Leukaemia is an umbrella term encompassing several different cancers of the blood and the blood-forming tissues of the body. All forms of leukaemia begin with problems in the creation of blood cells.
The body constantly produces millions of blood cells, primarily in the bone marrow—the spongy interior of bones that contains immature stem cells. In a healthy individual, these immature stem cells develop into either lymphoid or myeloid stem cells.
Lymphoid stem cells mature into white blood cells, which are crucial components of the immune system. They first become immature cells called lymphoblasts and then mature into lymphocytes, such as B cells (producing antibodies to fight invaders) and T cells (alerting other immune cells and fighting infection directly).
Myeloid stem cells also develop into various blood cells. They become myeloblasts, which mature into monocytes and granulocytes (like neutrophils) that fight disease. Other myeloid stem cells develop into red blood cells (carrying oxygen) and platelets (aiding blood clotting).
Leukaemia develops when the DNA—the genetic instructions controlling cell activity—of a bone marrow stem cell mutates. The cell becomes cancerous, begins multiplying rapidly, and overwhelms the healthy cells in the blood and bone marrow. These diseased cells can also gather in organs such as the liver, lymph nodes, spleen, and skin.
Leukaemia is typically classified based on two main criteria:
By the type of stem cell that turns cancerous, either lymphoid or myeloid.
As either acute or chronic.
Acute leukaemia affects immature cells, preventing them from developing and functioning correctly. These cells multiply rapidly, making acute leukaemia a more aggressive form of the disease.
Chronic leukaemia involves mature or partially mature cells. These cells multiply more slowly and are generally less aggressive than acute leukaemia.
An aggressive form developing from immature lymphoid stem cells, affecting both adults and children.
An aggressive type developing from myeloid stem cells, affecting both adults and children, though prognosis varies between groups.
A slow-growing type developing from lymphoid stem cells that are further along in development. It primarily impacts older patients.
A slower-growing form developing from more mature myeloid stem cells, most often diagnosed in older adults.
A rare, typically aggressive leukaemia developing from B cells that rapidly multiply.
An aggressive subtype of acute leukaemia, a cancer of plasmacytoid dendritic cells, most common in older patients.
A rare, slow-growing type, mainly impacting people in their 60s and older, characterised by low counts of healthy blood cells and high counts of diseased monocytes.
Lymphoid stem cells produce too many diseased B cells, which have thin, hair-like growths on their surface. It is typically slow to develop and more common in males aged 50 and older.
A rare type mostly found in children aged 4 and younger, faster-growing than chronic but slower than acute leukaemia.
A rare, generally slow-growing leukaemia developing from mature T cells or Natural Killer (NK) cells. It is primarily diagnosed in older patients.
An aggressive, extremely rare form of leukaemia involving T-lymphoid stem cells. It can be slow-growing initially but often progresses to a more advanced, aggressive disease.
Symptoms can vary, and patients with chronic leukaemia may have no symptoms at all when diagnosed. Acute forms are more aggressive and more likely to present symptoms. Many symptoms are a result of a lack of properly functioning blood cells to carry oxygen, fight infection, or clot blood.
Common leukaemia symptoms include:
A successful treatment journey begins with an accurate and precise diagnosis. At SSCHRC, suspected leukaemia cells are examined by pathologists who specialise exclusively in diagnosing leukaemia and its many subtypes, enabling patients to receive the most effective treatment for their specific condition.
The diagnostic process typically starts with a simple blood test called a complete blood count (CBC), which may be ordered after evaluating the patient's symptoms or as part of a routine check-up. If the CBC shows the presence of leukaemia cells or abnormal levels of red blood cells, white blood cells, or platelets, further tests are ordered for a definitive diagnosis and to determine the extent of the disease.
Common diagnostic tests include:
Suspected cancer cells are retrieved and studied under a microscope. For leukaemia, patients typically undergo a bone marrow biopsy, which involves taking a sample of bone marrow from the hip using a needle to check for cancerous cells.
If leukaemia is diagnosed, additional testing determines whether specific chromosomes, gene mutations, proteins, or molecules are present in the diseased cells. This helps doctors determine the exact type of leukaemia and prognosis, and create a targeted treatment plan.
As leukaemia may spread to the central nervous system (brain and spinal cord), a lumbar puncture is performed to examine the patient's spinal fluid for any signs of spread.
Doctors may order imaging exams to look for the presence of cancer in different parts of the body.
Staging is the process of learning how far a cancer has spread. While rare leukemias often do not have a set staging system, the four most common types have their own specific systems or methods to describe the disease's status, which impacts the patient's prognosis and treatment plan.
The goal of leukaemia treatment is to achieve remission (where no cancer is detectable in the patient's body) and ultimately to cure the patient. For leukaemia, complete remission means the patient's bone marrow has no detectable microscopic evidence of the disease and their blood counts have returned to normal. Patients who remain in complete remission for an extended period are considered cured, with an extremely low chance of recurrence.
At SSCHRC, internationally renowned physicians and a specialised support team collaborate daily to customise comprehensive leukaemia treatment plans. Many doctors focus on specific types of leukaemia, providing a deep level of knowledge for designing treatment plans.
Key treatment modalities include:
Drugs used to kill cancer cells, control their growth, or relieve symptoms. It may involve a single drug or a combination of drugs.
Uses powerful beams of energy to kill cancer cells. Since leukaemia cells travel in the bloodstream, radiation is typically used when the disease has spread to the central nervous system.
A procedure that replaces cancerous bone marrow with new, healthy bone marrow stem cells. It is usually performed after intensive chemotherapy and may be needed for patients whose leukaemia has returned, not responded to standard treatments, or who have a high-risk form of the disease.
A treatment where T cells (a type of immune system cell) are modified to recognise and attack cancer cells.
Drugs designed to interfere with or 'target' specific molecules (often proteins) that cancer cells need to survive, multiply, and spread.
SSCHRC offers multiple clinical trials for leukaemia, exploring new drug combinations and innovative treatments, including targeted therapies and immunotherapies, which may not be available elsewhere.
Even with normal blood counts, many leukaemia patients require ongoing maintenance therapy to remain in remission. In some cases, patients in remission may undergo a stem cell transplant to maintain remission.
Men are more likely to develop leukaemia than women.
Most types impact older adults, though some are common among paediatric patients.
Prior treatment with chemotherapy or radiation therapy for a previous cancer can be a risk factor.
Having a parent, sibling, or child with certain types of leukaemia increases the risk.
These chronic bone marrow and blood cancers (especially myelofibrosis) can transform into acute myeloid leukaemia.
Individuals with certain genetic disorders have a higher risk, including: Ataxia telangiectasia, Bloom syndrome, Down syndrome, Fanconi anaemia, Klinefelter syndrome, Li-Fraumeni syndrome, and Wiskott-Aldrich syndrome.
Long-term exposure to chemicals like benzene or Agent Orange.
Exposure to radiation from nuclear incidents.
Genetic counselling may be right for you if some cases of leukaemia have been passed down from one generation to the next.