This information has been prepared to help you understand more about acute leukaemia.

Many people feel understandably shocked and upset when they are told they have acute leukaemia. This information is intended to help you understand the diagnosis and treatment of acute leukaemia.

We cannot advise you about the best treatment for you. You need to discuss this with your doctors. However, we hope this information will answer some of your questions and help you think about the questions you want to ask your doctors or other health carers.

The blood

Blood is pumped around your body to provide oxygen and nutrients and to remove waste products. It is made up of three main types of blood cells, which are carried along in a clear fluid called plasma.

  • Red blood cells: Carry oxygen from your lungs to the rest of your body. If you don’t have enough red cells, you may be pale and tire easily because your body is not getting enough oxygen. A shortage of red blood cells is called anaemia (R).
  • White blood cells: Play an important role in fighting infection. If you do not have enough white cells, you may get more infections (W). There are many types of white blood cells. They can be grouped into two families: lymphoid or myeloid.
  • Platelets:Help your blood clot and stop bleeding. If you do not have enough platelets, you may get a lot of bruising, frequent nose bleeds or prolonged bleeding from cuts or lesions (P).

Blood cells are made in the bone marrow — the soft spongy material in the centre of your bones. The bone marrow makes early-stage blood cells (stem cells), which eventually become red cells, white cells or platelets. When the stem cells have matured, they are usually released into the bloodstream.

Stem cells become either myeloid or lymphoid stem cells. These then develop into immature blood cells called blast cells. The types of blast cells affected in acute leukaemia are myeloblast cells and lymphoblast cells. In acute leukaemia, the blast cells never develop into mature white blood cells. These abnormal blast cells are also called leukaemia cells.

 

What is acute leukaemia

Acute leukaemia appears suddenly and develops quickly. It occurs when immature white blood cells (blast cells) grow out of control and continue to divide but never mature.

These abnormal cells are known as leukaemia cells. They do not carry out the usual function of white blood cells and they crowd out the normal white blood cells, which leads to an increased risk of infection.

When the bone marrow fills with leukaemia cells, there is less room for healthy red cells and platelets. This causes other health problems.

 

Types of acute leukaemia

There are two types of acute leukaemia, depending on what type of white blood cell is involved:

  • Acute lymphoblastic leukaemia (ALL): a leukaemia involving lymphoid blast cells, which are known as lymphoblasts. ALL is also sometimes called acute lymphatic leukaemia.
  • Acute myeloid leukaemia (AML): a leukaemia involving myeloid blast cells, also called myeloblasts.

 

Acute leukaemia versus chronic leukaemia

While all leukaemias start in the bone marrow and affect white blood cell production, there are different types. They are grouped depending on how quickly the disease develops and which type of white blood cell is affected (lymphoid or myeloid).

  • Acute leukaemia: affects immature blood cells, occurs suddenly and develops quickly.
  • Chronic leukaemia:usually affects older cells, appears gradually and develops slowly over months to years.

All leukaemia types have their own subgroups and characteristics. They require different treatments.

 

How common is it?

Acute leukaemia is rare, accounting for 1.1% of all cancer cases in NSW.

In 2005, there were 39 adults and 68 children (aged 19 or under) diagnosed with acute lymphoid leukaemia (ALL). ALL is most common in children aged between one and four.

In 2005, there were 267 adults and 16 children diagnosed with acute myeloid leukaemia (AML). AML is more common in adults than in children.

What is the cause?

The definite causes of acute leukaemia are not known, but some factors may increase the chance of developing it, including:

  • exposure to x-rays and other forms of radiation
  • previous treatment with chemotherapy or radiation for other forms of cancer
  • continued exposure to some chemicals, such as benzene, petroleum products, paints, certain pesticides and heavy metals
  • viral infections

It is important to remember that acute leukaemia is not caused by anything you have done or anything you have eaten.

What are the symptoms?

The main symptoms are caused by the continually increasing number of leukaemia cells in the bone marrow, which reduces the number of normal blood cells.

The main signs include:

  • anaemia: the lack of red blood cells can cause paleness, weakness and breathlessness.
  • repeated or persistent infections: the lack of normal white blood cells can cause sore mouth and throat, fevers, frequent passing of urine with irritation, boils and infected cuts.
  • increased bruising and bleeding: the lack of platelets can cause easy bruising, frequent nosebleeds or bleeding gums, and heavy periods in women.

