Introduction to Leukemia
Leukemia is a type of blood cancer that affects white blood cells, which typically fight infection.
Healthy and abnormal white blood cells are produced in the bone marrow, along with other types of cells found in the blood. As far as we know, there is no definitive cause of leukemia, but when abnormal white cells are produced in large amounts, they can take over the bone marrow and spill out into the blood stream, causing the symptoms associated with these diseases; including fatigue, susceptibility to infections and weight loss.
Leukemias can be split into several different subtypes, depending on how fast they progress (acute leukemias develop faster, and chronic leukemias develop slower), or on the type of cells affected (lymphoid or myeloid). The various subtypes of leukemia have different symptoms, and therefore have their own specific treatment regimes.
- Acute lymphoblastic leukemia (ALL)
- Acute myeloid leukemia (AML)
- Acute premyelocytic leukemia (APL)
Symptoms of leukemia can be vague and non-specific, and not everyone experiences the same symptoms before diagnosis.
Which may be experienced as:
- Shortness of breath
- Chest pain
You might experience frequent and severe infections before and after your diagnosis.
Unexplained weight loss or loss of appetite can be associated with acute leukemia
Bruising or bleeding
You might find that you’re more prone to bruising than normal, or that you bleed from unexpected places, such as the gums and nose. Bleeding for longer than usual can also be a sign of acute leukemia.
Fever or night sweats
Among leukemia side effects, night sweats are common; they are also a side effect of chemotherapy.
Pain in bones or joints
When bone pain occurs, it’s most often felt in the long bones of the arms and legs and in the ribs and sternum of the rib cage. Pain in bones or joints are less common in acute myeloid leukemia or myelodysplastic syndromes.
If your doctor suspects you may have leukemia, they will conduct a variety of tests to confirm this. The tests may include a full blood count, bone marrow biopsy, and other general health tests and infection screening.
Acute Lymphoblastic Leukemia (ALL)
ALL is a type of acute leukemia that affects a specific type of blood stem cell called lymphoblasts – these are the precursors of some white blood cells. These cells are produced in the bone marrow and, when they are abnormal, they multiply excessively preventing the production of other types of blood cells. The reduced number of healthy white blood cells, red blood cells and platelets results in the symptoms experienced by patients, such as fatigue, bleeding/bruising, and infections.
Despite certain risk factors being associated with ALL, there is no definitive cause. ALL is more common in young children but adults are affected too. Symptoms can be vague but they do include enlarged lymph nodes, enlarged liver or spleen and joint pains. Treatment can include chemotherapy, immunotherapy, targeted therapy, radiation therapy or stem cell transplant.
Acute Myeloid Leukemia (AML)
AML is a type of acute leukemia that affects young myeloid cells. Normal myeloid cells will mature into red blood cells, some types of white blood cells and platelets. If abnormal, myeloid cells can grow excessively and overcrowd the bone marrow, preventing the production of healthy cells, and therefore causing symptoms commonly experienced by AML patients, such as fatigue, bleeding/bruising and infections.
Despite many risk factors being associated with AML, there is no definitive cause. AML is more common in older people, and affects men and women in a similar way. AML can progress from myelodysplastic syndrome (MDS) or myeloproliferative neoplasms (MPN), which is why these diseases are often referred to when discussing acute leukemias. Like ALL, symptoms can be vague, but include bone pain, enlarged liver or spleen and swollen gums. Treatment can include chemotherapy or stem cell transplant.
Acute Promyelocytic Leukemia (APL)
APL is a rare form of AML. It affects promyelocytes, which develop into granulocytes, a type of white blood cell. There is no definitive cause for APL, but most people with the disease have a faulty gene in the leukemia cells called PML/RARA. There is also a slightly higher risk of developing APL if you have received treatment for other types of cancer. APL is treated in a very different way to AML because the usual treatments for AML may seriously affect blood clotting in these patients. Treatment can include all-trans retinoic acid (ATRA), anthracyclines, arsenic trioxide (ATO), and blood, platelet or plasma transfusion.
There are trustworthy resources you can use to learn more about acute leukemia, and to guide decisions as a patient, carer or family/friend. See our resources page for more information.
The type of treatment you receive will depend on the type of acute leukemia you have. As the disease can progress rapidly, it is likely that you will discuss treatment options with your doctor within the first few days after diagnosis. At this time, it is important that you make every effort to fully understand your diagnosis, the treatment options available and how they will impact your life. You should contact your professional healthcare team to discuss any questions you may have, as well as to clarify anything you may not understand about your diagnosis.
Some of the strategies being used to treat acute leukemia are :
- Chemotherapy – drugs that destroy abnormal and rapidly dividing cells. Chemotherapy is usually administered intravenously (in the vein)
- Radiation therapy – high-energy radiation that destroy cancer cells. It is typically only used in advanced or metastatic leukemia
- Targeted therapy – drugs that target specific mutated genes or proteins
- Immunotherapy – drugs that boost the immune system, enabling them to kill cancer cells more effectively
- Stem cell transplant – replacement of bone marrow from either yourself or a donor. This encourages the production of healthy white blood cells
- Clinical Trials – clinical trials can enable you to access the most cutting-edge treatments as they are designed to determine which treatments are the most effective in specific patient group. These trials will define the best standard of care for patients