid from your spinal cord. It can tell your doctor whether the leukemia has spread.
- Imaging tests. Things CT, MRI, and PET scans can spot signs of leukemia.
The treatment you get depends on the type of leukemia you have, how far it’s spread, and how healthy you are. The main options are:
Chemotherapy uses drugs to kill cancer cells in your blood and bone marrow. You can get the medicine:
- Through a shot into a vein or muscle
- As a pill
- Into the fluid around your spinal cord
Radiation uses high-energy X-rays to kill leukemia cells or keep them from growing. You can get it all over or in only one part of your body where there are a lot of cancer cells.
Biologic therapy, also called immunotherapy, helps your immune system find and attack cancer cells. Drugs interleukins and interferon can help boost your body's natural defenses against leukemia.
Targeted therapy uses drugs to block specific genes or proteins that cancer cells need to grow. This treatment can stop the signals that leukemia cells use to grow and divide, cut off their blood supply, or kill them directly.
A stem cell transplant replaces the leukemia cells in your bone marrow with new ones that make blood. Your doctor can get the new stem cells from your own body or from a donor.
First, you'll have high doses of chemotherapy to destroy the cancer cells in your bone marrow. Then, you'll get the new stem cells through an infusion into one of your veins.
They will grow into new, healthy blood cells.
Surgery. Your doctor can remove your spleen if it’s filled with cancer cells and is pressing on nearby organs. This procedure is called a splenectomy.
American Cancer Society: “Learn About Cancer (Detailed Guide): Leukemia — Acute Lymphocytic,” “Learn About Cancer: Leukemia — Acute Myeloid (AML),” “Learn About Cancer: Leukemia — Chronic Lymphocytic (CLL),” “Learn About Cancer: Leukemia — Chronic Myeloid (CML),” “Learn About Cancer: Leukemia in Children.”
National Cancer Institute: “Leukemia.” “Adult Acute Myeloid Leukemia Treatment (PDQ)-Patient Version. Treatment Option Overview,” “Chronic Lymphocytic Leukemia Treatment (PDQ)-Patient Version.”
Leukemia & Lymphoma Society: “Leukemia.”
Cancer.Net: “Understanding Targeted Therapy.”
Mayo Clinic: “Leukemia: Treatments and drugs.”
University of Texas M.D. Anderson Cancer Center: “Leukemia Treatment.”
Cleveland Clinic: “Leukemia.”
American Association for Clinical Chemistry: “Leukemia.”
American Society of Hematology: “Leukemia.”
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Leukemia Treatment, Diagnosis, Causes, Symptoms & Prognosis
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There are a number of different medical approaches to the treatment of leukemia.
Treatment will typically depend upon the type of leukemia, the patient's age and health status, as well as whether or not the leukemia cells have spread to the cerebrospinal fluid.
The genetic changes or specific characteristics of the leukemia cells as determined in the laboratory can also determine the type of treatment that may be most appropriate.
Watchful waiting may be an option for some people with a chronic leukemia who do not have symptoms. This involves close monitoring of the disease so that treatment can begin when symptoms develop. Watchful waiting allows the patient to avoid or postpone the side effects of treatment. The risk of waiting is that it may eliminate the possibility of controlling the leukemia before it worsens.
Treatments for leukemia include chemotherapy (major treatment modality for leukemia), radiation therapy, biological therapy, targeted therapy, and stem cell transplant. Combinations of these treatments may be used. Surgical removal of the spleen can be a part of treatment if the spleen is enlarged.
Acute leukemia needs to be treated when it is diagnosed, with the goal of inducing a remission (absence of leukemia cells in the body). After remission is achieved, therapy may be given to prevent a relapse of the leukemia. This is called consolidation or maintenance therapy. Acute leukemias can often be cured with treatment.
Chronic leukemias are unly to be cured with treatment, but treatments are often able to control the cancer and manage symptoms. Some people with chronic leukemia may be candidates for stem cell transplantation, which does offer a chance for cure.
