Acute Leukaemia
Acute leukaemia is an aggressive cancer of the blood and bone marrow that develops quickly and requires immediate treatment. While it can be life-threatening, newer treatments are helping more people live longer, and in children with certain types, there is a good chance for a cure.
Table of contents
- What is acute leukaemia?
- Types of acute leukaemia
- How acute leukaemia develops
- Signs and symptoms
- Causes and risk factors
- Diagnosis
- Treatment approaches
- Living with acute leukaemia
What is acute leukaemia?
Acute leukaemia is a cancer of the blood and bone marrow (the soft, spongy tissue inside bones where blood cells are made). The word “acute” means that the disease progresses rapidly and creates immature blood cells, rather than mature ones. This is different from chronic leukaemia, which develops more slowly over time[1][2].
In acute leukaemia, abnormal cancer cells multiply rapidly in your bone marrow. These cells soon outnumber your healthy blood cells. The abnormal cells are usually immature white blood cells that don’t function properly. They cannot fight infections like normal white blood cells do[2].
Unlike other cancers, leukaemia doesn’t generally form a solid mass or tumor that shows up in imaging tests such as X-rays or CT scans. Instead, it affects the blood and bone marrow throughout the body[2].
- Bone marrow
- Blood
- Lymph nodes
- Spleen
- Liver
Types of acute leukaemia
There are two main types of acute leukaemia, classified according to which type of white blood cells are affected[3].
Acute lymphoblastic leukaemia (ALL), also called acute lymphocytic leukaemia, affects lymphocytes (a type of white blood cell). Lymphocytes develop from lymphoid stem cells. This is the most common type of cancer in children, and treatments result in a good chance for a cure. ALL can also occur in adults, though the chance of a cure is greatly reduced[1][7].
Acute myeloid leukaemia (AML) is an aggressive cancer of the monocyte or granulocyte cells, which develop from myeloid stem cells. AML is the most common type of acute leukaemia in adults, with around 3,100 people diagnosed with it each year in the UK. The risk of developing AML increases with age, and it’s most common in people over 75[3][12].
Both types of acute leukaemia can affect children and adults. Each year, about 1,160 children in the United States receive an AML diagnosis[12].
How acute leukaemia develops
To understand how acute leukaemia develops, it helps to know how normal blood cells are made. Your bone marrow produces blood stem cells, which are immature cells that develop over time into mature blood cells. These stem cells can become either myeloid cells or lymphoid cells[2].
Myeloid cells develop into red blood cells (which carry oxygen), platelets (which help blood clot), and certain types of white blood cells. Lymphoid cells develop into other types of white blood cells called lymphocytes, which help fight infection[2][7].
Normally, your bone marrow works like an efficient production line, consistently making the exact number of blood cells and platelets that your body needs to function. In acute leukaemia, however, a bone marrow cell develops changes in its genetic material or DNA. These genetic changes cause one of the developing blood cells to begin multiplying out of control[1][12].
The abnormal cells, called blasts or leukaemia cells, begin to take over the space inside your bone marrow. They crowd out the cells trying to develop into healthy red blood cells, white blood cells, and platelets. As a result, your body’s organs and tissues won’t get the oxygen they need to work properly. Also, your body won’t be able to fight infections or form blood clots when needed[2][4].
Signs and symptoms
The symptoms of acute leukaemia usually develop over a few weeks and become worse over time. Acute leukaemia is aggressive, which means you quickly develop new and more noticeable symptoms[3][12].
Common symptoms of acute leukaemia include[1][3][12]:
- Looking pale or “washed out”
- Feeling tired or weak (fatigue)
- Breathlessness
- Frequent infections
- Fever or night sweats
- Easy bruising or bleeding, such as bleeding gums or frequent nosebleeds
- Tiny red spots on your skin (petechiae)
- Bone pain or back pain
- Loss of appetite
- Unexplained weight loss
- Swollen lymph nodes in and around the neck, armpits, abdomen, or groin
- Headaches or dizziness
Early on, symptoms may feel like you have a cold or flu that won’t go away. Many signs and symptoms of acute leukaemia mimic those of the flu. However, flu symptoms eventually improve. If signs and symptoms don’t improve as expected, you should make an appointment with your doctor[1][12].
If your doctor thinks you may have leukaemia, they’ll arrange blood tests to check your blood cells. If the tests suggest there’s a problem, you’ll be urgently referred to a specialist in treating blood conditions (haematologist) for further tests and treatment[3].
Causes and risk factors
Experts aren’t sure exactly what causes acute leukaemia, and in most cases, there’s no identifiable cause. The condition happens when certain genes or chromosomes mutate (change), creating abnormal blood cells[1][12].
These genetic changes may happen in different ways. They can occur during your lifetime when something changes your DNA. They might also happen if you inherited a genetic disorder that increases your risk of developing acute leukaemia. In some cases, there may have been a change in certain genes in your biological parents’ sperm or egg[12].
There are many risk factors for acute leukaemia, but many do not directly cause cancer. Instead, they increase the chance of DNA damage in cells that may lead to leukaemia. Some things that can increase your risk include[3][7]:
- Previous chemotherapy or radiotherapy treatment
- Exposure to very high levels of radiation
- Smoking and other exposure to benzene, a chemical used in manufacturing that’s also found in cigarette smoke
- Having a blood disorder or some genetic conditions, such as Down’s syndrome
- Age (AML is more common in older people, especially those over 75)
Some risk factors for cancer, like smoking, can be changed. However, risk factors also include things people cannot change, like their genetics, getting older, and their health history[7].