Other less common symptoms include: bone pain, skin rashes, vision problems, enlarged lymph glands, chest pains and enlarged spleen (which causes discomfort).

Acute leukaemia is usually diagnosed soon after these symptoms appear. Occasionally, leukaemia is discovered during a routine blood test.

Tests to diagnose acute leukaemia

Your doctor will often do a number of tests before they diagnose acute leukaemia.

Blood tests

An initial blood test will show if leukaemia cells are present or if the levels of blood cells are different to those of a healthy person. Other tests will confirm a diagnosis and will determine what type of leukaemia you have.

Bone marrow biopsy

Confirms the presence of leukaemia cells and the type of leukaemia you have. The bone marrow sample is examined for cell and chromosome changes, which in leukaemia cells are different to the normal cells. These changes also influence the type of treatment your doctor recommends for you.

During the procedure, you will be given a local anaesthetic to numb the area. You may also be given a painkiller or a drug to relax you, as it can be uncomfortable. Ask your doctor what is suitable for you before the biopsy. A small amount of bone marrow is removed from the hipbone using a thin needle. The procedure only lasts a few minutes, though preparation for it can take up to 30 minutes.

You may be asked to fast (not eat or drink) prior to the procedure. If you have sedation for the procedure this will make you drowsy so you will need someone to drive you home.

Chest x-ray and other imaging

The following tests may be done to check the health and function of your body before treatment:

X-ray

A chest x-ray is taken to check the heart and lungs, and to see whether there are enlarged lymph nodes in the chest. This is sometimes seen in certain types of ALL. The following tests are done to find out if your cancer has spread.

CT scans

A computerised tomography (CT) scan is a type of X-ray that takes several pictures that can be put together to build up a three-dimensional picture of your body. A CT scan is used to diagnose cancer and show if it has spread. Before the scan, a dye is injected into your vein. You may feel hot and flushed, with some discomfort in your abdomen for a short time. Rarely, more serious reactions occur, such as breathing difficulties or low blood pressure. Your doctor will take the necessary measures to manage any side effects.

You need to lie still on a table while the large, round CT scanner slowly rotates around you. You may be asked to hold your breath for a few seconds or change position during the scan to help get better pictures. This painless scan takes about 10-15 minutes, and most people can go home as soon as it is finished.

MRI

A magnetic resonance imaging (MRI) uses magnetic waves to create detailed cross-sectional pictures of organs in your body. You may be injected with a dye that highlights your organs. The pictures produced during the scan show the difference between normal and diseased tissue.

Gated heart pool scan

A computerised tomography (CT) scan is a type of X-ray that takes several pictures that can be put together to build up a three-dimensional picture of your body. A CT scan is used to diagnose cancer and show if it has spread. Before the scan, a dye is injected into your vein. You may feel hot and flushed, with some discomfort in your abdomen for a short time. Rarely, more serious reactions occur, such as breathing difficulties or low blood pressure. Your doctor will take the necessary measures to manage any side effects.

You need to lie still on a table while the large, round CT scanner slowly rotates around you. You may be asked to hold your breath for a few seconds or change position during the scan to help get better pictures. This painless scan takes about 10-15 minutes, and most people can go home as soon as it is finished.

Lumbar puncture

Once you have been diagnosed with leukaemia, you may have a lumbar puncture. This is to look for leukaemia cells that may have travelled to the fluid around your spine. The fluid is called cerebrospinal fluid (CSF).

  • ALL – Everyone with ALL has a lumbar puncture.
  • AML – Only some people with AML have a lumbar puncture.

This test only takes a few minutes. Using a thin needle, a little fluid is taken from a space between the bones in your lower back. The fluid is tested in a laboratory to check if it contains any leukaemia cells.

A lumbar puncture can be uncomfortable, so your doctor can give you painkillers to ease the pain. In some people, this test can cause the back of the legs to tingle when the needle goes in. This feeling is harmless and doesn’t last long. You will need to lie flat for a few hours afterwards to reduce the chance of developing a headache.

In cases of spinal bone degeneration, a lumbar puncture can be performed under x-ray guidance.