Many patients opt to receive a second opinion before beginning treatment for leukemia. In most cases, there is time to receive a second opinion and consider treatment options without making the treatment less effective.
However, in rare cases of very aggressive leukemias, treatment must begin immediately. One should discuss with a doctor the possibility of obtaining a second opinion and any potential delays in treatment.
Most doctors welcome the possibility of a second opinion and should not be offended by a patient's wish to obtain one.
Chemotherapy is the administration of drugs that kill rapidly dividing cells such as leukemia or other cancer cells.
Chemotherapy may be taken orally in pill or tablet form, or it may be delivered via a catheter or intravenous line directly into the bloodstream.
Combination chemotherapy is usually given, which involves a combination of more than one drug. The drugs are given in cycles with rest periods in between.
Sometimes, chemotherapy drugs for leukemia are delivered directly to the cerebrospinal fluid (known as intrathecal chemotherapy).
Intrathecal chemotherapy is given in addition to other types of chemotherapy and can be used to treat leukemia in the brain or spinal cord or, in some cases, to prevent spread of leukemia to the brain and spinal cord.
An Ommaya reservoir is a special catheter placed under the scalp for the delivery of chemotherapy medications. This is used for children and some adult patients as a way to avoid injections into the cerebrospinal fluid.
Side effects of chemotherapy depend on the particular drugs taken and the dosage or regimen.
Some side effects from chemotherapy drugs include hair loss, nausea, vomiting, mouth sores, loss of appetite, tiredness, easy bruising or bleeding, and an increased chance of infection due to the destruction of white blood cells. There are medications available to help manage the side effects of chemotherapy.
Some adult men and women who receive chemotherapy sustain damage to the ovaries or testes, resulting in infertility. Most children who receive chemotherapy for leukemia will have normal fertility as adults, but depending on the drugs and dosages used, some may have infertility as adults.
Biological therapy is any treatment that uses living organisms, substances that come from living organisms, or synthetic versions of these substances to treat cancer. These treatments help the immune system recognize abnormal cells and then attack them.
Biological therapies for various types of cancer can include antibodies, tumor vaccines, or cytokines (substances that are produced within the body to control the immune system).
Monoclonal antibodies are antibodies that react against a specific target that are used in the treatment of many kinds of cancer.
An example of a monoclonal antibody used in the treatment of leukemia is alemtuzumab, which targets the CD52 antigen, a protein found on B-cell chronic lymphocytic leukemia (CLL) cells. Interferons are cell signaling chemicals that have been used in the treatment of leukemia.
Side effects of biological therapies tend to be less severe than those of chemotherapy and can include rash or swelling at the injection site for IV infusions of the therapeutic agents. Other side effects can include headache, muscle aches, fever, or tiredness.
Targeted therapies are drugs that interfere with one specific property or function of a cancer cell, rather than acting to kill all rapidly growing cells indiscriminately. This means there is less damage to normal cells with targeted therapy than with chemotherapy.
Targeted therapies may cause the target cell to cease growing rather than to die, and they interfere with specific molecules that promote growth or spread of cancers.
Targeted cancer therapies are also referred to as molecularly targeted drugs, molecularly targeted therapies, or precision medicines.
Monoclonal antibodies (described above in the section on biologic therapy) are also considered to be targeted therapies since they specifically interfere and interact with a specific target protein on the surface of cancer cells.
Imatinib (Gleevec) and dasatinib (Sprycel) are examples of targeted therapies that are used to treat CML, some cases of ALL, and some other cancers.
These drugs target the cancer-promoting protein that is formed by the BCR-ABL gene translocation.
Targeted therapies are given in pill form or by injection. Side effects can include swelling, bloating, and sudden weight gain. Other side effects can include nausea, vomiting, diarrhea, muscle cramps, or rash.
