Leukemia

Leukemia Cancer Patient with Nurse

Facts and figures of leukemia

Leukemia is cancer that starts in the tissue that forms blood. Most blood cells develop from cells in the bone marrow called stem cells. Stem cells mature into different kinds of blood cells; a myeloid stem cell matures into a myeloid blast which can form a red blood cell, platelets, or one of several types of white blood cells.

A lymphoid stem cell matures into a lymphoid blast; these can form one of several types of white blood cells, such as B cells or T cells. Therefore leukaemias may be lymphoblastic (sometimes referred to lymphocytic) or myeloid. There are four different leukaemias, some of them occur mainly in children and others mainly in adults. 90% of all leukaemias occur in adults.

Childhoood leukaemia

Leukaemia is the most common childhood cancer in the UK and accounts for approximately 33% of all childhood cancers. Higher incidence in boys, male to female ratio is approximately 12:10. The highest incidence occurs between 2 and 5 years of age, particularly acute lymphoblastic leukaemia (ALL) which accounts for 75% of childhood leukaemia.

Most others are acute myeloid leukaemia, with a very small number of chronic myeloid leukaemia but this only about 15 cases a year in the UK. Risk factors include some genetic conditions such as Down’s syndrome, immune system disorders, a sibling having been diagnosed with leukaemia, possibly radiation exposure during early childhood or in utero. There is also some possibility that children whose mothers had a high alcohol intake during the pregnancy may have a slightly increased risk.

Adult leukaemia

Leukaemia is the 11th most common cancer in the UK, accounting for approximately 3% of all new cancer cases. Higher incidence in men, male to female ratio is approximately 14:10. Age related, rises sharply from 45 years of age with an average of 38% being diagnosed in those over 75 years of age and the highest incidence in the 85+ years age group.

Risk factors include exposure to high levels of radiation, previous radiotherapy or chemotherapy, exposure to chemicals such as benzene, smoking, some genetic conditions such as Downs Syndrome and Fanconi anaemia and family history of leukaemia. There are four types of leukaemia in adults:

  • Chronic lymphocytic leukaemia (CLL) – this is the most common adult leukaemia, approximately 3,000 new cases are diagnosed each year in the UK, usually in those over 60 years of age.
  • Acute lymphoblastic leukaemia (ALL) – only about 400 adults are diagnosed each year in the UK, although it is the most common childhood leukaemia. In adults it is most frequently diagnosed in the 15-25 years age group and then in those over 75 years of age.
  • Acute myeloid leukaemia (AML) – this is the 2nd most common adult leukaemia; approximately 2,200 new cases diagnosed each year in the UK, usually in those over 60 years of age.
  • Chronic myeloid leukaemia (CML) is far less common, approximately 680 new cases diagnosed each year in the UK, most commonly occurring in the 40-60 years age group.

Adult leukemia symptoms

  • Increased incidents of fever and infection over short periods of time.
  • Night sweats/unexplained fevers.
  • Pale and lethargic and feeling generally unwell- may be due to anaemia.
  • Abnormal bruising or excessive bleeding.
  • Poor appetite/ abnormal weight loss.
  • Bone or joint pain.
  • Headaches and other neurological complaints.

Child leukemia symptoms

  • Increased incidents of fever and infection over short periods of time.
  • Night sweats.
  • Red spots on the skin.
  • Pale and lethargic- may be due to anaemia.
  • Frequent nose bleeds.
  • Poor appetite/ abnormal weight loss.
  • Bone or joint pain.
  • Occasionally shortness of breath.
  • Abdominal pain or discomfort if liver, kidneys or spleen enlarged.
  • Enlarged lymph nodes in the axilla, neck or groin.

Diagnosis of leukemia

Investigations may include:

  • Physical examination.
  • Blood tests.
  • Chest X-ray.
  • Bone marrow aspiration.
  • Bone marrow biopsy.
  • Lumbar puncture.
  • CT scan.
  • MRI scan.
  • Ultrasound scan.

Leukemia treatment

Depends on several factors:

  • The type of leukaemia:

Chronic lymphocytic leukaemia
Acute lymphoblastic leukaemia
Acute myeloid leukaemia
Adult myeloid leukaemia
Chronic myeloid leukaemia

  • Stage of disease.

  • Age and general health. 

Chronic lymphocytic leukaemia

‘Watchful waiting’ treatment depends on the stage of CLL and in some cases there are no early symptoms so a policy of ‘watchful waiting’ may be recommended.

Chemotherapy

In later stages chemotherapy is usually the main treatment, using fluradarabine, cyclophosphamide and the monoclonal antibody rituximab (FCR), but there are some other options that may be used.

Bone marrow or stem cell transplants

Bone marrow or stem cell transplants are sometimes used, using high dose chemotherapy or radiation to destroy malignant cells in the bone marrow prior to the transplant to put the leukaemia into remission.

Acute lymphoblastic leukaemia (ALL)

Chemotherapy

Chemotherapy will be the main treatment used to treat this form of the disease, along with steroids, the aim being to achieve remission (this is not necessarily a cure). The drugs commonly used are L-asparaginase and vincristine, usually given with the steroid dexamethasone, sometimes methotrexate or daunorubicin may be used. Intrathecal chemotherapy (drugs are administered directly into the cerebrospinal fluid) will also be required to destroy any leukaemic cells that have spread to the brain and spinal cord.

Stem cell transplants

Some will require a stem cell transplant, which involves stem cells being removed from the patient or a donor, then frozen and put into storage. High dose chemotherapy or radiation (total body irradiation TBI) is given to destroy the patient’s bone marrow and then the stored stem cells given to the patient.

Acute myeloid leukaemia (AML)

Chemotherapy

Chemotherapy will be the main treatment used to treat this form of the disease, along with steroids, but it is more intensive than for ALL and is given in 2 phases. The initial phase is remission induction followed by post-remission treatment.

The initial phase usually involves 2 cycles of chemotherapy (often the same drugs as used for ALL) followed by intrathecal chemotherapy to destroy any leukaemic cells that have spread to the brain and spinal cord. A bone marrow biopsy will then be performed and if there are no leukaemic cells found, the child is regarded as in remission and a further course of chemotherapy will be given to destroy any remaining leukaemic cells, aiming to retain remission. Intrathecal chemotherapy will normally be given again after the second course.

Stem cell transplants

Stem cell is used more often in AML than ALL but is still largely limited to children who have experienced relapse.

Adult myeloid leukaemia

Chemotherapy

Chemotherapy will be the main treatment used to treat this form of the disease, and will have two phases, remission induction and post remission treatment. The drugs used may include daunorubicin, doxorubicin and cytarabine. Intrathecal chemotherapy may also be given to treat any leukaemic cells that have, or may have spread to the brain and spinal cord.

Stem cell transplants

Stem cell transplants, using high dose chemotherapy or radiation to destroy malignant cells in the bone marrow prior to the transplant to put the leukaemia into remission.

Other drug therapy

Arsenic trioxide and all-trans retinoic acid (ATRA) destroy leakaemic cells, stop the leukaemic cells from dividing or help leukaemia cells develop into white cells, being used in the treatment of a subtype of AML called promyelocytic leukaemia. Monoclonal antibody is one type of targeted therapy being studied in the treatment of adult AML.

Chronic myeloid leukaemia

Targeted therapy

Patients usually treated initially with imatinib or nilotinib, imatinib usually reduces the number of leukaemia cells in the blood and bone marrow to a level that cannot be detected. Some patients respond initially and then become resistant and a second line drug, dasatinib may be beneficial.

Stem cell transplants

Stem cell transplants are only performed if the disease does not respond to drugs.

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