Leukaemia

  • Leukaemia is cancer of blood and bone marrow.
  • This can be the cause when there is a problem with the production of blood cells.
  • It usually affects leukocytes/ white blood cells.
  • It is most likely to affect people over age of 55, but is also the most common cancer in those aged under 15.
  • Acute leukaemia develops quickly and worsens rapidly. Chronic leukaemia gets worse over time.

Statistics

  • Leukaemia statistics in South Africa is not readily available, but based on U.S. statistics from 2014 – 2016, approximately 1.6% of men and women will be diagnosed with leukaemia in their lifetime.
  • An estimated 3.5% of all cancer cases in the U.S. will be leukaemia in 2019.
  • An estimated 3.8% of all cancer related deaths in the U.S. will be from leukaemia in 2019.

Signs and Symptoms

Early signs and symptoms of leukaemia include:

  • Being tired all the time
  • Flu-like symptoms
  • Nausea
  • Weight loss
  • Bone pain
  • Fevers/ Chills/ Night sweats
  • Getting frequent infections:
    • White blood cells are crucial for fighting off infections.
    • If supressed or not working properly, frequent infections can result.
    • The immune system may attack other good body cells.
  • Poor blood clotting:
    • Immature white blood cells crowd out platelets which are crucial for blood clotting.
    • This causes a person to bruise/ bleed easily and heal slowly.
    • May develop petechiae
      • These are small red purple spots on the body, indicating a minor haemorrhage.
    • Anaemia
      • This is the result of a shortage of good red blood cells.
      • It can involve difficult/ laboured breathing and pale skin.

Diagnosis

  • Doctor will carry out a physical examination and ask about your personal and family history.
  • They will check for signs of anaemia.
  • They will feel for an enlarged liver or spleen.
  • Blood samples will be taken for assessment in a laboratory.

If leukaemia is suspected, a bone marrow test may be suggested:

  • Bone marrow is usually taken from the hip, using a long fine needle.
  • This will help determine which kind of leukaemia is present (if any).

Risk Factors

  • Previous cancer treatment:
    • People who have had certain types of chemotherapy and radiation therapy for other cancers have an increased risk of developing certain types of leukaemia.
  • Genetic disorders:
    • Genetic abnormalities play a role in the development of leukaemia.
    • Certain genetic disorders, such as Down syndrome, are associated with an increased risk of leukaemia.
  • Exposure to certain chemicals:
    • Certain chemicals such as benzene is linked to an increased risk of leukaemia.
  • Smoking:
    • Smoking cigarettes increases the risk of acute myelogenous leukaemia.
  • Family history of leukaemia:
    • Most leukaemia’s have no family links.
    • If, however, you are a first degree relative of a chronic lymphocytic leukaemia (CLL) patient, or if you have an identical twin who has or had acute myeloid leukaemia (AML) or acute lymphocytic leukaemia (ALL), you may have an increased risk of leukaemia.
  • Gender:
    • Men are more likely than women to develop leukaemia.
  • Age of a person:
    • The risk of most leukaemia’s increase with age, as it does with most cancers.
    • The average age of a patient diagnosed with acute myeloid leukaemia (AML), chronic lymphocytic leukaemia (CLL) or chronic myeloid leukaemia (CML) is 65 years and older.
    • Most cases of acute lymphocytic leukaemia (ALL) occur in people under the age of 15, which is the average age of an acute lymphocytic leukaemia (ALL) patient.
  • Blood disorders:
    • Certain blood disorders, including chronic myeloproliferative disorders, increase the chance of developing acute myeloid leukaemia (AML).

Treatment

Treatment depends on many factors determined by a doctor.

Treatment options are based on age and overall health, the type of leukaemia, and whether it has spread to other parts of the body, including the central nervous system.

Common treatments include:

  • Chemotherapy:
    • This is the major form of treatment for leukaemia.
    • This treatment uses chemicals to kill leukaemia cells throughout the body.
    • Depending on the type of leukaemia a person has, they may receive a single drug or a combination of drugs.
    • These may come in the form of a pill or may be injected directly into the veins.
  • Biological therapy:
    • This works by using treatments that helps the immune system recognise and attack the leukaemia cells.
  • Targeted therapy:
    • Specific drugs are used to attack specific vulnerabilities within your cancer cells.
  • Radiation therapy:
    • Radiation therapy uses x-rays or other high-energy beams to damage leukaemia cells and stop their growth.
    • Radiation may be received over the whole body or in one specific area of the body where there is a collection of leukaemia cells.
    • Radiation therapy may be used to prepare a person for a stem cell transplant.
  • Stem cell transplant:
    • This is a procedure to replace the diseased bone marrow with healthy bone marrow.
    • Before a stem cell transplant, a high dose of chemotherapy or radiation therapy to destroy the diseased bone marrow is received.
    • An infusion of blood-forming stem cells that help rebuild the bone marrow is then received.
    • Stem cells may be received from a donor or in some cases, a person may be able to use their own stem cells.
    • Stem cell transplant is very similar to a bone marrow transplant.

Types of Leukaemia

  • Acute and chronic leukaemia:
    • During its lifespan, white blood cells go through several stages.
    • Acute leukaemia
      • Immature, useless cells develop rapidly and collect in marrow and blood.
      • They are squeezed out of the bone marrow too early and are not functional.
    • Chronic leukaemia
      • Progresses more slowly
      • Allows more mature, useful cells to be made.
  • Lymphocytic and myelogenous leukaemia:
  • Leukaemia is also classified according to the type of blood cell they affect.
  • Lymphocytic leukaemia
    • Occurs if cancerous changes affect the type of bone marrow that make lymphocytes
    • A lymphocyte is a kind of white blood cell that plays a role in the immune system.
  • Myelogenous leukaemia
    • This occurs when changes affect the type of bone marrow cells that produce red blood cells, other types of white blood cells and platelets.
  • Acute Lymphocytic Leukaemia (ALL)
  • Known as acute lymphoblastic leukaemia
  • It is the most common type of leukaemia among young children.
  • It can also affect adults, especially after age of 65.
  • Among children, the 5-year survival rate is higher than 85%.
  • Subtypes of acute lymphocytic leukaemia (ALL):
    • Precursor B acute lymphoblastic leukaemia.
    • Precursor T acute lymphoblastic leukaemia.
    • Burkitt’s leukaemia.
    • Acute bi-phenotypic leukaemia.
  • Chronic Lymphocytic Leukaemia (CLL)
    • This is the most common among adults over 55 years.
    • It rarely affects children.
    • It is more common in men than women.
    • The 5-year survival rate is 82%.
  • Acute Myelogenous Leukaemia (AML)
    • This type of leukaemia is more common in adults than in children.
    • It affects men more often than women.
    • It develops quickly.
    • Symptoms include fever, difficulty breathing, joint pains and it is triggered by environmental factors.
    • Chemotherapy is the main treatment.
    • Sometimes a bone marrow transplant may be recommended.
  • Chronic Myelogenous Leukaemia (CML)
    • It mostly affects adults.
    • The 5-year survival rate is 65.1%.
    • Many people with chronic myelogenous leukaemia (CML) have a gene mutation that responds to targeted cancer therapy called Gleevec or Imatinib.