Radiation therapy uses high energy radiation to target cancer cells. Radiation therapy may be used in the treatment of leukemia that has spread to the brain, or it may be used to target the spleen or other areas where leukemia cells have accumulated.
Radiation therapy also causes side effects, but they are not ly to be permanent. Side effects depend on the location of the body that is irradiated.
For example, radiation to the abdomen can cause nausea, vomiting, and diarrhea. With any radiation therapy, the skin in the area being treated may become red, dry, and tender.
Generalized tiredness is also common while undergoing radiation therapy.
Stem cell transplant
In stem cell transplantation, high doses of chemotherapy and/or radiation are given to destroy leukemia cells along with normal bone marrow. Then, transplant stem cells are delivered by an intravenous infusion. The stem cells travel to the bone marrow and begin producing new blood cells. Stem cells may come from the patient or from a donor.
Autologous stem cell transplantation refers to the situation in which the patient's own stem cells are removed and treated to destroy leukemia cells. They are then returned to the body after the bone marrow and leukemia cells have been destroyed.
An allogeneic stem cells transplant refers to stem cells transplanted from a donor. These may be from a relative or an unrelated donor. A syngeneic stem cell transplant uses stem cells taken from a healthy identical twin of the patient.
Stem cells may be removed (harvested) in different ways. Typically, they are taken from the blood. They can also be harvested from the bone marrow or from umbilical cord blood.
Stem cell transplantation is done in a hospital, and it is necessary to remain in the hospital for several weeks. Risks of the procedure include infections and bleeding due to the depletion of normal blood cells. A risk of stem cell transplant with donor cells is known as graft-versus-host disease (GVHD).
In GVHD, the donor white blood cells react against the patient's normal tissues. GVHD can be mild or very severe, and often affects the liver, skin, or digestive tract. GVHD can occur at any time after the transplant, even years later.
Steroids or medications that suppress the immune response may be used to treat this complication.
Chimeric antigen receptor (CAR) T-cell treatment
Chimeric antigen receptor (CAR) T-cell treatment is a new form of treatment in which a patient's own normal T lymphocytes are re-engineered in a laboratory to attack the leukemia cells and are then reintroduced into the patient's bloodstream.
This treatment has been used for people with B-cell lymphomas that have relapsed or are refractory to treatment. It is also an approved treatment option for certain cases of leukemia. The U.S.
FDA approved tisagenlecleucel (Kymriah) in 2018 for the treatment of patients up to 25 years of age with B-cell precursor acute lymphoblastic leukemia (ALL) that is refractory or in second or later relapse.
CAR-T therapy is also available in clinical trials. Cytokine-release syndrome (CRS) is a potentially serious side effect frequently associated with CAR T-cell therapy. Cytokines are chemical messengers produced when the CAR T-cells multiply in the body and kill cancer cells.
CRS may cause a range of symptoms from mild flu- symptoms to more serious symptoms including fast heart rate, low blood pressure, and heart problems.
Other side effects can include nerve damage, suppressed immune function, and a condition known as tumor lysis syndrome that results when cancer cells are rapidly destroyed.
Because CAR T-cell therapy is so new, the patients who have had this treatment have not been followed over the long term. Studies are under way to determine whether CAR-T treatment may be useful in other types of leukemia.
Because many of the treatments for leukemia deplete normal blood cells, increasing the risk for bleeding and infection, supportive treatments may be needed to help prevent these complications of treatment. Supportive treatments may also be needed to help minimize and manage unpleasant side effects of medical or radiation therapy.
