Leukaemia

Leukaemia

Leukaemias (or leukemias - U.S. spelling) are cancers of the white blood cells, which begin in the bone marrow. This information refers to four types of leukaemia; acute lymphocytic leukaemia, chronic lymphocytic leukaemia, acute myeloid leukaemia and chronic myeloid leukaemia.

Leukaemias are grouped in two ways: the type of white blood cell affected – lymphoid or myeloid; and how quickly the disease develops and gets worse – acute leukaemia appears suddenly and grows quickly while chronic leukaemia appears gradually and develops slowly over months to years.

Incidence and mortality

In 2011, 2774 people in Australia were diagnosed with leukaemia. Chronic lymphocytic leukaemia is the most common type of leukaemia in Australia, in 2011 1174 people were diagnosed. There were 913 people diagnosed with acute myeloid leukaemia, 334 with chronic myeloid leukaemia and 353 with acute lymphocytic leukaemia.

In 2012, there were 1368 deaths due to these four cancer types. Acute myeloid leukaemia caused the most deaths, with 813 deaths. Chronic lymphocytic leukaemia caused 342 deaths, chronic myeloid leukaemia caused 102 deaths and acute lymphocytic leukaemia caused 111 deaths.

Screening

There is no routine screening test for leukaemia.

Symptoms and diagnosis

Many people with leukaemia have no symptoms. Symptoms tend to be mild at first and worsen slowly.

The main symptoms include:

tiredness and/or anaemia (pale complexion, weakness and breathlessness)

repeated infections (mouth sores, sore throat, fevers, sweats, coughing, frequent passing of urine with irritation, infected cuts and scratches, and boils)

increased bruising and bleeding.

Other less common symptoms include:

bone pain

swollen tender gums

skin rashes

headaches

vision problems

vomiting

enlarged lymph glands

enlarged spleen that may cause pain or discomfort

chest pains.

An initial blood test will show if blast cells are present. A bone marrow biopsy, chest x-ray and lumbar puncture are done to confirm diagnosis and the type of leukaemia.

Staging

Chest x-ray, CT scan and lumbar puncture determine if the leukaemia has spread. Cytogenetic analysis also may be used, to look for chromosomal changes.

For acute myeloid leukaemia and acute lymphoblastic leukaemia there is no standard staging system; the disease is described as untreated, in remission, or recurrent.

Staging of chronic myelogenous leukaemia is described in three phases:

chronic – a few blast cells are found in the blood and bone marrow

accelerated – after a few years the leukaemia may suddenly change and grow quicker

blast – the number of blast cells increases, causing symptoms to worsen. Blast cells often spread to other organs.

Chronic myelogenous leukaemia is described as stage 0 to IV, determined by the lymphocytes in the blood, size of lymph nodes and organs such as liver and spleen (larger = higher stage) and impact on red blood cells and platelets (fewer = higher stage).

Causes

The cause of acute leukaemia is unknown, but factors that put some people at higher risk are:

exposure to intense radiation

exposure to certain chemicals, such as benzene

viruses like the Human T-Cell leukaemia virus.

Most people diagnosed with chronic myeloid leukaemia have an abnormal chromosone called the Philadelphia chromosone. It has also been linked to exposure to high levels of radiation.

Prevention

There are no proven measures to prevent leukaemia.

Treatment

Treatment depends on the type of leukaemia. Acute leukaemias develop quickly and need to be treated urgently, typically within 24 hours of diagnosis.

Common treatment options are:

Acute lymphoblastic leukaemia

chemotherapy

peripheral blood stem cell and bone marrow transplantation

radiotherapy to the head

steroid therapy.

Acute myeloid leukaemia

chemotherapy

peripheral blood stem cell and bone marrow transplantation

radiotherapy to the head.

Chronic lymphoblastic leukaemia

watchful waiting

radiation therapy

chemotherapy (chemotherapy with stem cell transplant is being tested in clinical trials)

surgery (removal of spleen)

monoclonal antibody therapy.

Chronic myeloid leukaemia

tyrosine kinase inhibitory therapy

chemotherapy

biologic therapy

high-dose chemotherapy with stem cell transplant

donor lymphocyte infusion

surgery (removal of spleen).

Prognosis

An individual's prognosis depends on the type and stage of cancer as well as their age and general health at the time of diagnosis. For most children and many adults who achieve remission, the leukaemia may be cured with peripheral blood stem cell or bone marrow transplantation and chemotherapy. In Australia, the five year survival rate for chronic lymphocytic leukaemia is around 73%, for acute myeloid leukaemia it is 24%.

For more information, contact Cancer Council 13 11 20 (cost of a local call).

1)
 Excluding non-melanoma skin cancer, which is the most commonly diagnosed cancer according to general practice and hospitals data, however there is no reporting of cases to cancer registries.