Leukaemia: Types, Symptoms, Diagnosis, Treatment

Leukaemia is a type of blood cancer that occurs when leukaemia cells (immature white blood cells) in the bone marrow multiply out of control. These abnormal leukaemia cells crowd out healthy cells that are trying to develop into healthy red blood cells, white blood cells and platelets.

As a result, the body’s organs and tissues may not get enough oxygen to function normally, and the body will not be able to fight infections or form blood clots when required.

This disease is rather common in Malaysia, as statistics for 2020 showed that leukaemia was ranked ninth among all new cancer cases, and was found in 4 out of every 100 newly diagnosed cancer cases.

Types of leukaemia

Leukaemia can be categorised into four main types:

• Acute lymphocytic leukaemia (ALL)
• Acute myeloid leukaemia (AML)
• Chronic lymphocytic leukaemia (CLL)
• Chronic myeloid leukaemia (CML)

Acute leukaemia vs. chronic leukaemia

Leukaemia is categorised as acute or chronic by looking at whether most of the cells are immature (stem cell-like) or mature (similar to normal white blood cells).

Acute leukaemia happens when bone marrow cells cannot mature the way they should. Yet, these cells continue to multiply and accumulate. Most patients without treatment would only live a few months, but cure is possible as some types of acute leukaemia respond well to treatment.

On the other hand, bone marrow cells in chronic leukaemia mature partly (but not completely). These cells live longer than normal cells, eventually building up and crowding out normal cells in the bone marrow. Chronic leukaemia may take many years before they cause problems, but this disease is usually more difficult to treat than acute leukaemia.

Lymphocytic leukaemia vs. myeloid leukaemia

Leukaemia is also named after the bone marrow cells that the cancer started in.

Myeloid leukaemia starts in early myeloid cells that are precursors to white blood cells (other than lymphocytes), red blood cells, or platelet-making cells. It is also known as myelocytic, myelogenous, or non-lymphocytic leukaemia.

Lymphocytic leukaemia starts in cells that become lymphocytes. It is also called lymphoid or lymphoblastic leukaemia.

Although both lymphocytic leukaemia and lymphomas are cancers that begins in the same cells, leukaemia is mainly concentrated in the bone marrow and blood, while lymphoma usually affects the lymph nodes and other tissues.

Risk factors of leukaemia

The following is a summary of risk factors for the main types of leukaemia:

• Exposure to radiation due to nuclear accidents or radiation therapy
• Exposure to industrial chemicals or chemotherapy drugs
• Certain genetic disorders
• Family history of leukaemia

Signs and symptoms of leukaemia

In leukaemia, leukaemia cells continue to crowd out normal blood-making cells in the bone marrow, leading to deficiencies of normal blood cells. These abnormalities can be detected through blood tests, but it can also cause symptoms like:

• Feeling tired, weak, or lightheaded
• Shortness of breath
• Pale skin
• Infections that do not go away or keep coming back
• Bruises (or small red or purple spots) on the skin
• Bleeding, observed as frequent or severe nosebleeds, bleeding gums, or heavy menstrual bleeding in women

Other general symptoms due to leukaemia are:

• Fever
• Chills
• Night sweats
• Weight loss or loss of appetite
• Swollen lymph nodes felt as lumps under the skin
• Feeling full after only a small meal

It is possible that these symptoms are not caused by leukaemia itself. Nevertheless, consult your doctor if any discomfort persists or worsens for further investigations.

Diagnosis of leukaemia

During consultation, the doctor will obtain a complete medical history to understand the symptoms, followed by a physical examination to find enlarged lymph nodes, areas of bleeding or bruising, or signs of infection. A blood test may be requested to check the levels of blood cells.

Other diagnostic tests that may be ordered include:

• Blood cell examination checks for markers of leukaemia cells.
• Blood marrow aspiration draws liquid bone marrow to confirm leukaemia.
• Bone marrow biopsy removes a small piece of bone and marrow using a needle to confirm leukaemia.
• Imaging tests determine the spread of the disease to other organs.
• Lumbar puncture (spinal tap) removes cerebrospinal fluid from the lower back over the spine to see if the disease has spread to the brain or spinal cord.

Learn more about the different types of screening and diagnostic procedures performed to diagnose leukamia.

Treatment options for leukaemia

The treatment plan for leukaemia is based on the type of leukaemia and extent of the disease, as well as the patient’s age and general health.

Common treatments usually include:

• Chemotherapy uses chemical to destroy leukaemia cells or stop them from multiplying.
• Immunotherapy uses certain drugs to boost immune system to fight leukaemia.
• Targeted therapy uses drugs designed to attack specific parts of a leukaemia cell to destroy the cells, or prevent the cells from multiplying.
• Radiation therapy employs strong energy beams to kill leukaemia cells or limit their growth.
• Haematopoietic cell transplant (stem cell or bone marrow transplant) replaces the cancerous blood-forming cells killed by chemotherapy and/or radiation therapy with new, healthy haematopoietic cells. These healthy new cells now multiply to form new bone marrow and blood cells.
• Chimeric antigen receptor (CAR) T-cell therapy extracts the body’s T-cells (infection-fighting cells) and engineers these cells to fight leukaemia cells, before infusing back into the body.

Learn more about the different types of treatment technologies to treat leukaemia

Prevention of leukaemia

There are no known ways to prevent leukaemia but maintaining a healthy lifestyle may be helpful.

On the other hand, avoiding industrial chemicals, like benzene, might reduce the risk of getting leukaemia. However, most experts agree that workplace exposure to these chemicals seems to result in only a small portion of leukaemia.

Detect to Protect!

Currently, there are no screening tests recommended to detect leukaemia. This disease is sometimes picked up due to abnormal results from routine blood tests. Regardless, the best way to detect leukaemia early is to report any possible signs or symptoms to the doctor as soon as possible.

Make an appointment at Gleneagles Hospitals

If you are experiencing any of the symptoms of leukaemia, get in touch with us to find out more about our Haemato-Oncology Services at your nearest Gleneagles Hospital.

Gleneagles Hospital works with oncologists to assist patients through cancer treatment. The caring and multidisciplinary team of healthcare professionals are available for consultation and to provide the best care.