Diagnosis
Tests and procedures used to diagnose acute leukaemia include[9]:
Blood tests may reveal too many or too few white blood cells, not enough red blood cells, and not enough platelets. A blood test may also show the presence of blast cells, which are immature cells normally found in the bone marrow[9].
Bone marrow test. During bone marrow aspiration and biopsy, a needle is used to remove a sample of bone marrow, usually from the hipbone or breastbone. The sample is sent to a lab for testing to look for leukaemia cells[9].
Doctors in the lab will classify blood cells into specific types based on their size, shape, and other genetic or molecular features. They also look for certain changes in the cancer cells. In ALL, they determine whether the leukaemia cells began from B lymphocytes or T lymphocytes. This information helps your doctor develop a treatment plan[9].
Imaging tests such as X-rays, computed tomography (CT) scans, or other imaging may be done to check if the cancer has spread to other parts of the body[9].
After acute leukaemia has been diagnosed, tests are done to find out if the cancer has spread to the central nervous system (brain and spinal cord) or to other parts of the body. This may include a lumbar puncture (spinal tap), where a needle is inserted into the spinal canal to collect cerebrospinal fluid for testing[7][9].
Treatment approaches
Treatment for acute leukaemia needs to begin as soon as possible, as it can develop quickly. The main treatment for both ALL and AML is chemotherapy. Treatment is often carried out in two main stages[3][10][14].
Induction therapy is the first stage of treatment. It aims to kill as many leukaemia cells in your blood and bone marrow as possible and treat any symptoms you may have. You’ll usually be given a combination of two or more chemotherapy medicines at a high dose. The treatment will be carried out in hospital or in a specialist centre, as you’ll need very close medical and nursing supervision[10][14].
During induction, you’ll have regular blood transfusions because your blood will not contain enough healthy blood cells. You’ll also be vulnerable to infection, so it’s important that you’re in a clean and stable environment where your health can be carefully monitored and any infection you have can be treated quickly. You may also be prescribed antibiotics to help prevent infections[10].
Consolidation therapy, also called continuation or maintenance therapy, is the next stage. This aims to prevent the cancer coming back (relapsing) by killing any remaining leukaemia cells. This phase of treatment lasts several months and often involves regularly having chemotherapy medicine, which may be given as injections or tablets[10][14].
The induction stage of treatment is not always successful and sometimes needs to be repeated before consolidation can begin[10].
Other treatment options that may be used include[10][14][15]:
- Targeted therapy: medicines that target specific features of cancer cells
- Immunotherapy: treatments that help your immune system fight cancer, including monoclonal antibodies
- Radiotherapy: using high doses of controlled radiation to kill cancerous cells, often used to prepare the body for a transplant or to treat cancer that has spread to the nervous system or brain
- Stem cell transplant (also called bone marrow transplant): the only established curative therapy for many patients with acute leukaemia
Side effects of intensive chemotherapy for acute leukaemia are common. They can include feeling or being sick, bruising or bleeding easily, diarrhoea, loss of appetite, sore mouth and mouth ulcers, tiredness, skin rashes, hair loss, and infertility (which may be temporary or permanent). Most side effects should resolve once treatment has finished[10].
If you’re thought to have a high risk of experiencing complications of treatment (for example, if you’re over 75 or have another underlying health condition), less intensive chemotherapy treatment may be carried out. Your doctors will watch you carefully and suggest other treatments if needed[10].
The goal of treatment is to reach a complete remission, which means that the numbers of blood cells have returned to normal levels and less than 5% of cells in the bone marrow are immature white blood cells. With a complete remission, there are no signs or symptoms of acute leukaemia[14].
Living with acute leukaemia
Coping with a diagnosis of acute leukaemia can be overwhelming. The disease develops fairly quickly, which means that treatment also starts quite quickly. It can feel like you have no time to adjust or think as everything is happening so fast[16][18].
You may have a number of different feelings when you’re told you have cancer. You may feel shocked, upset, frightened, uncertain, confused, angry, guilty, or sad. You may have some or all of these feelings, or you might feel totally different. You may feel them a few at a time or altogether, leaving you feeling exhausted. Everyone reacts in their own way[16].
Finishing treatment for acute leukaemia is a big achievement worth celebrating, although it can take time for your body to recover. People with acute leukaemia say it’s important to know that after finishing treatment, there is another stage to the journey. Recovering isn’t the same as recovering from other illnesses. It can take several months to rebuild your fitness[17].
You will have check-ups with your medical team regularly after treatment. This could be several times a week at first, to make sure you are OK. Eventually the check-ups will be monthly, and later every few months. Follow-up appointments last several years, although they get more spaced out as time goes on[17].
Here are some suggestions for coping with acute leukaemia[16][18][19]:
- Get as much information about your type of leukaemia as you can to help you make decisions about your care
- Make a list of questions before you see your doctor, and take someone with you to appointments to help you remember
- Let friends and family help with errands, household chores, and preparing meals
- Maintain a healthy lifestyle by eating a healthy diet and getting adequate rest
- Do light exercise and activities you enjoy, knowing your limits
- Schedule time for self-care practices such as journaling, taking walks, or doing things that make you feel fulfilled
- Talk to your friends and relatives about your cancer if you feel comfortable doing so
- Consider talking to someone outside your family and friends, such as a counselor or joining a support group
A leukaemia diagnosis often comes with many unexpected financial expenses. Your treatment may require time away from work. Consider the additional costs of medications, medical devices, and traveling for treatment. Familiarize yourself with your health insurance plan and what is covered[18].
Help and support are available. There are organizations that offer information, advice, and support if you or a family member has been diagnosed with acute leukaemia[3].