A lumbar puncture is also used to inject drugs into the fluid surrounding the spine.

Prognosis

Prognosis is the expected outcome of a disease. You need to discuss this with your doctor. Only someone who knows your medical history can tell you what to expect and the treatment options that are best for you.

For many people, treatment can control acute leukaemia for years, allowing them to lead a normal life. This is known as remission. Most children and many adults who go into remission have a good chance of being cured with chemotherapy and a peripheral blood stem cell or bone marrow transplant.

Which health professionals will I see?

You will be cared for by a range of health professionals who specialise in different aspects of your treatment. Health professionals who may care for you include:

  • General practitioner (GP) – arranges the first tests to investigate your symptoms.
  • Haematologist – a doctor who treats people with blood diseases.
  • Medical oncologist – prescribes and coordinates targeted therapies and chemotherapy.
  • Radiation oncologist – prescribed and coordinates radiotherapy.
  • Nurses – support you through all stages of your cancer treatment.
  • Cancer care coordinator or clinical nurse consultant (CNC) – supports patients and families throughout treatment and liaises with other staff.
  • Dietician – recommends an eating plan to follow while you’re in treatment and recovery.
  • Social workers, counsellors, physiotherapists and occupational therapists – link you to support service social worker, and help with emotional, physical or practical issues.

Treatment

Treatment usually begins as soon as you have been diagnosed and will depend on what type of acute leukaemia you have. You will probably have chemotherapy and you may have radiotherapy. You may also need steroid therapy, or a peripheral blood stem cell or bone marrow transplant, depending on the type of leukaemia you have and your response to chemotherapy. In cases of advanced cancer, you may have palliative care.

Chemotherapy

Chemotherapy uses drugs to kill or slow the growth of leukaemia cells. It is usually given by injection into a vein (intravenously) but it can also be given as tablets or orally, or as an injection into the spine during a lumbar puncture.

Chemotherapy for acute leukaemia is given in two or three stages: induction, consolidation and maintenance. Only people with ALL and a rare type of AML are given maintenance treatment.

Radiotherapy

A painless procedure using x-rays to kill cancer cells or injure them so they cannot multiply.

Radiotherapy is part of treatment for people with ALL and, less commonly, AML. It is usually directed at the brain and also the spine, and may sometimes be given to the whole body in preparation for a transplant.

Your radiation oncologist and haematologist will discuss the type of radiotherapy and the number of treatments you need.

Steroid therapy

Steroids are made naturally in the body, but they can be produced artificially and used as drugs. Steroid therapy is often given with chemotherapy to help destroy leukaemia cells. It is usually given for a few weeks only, but can be given for several months.

Peripheral blood stem cell and bone marrow transplantation

This treatment may be offered to some people with certain types of acute leukaemia to try to improve the outcome achieved with normal chemotherapy alone. Your doctor will tell you if they think a transplant will be helpful for your type of leukaemia.

There are different stages in the transplant process: collection of stem cells, storage of stem cells, chemotherapy or radiotherapy, the transplant and recovery.

Palliative treatment

Palliative treatment helps improve quality of life by alleviating the symptoms of cancer without trying to cure the disease. It is particularly important for people with advanced cancer.

Often treatment is concerned with symptom control and stopping the spread of cancer, but it can also involve the management of other physical and emotional symptoms. Treatment may include radiotherapy, chemotherapy or other medication.

After treatment

After your treatment is over, you will need regular checkups with your doctor or your cancer treatment centre. Blood tests will be done to check your general health and your blood count. Regular checkups can help find a recurrence early, and this gives you the best chance of getting the disease under control.

Checkups will continue for several years but will become less frequent if you have no further problems.

Between follow-up appointments, let your doctor know immediately of any health problems.

What if the leukaemia returns?

Some people find their leukaemia comes back. This is called relapse. Leukaemia may be found in the bone marrow again or, for those with acute lymphoblastic leukaemia (ALL), in the fluid around the brain and the spinal cord. Men also may have leukaemia cells in the testicles.

If you have a relapse, further treatment can be given — usually using a different combination of chemotherapy drugs to those you had before. Often this can lead to a second remission. If you have not had a transplant before, your doctors may recommend a bone marrow or stem cell transplantation.