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Leukaemia

Leukaemia is the name given to the group of cancers that develop in the blood-forming tissue.

What is leukaemia?

Leukaemia occurs when the blood-making cells, which reside in our bone marrow (the soft tissue inside our bones), grow abnormally.1

There are three types of blood cells; red blood cells (which deliver oxygen to the body), white blood cells (which help fight infection) and platelets (which help the blood to clot and prevent us from bleeding). 1

Leukaemia typically affects the white blood cells. There are four main types of leukaemia (although there are many sub-types), depending on what type of white blood cell is affected (either myeloid or lymphoid) and whether it is fast growing (acute) or relatively slow growing (chronic).4

Types of leukaemia

Acute and chronic classifications do not reflect how serious the disease is, but the rate of progression. Acute leukaemia develops and progresses rapidly, while chronic leukaemia appears gradually and is slow growing over months to years.

Due to the rapid nature of acute leukaemia treatment usually begins quickly after diagnosis. Chronic leukaemia may not require treatment for a long time after it is diagnosed.

Acute Leukaemia

Healthy bone marrow produces immature white blood cells, called blast cells. These blast cells then develop into mature white cells, red cells and platelets, and 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 immature cells accumulate in the bone marrow interfering with the production of normal blood cells.

Common forms of acute leukaemia:

  • Acute lymphoblastic leukaemia (ALL) – affects immature cells called lymphoblasts. This type of leukaemia develops quickly.5 Most ALL occur in children under four years of age. 5
  • Acute myeloid leukaemia (AML) – affects immature cells called myeloblasts. It is the most common form of acute leukaemia in adults.6

Chronic Leukaemia

In chronic leukaemia there is a build-up of mature but abnormal white blood cells that have undergone a malignant change when developing from a blast cell.

Common forms of chronic leukaemia are:

  • Chronic lymphocytic leukaemia (CLL) – the most common type of leukaemia in western countries. Predominantly affects older people and is often very slow growing.7
  • Chronic myeloid leukaemia (CML) – typically grows slowly in the early phases but can transform to acute leukaemia.3

Signs and symptoms of leukaemia

Acute Lymphoblastic Leukaemia (ALL)Chronic Lymphocytic Leukaemia (CLL)Acute Myeloid Leukaemia (AML)Chronic Myeloid Leukaemia (CML)15
o Bone pain due to cancerous cells in the bone marrow
o Loss of weight and appetite
o Pain in the chest and abdomen due to enlarged liver and spleen
o Anaemia resulting in tiredness and breathlessness
o Often has no symptoms and is found on routine blood tests
o Excessive night sweats
o Swollen lymph nodes in the groin, arm pit and neck area
o Repeated infections with slow recovery
o Aches and pains in the bones
o Swollen lymph nodes
o Chest and stomach pain
o Low red blood cell count (anaemia) which causes; s
o Loss of weight and appetite.
o Often diagnosed on routine blood tests
o Low red blood cell count (anaemia)
o Loss of weight and appetite
o Rib pain on the left side of the body or early satiety (due to an enlarged spleen)

Having one or all of these symptoms does not mean you have leukaemia, as many conditions can cause these symptoms. However, if you experience any of the above, to see your doctor. 4,5,6

Stages of leukaemia

Acute Lymphoblastic Leukaemia (ALL)

There is no standard staging system for ALL.4 Rather, laboratory tests (such as blood and bone marrow tests) can determine the subtype of ALL, which is based on the World Health Organisation (WHO):13

  • Pre-B cell ALL – early stage development of leukaemia in the bone marrow
  • B-cell ALL – is found in developed, or more mature lymphoid cells
  • T-cell ALL – leukaemia is found in developing T-cells

Chronic Lymphocytic Leukaemia (CLL)

Most Australian doctors use what is called the Binet staging system to classify CLL. (The other system also used is known as the Rai system is more commonly used in the United States).12

The Binet system classifies CLL into three stages: 12

  • Stage A – increased white blood cell count but < 3 enlarged lymph nodes
  • Stage B – increased white blood cell count and >3 enlarged lymph nodes
  • Stage C – increased white blood cell count and low red cell and/or platelets

 Acute Myeloid Leukaemia (AML)

There is no staging system for AML.4 Rather, based on laboratory testing (including genetic testing) AML can be classified into a subgroup, which then has an effect outcome.14

 Chronic Myeloid Leukaemia (CML)

There are three stages of phases of CML:

  • Chronic phase – this stage can last many years and is characterised by relative clinical stability. Blast cell numbers in the blood and bone marrow are low (< 5%).15
  • Accelerated phase – during this period the number of blast cells start to increase in the bone marrow and blood. 15
  • Blast phase – is a period of rapid progression and the disease is similar to acute leukaemia. Blast cell numbers in the blood and bone marrow increase rapidly.15

Treatment

Frequently asked questions

Is leukaemia hereditary?