Types of supportive and preventive treatments that can be used for patients undergoing treatment for leukemia include the following:
- Vaccines against the flu or pneumonia
- Blood or platelet transfusions
- Anti-nausea medications
- Antibiotics or antiviral medications to treat or prevent infections
- White blood cell growth factors to stimulate white blood cell production (such as granulocyte-colony stimulating factor [G-CSF], made up of filgrastim [Neupogen] and pegfilgrastim [Neulasta] and granulocyte macrophage-colony stimulating growth factor [GM-CSF], made up of sargramostim [Leukine])
- Red cell growth factors to stimulate red blood cell production (darbepoetin alfa [Aranesp] or epoetin alfa [Procrit])
- Intravenous injections of immunoglobulins to help fight infection
Leukaemia is the general name given to a group of cancers that develop in the bone marrow. Leukaemia originates in developing blood cells that have undergone a malignant change. This means that they multiply in an uncontrolled way and do not mature properly, leaving them unable to function as they should.
Most cases of leukaemia originate in developing white cells. In a small number of cases leukaemia develops in other blood-forming cells, for example in developing red cells or developing platelets. Leukaemia can also be either myeloid or lymphocytic.
The terms myeloid and lymphocytic refer to the types of cells in which the leukaemia first started. Myeloid stem cells develop into red cells, white cells (neutrophils, eosinophils, basophils and monocytes) and platelets.
Lymphoid stem cells develop in two other types of white cells called T-lymphocytes and B-lymphocytes.
Both adults and children can develop leukaemia but certain types are more common in different age groups.
Types of leukaemia
There are several different types and subtypes of leukaemia. Leukaemia can be either acute or chronic.
Under normal conditions the bone marrow contains a small number of immature cells, called blast cells. These immature blast cells develop into mature white cells, red cells and platelets which are eventually released into the blood stream.
In people with acute leukaemia, the diseased bone marrow produces an excessive number of abnormal blast cells, called leukaemic cells. These cells accumulate in the bone marrow interfering with the production of normal blood cells. Acute leukaemia develops and progresses quickly and therefore needs to be treated as soon as it is diagnosed.
Common forms of acute leukaemia are:
» Acute myeloid leukaemia (AML)
» Acute lymphoblastic leukaemia (ALL)
» Acute promyelocytic leukaemia (APML)
In chronic leukaemia there is an accumulation of mature but abnormal white blood cells that have undergone a malignant change when developing from a blast cell. Chronic leukaemia progresses more slowly than acute leukaemia and may not require treatment for a long time after it is diagnosed.
Common forms of chronic leukaemia are:
» Blood cancer resources
» Leukaemia videos
» Our publications and newsletters
» Support, information and advice
Last updated on March 26th, 2020
Developed by the Leukaemia Foundation in consultation with people living with a blood cancer, Leukaemia Foundation support staff, haematology nursing staff and/or Australian clinical haematologists.
This content is provided for information purposes only and we urge you to always seek advice from a registered health care professional for diagnosis, treatment and answers to your medical questions, including the suitability of a particular therapy, service, product or treatment in your circumstances.
The Leukaemia Foundation shall not bear any liability for any person relying on the materials contained on this website.
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What is acute lymphoblastic leukaemia (ALL)
Acute lymphoblastic leukaemia (ALL) is a type of blood cancer. It starts from young white blood cells called lymphocytes in the bone marrow. The bone marrow is the soft inner part of the bones, where new blood cells are made.
ALL usually develops quickly over days or weeks. It is the most common type of leukaemia to affect children but can also affect adults.
How common is ALL?
Acute lymphoblastic leukaemia is rare. Around 790 people are diagnosed with ALL in the UK each year.
ALL is most often diagnosed in children, teenagers and young adults. The age group with the highest incidence is young children aged 0 – 4 years.
What happens in ALL
The word acute means that the leukaemia can develop quickly. This is because the lymphocytes are growing and dividing much quicker than usual. These abnormal cells build up in the blood.
The leukaemia cells can spread into other parts of the body, including the:
- lymph nodes
- central nervous system (brain and spinal cord)
The leukaemia cells can build up in the lymph nodes, bone marrow and spleen and make them bigger.
