Leukaemia

Leukaemia is a cancer of the blood-forming cells, usually originating in the bone marrow, resulting in the overproduction of abnormal white blood cells that crowd out normal blood cell production. It can be acute (rapidly progressing) or chronic (more slowly progressing), and affects both children and adults.

• Fatigue and weakness, related to a low red blood cell count (anaemia)
• Frequent or severe infections, related to abnormal white blood cell function despite high numbers
• Easy bruising or bleeding, including nosebleeds or bleeding gums, related to a low platelet count
• Unexplained weight loss and night sweats
• Bone or joint pain, particularly in children
• Swollen lymph nodes or an enlarged spleen in some cases

• Results from abnormal, uncontrolled growth of blood-forming cells in the bone marrow, the exact trigger for which is often not identified in an individual case.
• Certain genetic conditions, prior exposure to specific chemicals or radiation, and, for some types, certain viral infections are recognised risk factors.
• Acute leukaemias, which progress rapidly, are more common in children (particularly acute lymphoblastic leukaemia) and can also occur in adults; chronic leukaemias progress more slowly and are more common in older adults.

• Suspected based on the combination of symptoms above together with a full blood count showing abnormal numbers or types of blood cells.
• Bone marrow examination (aspirate and biopsy) is the key test to confirm the diagnosis and determine the specific type of leukaemia, which guides treatment.
• Further tests help classify the specific subtype and guide the treatment plan, and are typically arranged at a specialist haematology or oncology centre.

Treatment depends heavily on the specific type of leukaemia and is coordinated by a specialist, typically involving chemotherapy as a core component.

Acute leukaemias generally require urgent treatment, as they progress rapidly, while chronic leukaemias may sometimes be monitored initially before treatment is needed, depending on the specific type and disease activity.

Supportive care during treatment includes management of infections, blood transfusions for anaemia or low platelets, and monitoring for treatment side effects.

Children with acute lymphoblastic leukaemia, the most common childhood leukaemia, have high cure rates with modern treatment protocols where these are accessible.

Long-term follow-up after treatment monitors for recurrence and manages any long-term effects of treatment.

• There is no proven way to prevent most leukaemias, since many cases arise without an identifiable cause.
• Seek prompt medical assessment for unexplained, persistent fatigue, easy bruising or bleeding, frequent infections, or bone pain, particularly in a child.
• Avoid unnecessary exposure to known risk factors, such as certain industrial chemicals, where possible.
• Complete recommended treatment and follow-up fully once diagnosed, as adherence significantly affects outcomes, particularly in childhood leukaemia.