Whilst the majority of leukaemias are not hereditary, there are some genetic disorders which can increase the chance of developing leukaemia, such as Li-Fraumeni Syndrome and Downs Syndrome. 11

Some inherited conditions which affect the immune system such as Bloom Syndrome, can also increase the risk for leukaemia. 15

Are there risk factors for leukaemia?
  • Alcohol: There is some evidence to suggest that mothers who drink alcohol during pregnancy may increase the risk for development of acute myeloid leukaemia in their children.10 However, not all studies have found this and further research is needed.
  • Exposure to large levels of radiation (such as survivors from the Japanese atomic bomb) have an increased the risk for leukaemia. The risk from radiation exposure due to X-rays and scans is not conclusive, however it is thought the risk is small.9
  • Chemical exposure such as benzene also carries an increased risk for leukaemia.11
  • Previous treatments with chemotherapy drugs or radiotherapy can also increase the risk for AML and ALL.11
  •  Smoking: is a proven risk factor for acute myeloid leukaemia (AML).12
  • Siblings: having a brother or sister with leukaemia has a small increase in risk of developing leukaemia, however having an identical twin with leukaemia increases the risk substantially more.
How common is leukaemia?

Each year in Australia, just under 4000 people are diagnosed with a form of leukaemia, and in people under 24 years, it is the most commonly diagnosed cancer.2

References

For a full list of references, click here.
  1. Cancer Council. (2017). Blood Cancer. Retrieved on 28th March 2019 from https://www.cancercouncil.com.au/blood-cancers/
  2. Cancer Australia, Australian Government. (2019). Leukaemia statistics. Retrieved on 28th March 2019 from https://leukaemia.canceraustralia.gov.au/statistics
  3. Cancer Australia, Australian Government. (2017). What are the symptoms of Leukaemia? Retrieved on 2nd April 2019 from https://leukaemia.canceraustralia.gov.au/symptoms
  4. Cancer Council. (2019). Retrieved on 2nd April 2019 from https://www.cancer.org.au/about-cancer/types-of-cancer/leukaemia.html
  5. Cancer Council. (2019). Acute Lymphoblastic Leukaemia. Retrieved on 8th April 2019 from https://www.cancercouncil.com.au/acute-lymphoblastic-leukaemia/
  6. Cancer Council. (2019). Acute Myeloid Leukaemia. Retrieved on 8th April 2019 from https://www.cancercouncil.com.au/acute-myeloid-leukaemia/
  7. Cancer Council. (2018). Chronic Lymphocytic Leukaemia. Retrieved on 8th April 2019 from https://www.cancercouncil.com.au/chronic-lymphocytic-leukaemia/
  8. American Cancer Society. (2018). Risk Factors for Childhood Leukaemia. Retrieved on 8th April 2019 from https://www.cancer.org/cancer/leukemia-in-children/causes-risks-prevention/risk-factors.html
  9. Karalexi, Maria A et al. (2017). Parental alcohol consumption and risk of leukaemia in the offspring: a systematic review and meta-analysis. European Journal of Cancer Prevention. 26 (5) 26(5):433-441. doi: 10.1097/CEJ.0000000000000350
  10. Cancer Australia, Australian Government. (n.d). Leukaemia Factsheet. Retrieved on 9th April 2019 from https://canceraustralia.gov.au/system/tdf/publications/leuk_leukemia_cancer_factsheet_51e648025a242.pdf?file=1&type=node&id=3603
  11. American Cancer Society. (2018). Risk Factors for acute myeloid leukaemia (AML). Retrieved on 9th April 2019.
  12. Cancer Council. (2018). Staging and prognosis for Chronic lymphocytic leukaemia (CLL). Retrieved on 9th April 2019. From https://www.cancercouncil.com.au/chronic-lymphocytic-leukaemia/diagnosis/staging-prognosis/
  13. Leukaemia Foundation. (2019). Acute Lymphoblastic Leukaemia. Retrieved on 9th April 2019 from https://www.leukaemia.org.au/disease-information/leukaemias/acute-lymphoblastic-leukaemia/
  14. Leukaemia Foundation. (2019). Acute Myeloid Leukaemia. Retrieved on 9th April 2019 from https://www.leukaemia.org.au/disease-information/leukaemias/acute-myeloid-leukaemia/
  15. Leukaemia Foundation. (2019). Chronic Myeloid Leukaemia. Retrieved on 9th April 2019 from https://www.leukaemia.org.au/disease-information/leukaemias/chronic-myeloid-leukaemia/
  16. Leukaemia Foundation. (2019). Chronic Lymphocytic Leukaemia (CLL). Retrieved on 9th April 2019 from https://www.leukaemia.org.au/disease-information/leukaemias/chronic-lymphocytic-leukaemia/

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