If it wasn't treated acute leukaemia would cause death within a few weeks or months. But treatments work well for most people with ALL.
Blood cells and ALL
To understand how and why leukaemia affects you as it does, it helps to know how you make blood cells.
Your body makes blood cells in the bone marrow. The bone marrow is the soft inner part of your bones. You make blood cells in a controlled way, as your body needs them.
All blood cells start as the same type of cell, called a stem cell. This stem cell then develops into:
- lymphoid stem cells, which become white blood cells called lymphocytes
- myeloid stem cells, which become white blood cells called monocytes and neutrophils (granulocytes), red blood cells and platelets
The diagram helps explain this:
In acute lymphoblastic leukaemia, the bone marrow makes too many lymphocytes. These lymphocytes are not fully developed and are not able to work normally.
How leukaemia can affect you
White blood cells help fight infection. But if your body makes abnormal white blood cells, they don’t work properly. So you are more ly to get infections and find it difficult to get rid of them.
Too many white blood cells can overcrowd the bone marrow. So there isn't enough space for other types of blood cells. This can cause a lower than normal number of red blood cells and platelets.
Having too few red blood cells makes you tired and breathless (anaemic). You can have bleeding problems such as nosebleeds, if you don’t have enough platelets.
Abnormal white blood cells can build up in parts of the lymphatic system, such as the spleen and lymph nodes, making them bigger. They might build up in the liver. This can make your tummy (abdomen) swell and feel uncomfortable. The leukaemia cells can also spread to the brain, and the testicles in men.
16 Apr 2018
Leukaemia – What is leukaemia?
Leukaemia is a cancerous illness of white blood cells, which are responsible for fighting infection. the other sorts of blood cell in the body (red blood cells, which carry oxygen; and platelets, which help control bleeding), white blood cells form in the bone marrow, a spongy material that fills the bones.
In the bone marrow, immature cells multiply and mature into red cells, white cells and platelets. As they mature they are released into the bloodstream.
In leukaemia, the white blood cells instead of growing and developing normally grow control and do not mature. This uncontrolled growth of immature white blood cells can crowd the bone marrow preventing it from producing healthy white blood cells, red blood cells and platelets.
There are several different types of leukaemia, each with its own particular characteristics and treatment. We asked an expert, Professor Asim Khwaja from University College London, to explain how the four main types differ:
• acute myeloid leukaemia (AML), • acute lymphoblastic leukaemia (ALL), • chronic myeloid leukaemia (CML) and
• chronic lymphocytic leukaemia (CLL)
There’s two main types of leukaemia. There is acute leukaemia and chronic leukaemia. And then within the acute leukaemias there’s two types' acute myeloid leukaemia and acute lymphoid leukaemia, and the same applies to the chronic leukaemias. And the definition of acute leukaemia comes from the fact that it normally is a very rapidly growing cancer and if left untreated would result in relatively short survival of the patient, but with effective treatment that can be reversed. And the symptoms that one normally gets with acute leukaemia are a consequence of the fact that the leukaemia takes over the bone marrow and therefore you can’t make your normal blood cells anymore. So the patient may become tired and breathless because they’re not making red blood cells which carry the oxygen around the body. They may notice that they’re having frequent infections because the normal white blood cells are not being produced. And also sometimes you get bruising or inappropriate bleeding because the blood cells that stop you doing that, platelets, are also reduced in number. Chronic leukaemias are normally much more slow growing. And in fact before we had treatments for leukaemias people could have certain types of chronic leukaemia for many, many years without requiring any treatment or coming to any harm from it. And with these more commonly the symptoms are to do, again patients can complain of fatigue and tiredness and weight loss but it doesn’t normally affect the bone marrow function the way that the acute leukaemias do. So there are, in the acute leukaemias there are two types, the myeloid type and the lymphoblastic type. And similarly in the chronic leukaemias there is a myeloid and a lymphoid type. The difference between these two is that they develop from slightly different types of white blood cells. So normally in our circulation we have white blood cells called neutrophils, which are the myeloid type of cells. These are very important in fighting bacterial infection in particular. And then the other main type of white blood cell we have is the lymphocyte, and this is important, especially important in fighting viral infections. So in chronic or acute myeloid leukaemia the cancer is developed in a cell that would normally have become a neutrophil, it would have become a normal myeloid cell but has become damaged in some way and is now growing control. And in the lymphoid types of leukaemias, what has happened is that a cell normally destined to become a lymphocyte has started to grow control and that’s what the lymphoid leukaemias are. On this section of healthtalk.org about leukaemia you will find the stories of people who have one of the four main types of leukaemia described above. Other, rarer types are represented too, such as hairy cell leukaemia, so called because of the hair- projections that can be seen through a microscope on the surface of the affected white blood cells. Several other non-cancerous conditions affect the production of blood cells, and may later develop into leukaemia; we have included the stories of some people with a condition called myelodysplastic syndrome. Professor Khwaja explains what this is.
So myelodysplasia or myelodysplastic syndrome, MDS, this a group of related conditions where you have poor production of your normal blood cells, but in contrast to acute leukaemia there isn’t an excess of malignant cells. So instead of the blood cells developing normally in the bone marrow, they develop in an abnormal way and they tend to die prematurely in the bone marrow and don’t find their way into the blood. So typically what this means is the patient usually is anaemic and needs regular red blood cells transfused to them. And sometimes there can be a reduction in the other blood cells as well, the platelets and the white blood cells. So the treatment in most instances requires regular transfusions and chemotherapy type treatments are not commonly used. Now, as I said at the beginning, it’s a range of conditions some of which behave in a very indolent and slow way in that, although the patient requires regular transfusions, the disease doesn’t progress in any sinister way. In other individuals the myelodysplastic syndrome can convert to an acute myeloid leukaemia, and at that stage it would require treatment with chemotherapy. At the point at which the MDS is diagnosed there are certain tests including the chromosomal make-up of the bone marrow cells that will help the clinicians to decide whether it’s the type of MDS that is less ly or more ly to develop into leukaemia. So with acute leukaemias the growth of the cancer cells is very rapid and therefore we need to get treatment started urgently, normally in a matter of days. And the treatment consists of chemotherapy. So these are drugs that damage the leukaemia cells and we hope cause them to die. Because the leukaemia cells can travel throughout the body and are found throughout the bone marrow the treatment has to be in a form that travels throughout the body, so you can’t have an operation. We need to give chemotherapy drugs that travel throughout the blood stream. And these are normally given in short intensive bursts of treatment, so this is sometimes called ‘intensive chemotherapy’. So there are combinations of drugs. You normally get at least two, sometimes three, and these are given daily over of a period of about a week to ten days. This sort of treatment needs to be given in hospital because one of the consequences of the chemotherapy is that there is damage to normal blood cells and normal bone marrow cells, and temporarily the patient has very low levels of these cells. So we have to support them through that period. They’re very ly to need blood transfusions, platelet transfusions and also treatment for infection. So this is a period when because of low immunity and the patient is very susceptible to getting serious infections and has to spend time in hospital. What we’re hoping with this intensive course of treatment is to induce what is called a remission, which means that we can’t detect the leukaemia cells anymore. However, we know that if we were to stop treatment at that stage the leukaemia would inevitably come back because although we can’t detect them there are still some left behind. So once the first course of treatment is completed, which normally for acute leukaemias takes about a month to six weeks, you usually have a short break of a week to two weeks, and then have further courses of treatment. And for acute myeloid leukaemia that normally takes about four courses of intensive chemotherapy which, with the intervals in between, requires about a six month period to complete your treatment. And normally that’s when the treatment stops, all being well. And then after that there’s monitoring usually as an outpatient to make sure that things stay in remission. For acute lymphoblastic leukaemia the treatment is very similar in the initial phases with intensive chemotherapy but then, once that’s been completed and you’re an outpatient again there is a more protracted period of about eighteen months after that where you have low doses of outpatient type chemotherapy. So these are doses not sufficient to reduce your normal blood cells right down, so you don’t need to be in hospital for them, but they’re a very effective and a very important part of the treatment. So for chronic myeloid leukaemia the treatment now involves most commonly taking a new type of drug which has become available over the last few years, and this is a drug called imatinib or Glivec. And this is a new type of drug in that it specifically is targeted towards a genetic abnormality that’s found only in the CML cells. So the CML cells are growing control because they’ve got a hyperactive molecule in them and what the Glivec does is it binds to this particular molecule and stops it working normally, and that puts the patient back into remission and restores normality in their blood. With the Glivec we at the moment don’t know how long we need to keep treatment going for and it’s ly that it would need to be life long. It’s a relatively simple treatment to take. It’s in the form of a tablet which needs to be taken daily over, as I say, probably many years. You were talking about the chromosomal abnormality in CML. Is that the Philadelphia chromosome? It’s not completely unique to CML. It’s also found in certain types of ALL, acute lymphoblastic leukaemia, but everybody who has CML has that abnormality in their leukaemia cells only. Not in other cells in the body but purely in the leukaemia cells. So the Glivec, the imatinib is also being used for treatment of those types of ALL where the Philadelphia chromosome may be present. But for those conditions it needs to be combined with intensive chemotherapy to get a remission, whereas in CML the Glivec alone is sufficient usually to induce the remission. So with chronic lymphocytic leukaemia the patient’s condition can vary hugely in that this can be present as a very, very slow growing and relatively benign condition, and sometimes it can be more aggressive than that. And in many cases no treatment is required initially so that one can just watch and wait until treatment becomes necessary. In some people this may never happen or it may take many years to happen. And there’s no advantage in starting the treatment early, and that can introduce complications of the treatment without actually offering any extra benefit. The sorts of treatment that you need for CLL are again chemotherapy type drugs but these are of a relatively low intensity type so that they can be delivered as an outpatient. You don’t normally need to be admitted to hospital for them. And there are some newer treatments coming through which are being incorporated also with monoclonal antibodies that, again, are more specifically targeted to the CLL cells. So what determines when someone with CLL needs treatment? There may be a number of things. It depends if the patient has significant symptoms. Sometimes with CLL this can also make the lymph glands in the body enlarge because the CLL cells can track their way into the lymph glands. So sometimes there are symptoms from having very large lymph glands that people can find uncomfortable or painful. CLL can affect the normal bone marrow function if the level of the leukaemia rises, so that the patient may become anaemic or start to get a lower platelet count than normal. And that would be another reason to start treatment, to reverse that balance, to try and restore some normality to the bone marrow. Also sometimes the CLL can get to a stage where the patient may be losing weight or has fevers or is generally becoming more poorly, and again that would be a reason to start treatment.
Before their own diagnosis most people we spoke to had known little or nothing about leukaemia and how it can affect people. However, all had heard of it and had known it was serious, often because they had known someone else who'd had it.
Many people had associated it with children and hadn’t realised that adults could also develop it. Several knew it was a disease of the blood or the bone marrow, but few knew that there were different types of leukaemia.
Some people said that leukaemia had just been a scary word to them before their diagnosis and a few hadn’t understood that it was a form of cancer until they were specifically told this or when chemotherapy was mentioned.
Did you know anything about leukaemia before all this happened to you? Not a lot. Not a lot. I knew it was something that maybe children, it was something a lot of children would have. And it was a cancer type illness.
Probably related to the blood, but that’s about, very scant details really, yeah. It was quite a big word, I know that much, it was quite a big word. I knew it was not something that you you’d want to be told about. Last reviewed: December 2018.
Last updated: December 2018.
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