Leukaemia

Leukaemia — cancer of blood-forming cells

Leukaemia is malignancy of haematopoietic stem cells in bone marrow — abnormal white cells crowd out normal blood production.

~10,000 UK cases/year — only cancer more common in children than adults proportionally — ALL peak age 2–5.

Types overview

Type	Cell line	Pace	Typical age
ALL	Lymphoid	Acute	Children, also adults
AML	Myeloid	Acute	Adults, some teens
CLL	Lymphoid	Chronic	Older adults
CML	Myeloid	Chronic	Middle age

How leukaemia affects the body

Marrow failure:

• Anaemia → fatigue, breathlessness
• Thrombocytopenia → bruising, bleeding
• Neutropenia → infection risk

Leukaemic infiltration:

• Bone pain
• Hepatosplenomegaly
• Lymphadenopathy

Red flags for GP

NICE 2-week wait haematology:

• Persistent unexplained blood count abnormality
• Blood film suggesting leukaemia
• Splenomegaly with cytopenia

Children — parent concern:

• Pallor + bruising + limp
• Recurrent infections

Diagnosis pathway

1. FBC + film
2. Urgent haematology
3. Bone marrow — aspirate + trephine
4. Immunophenotyping, genetics
5. Staging — lumbar puncture in ALL — CNS involvement

Treatment by type

ALL

• Induction → consolidation → maintenance — 2–3 years children
• CNS prophylaxis
• CAR-T — relapsed/refractory

AML

• Intensive chemo — age/fitness dependent
• Transplant — high-risk genetics

CLL

• Watch and wait if asymptomatic
• Chemoimmunotherapy or targeted agents when symptomatic — B symptoms, marrow failure, bulky nodes

CML

• Tyrosine kinase inhibitors — imatinib first line
• Excellent long-term control — near-normal lifespan many patients

Living through treatment

Neutropenic sepsis — temperature 37.5°C once during chemo — 999 or emergency unit — don’t wait

Fertility — ** sperm/egg storage before treatment**

Late effects — children — growth, heart, second cancers — long-term follow-up

Unexplained bruising + fatigue — GP blood test this week — not rare in busy lives — rare disease needs early pick-up.

Common questions

What are the symptoms of leukaemia?

Fatigue and breathlessness (anaemia), frequent or severe infections (low normal white cells or dysfunctional leukaemic cells), easy bruising and bleeding (low platelets), bone or joint pain, swollen lymph nodes, enlarged spleen causing fullness after eating, night sweats, weight loss, fever. Acute leukaemia symptoms worsen over weeks; chronic may be silent early.

What is the difference between acute and chronic leukaemia?

Acute — immature blast cells multiply rapidly — ALL and AML — need immediate chemotherapy. Chronic — mature but abnormal cells accumulate slowly — CLL and CML — some patients monitored without treatment for years until symptoms or counts warrant therapy.

How is leukaemia diagnosed?

Full blood count shows high white cells (or sometimes low), low haemoglobin, low platelets. Blood film shows blasts. Bone marrow aspirate and biopsy confirms type and genetics — guides treatment. Flow cytometry, cytogenetics, molecular tests (BCR-ABL in CML, Philadelphia chromosome).

How is leukaemia treated?

Chemotherapy mainstay — intensive multi-drug regimens for acute leukaemia. Targeted drugs — imatinib for CML, venetoclax for CLL. Immunotherapy — CAR-T cells for some relapsed ALL. Stem cell transplant for high-risk disease. Radiotherapy to spleen or brain if needed. Supportive care — transfusions, antibiotics, G-CSF.

Can leukaemia be cured?

Many childhood ALL patients cured. Adult acute leukaemia — cure possible in selected patients. CLL often managed as chronic disease — not always curable but long survival. CML controlled long-term with tyrosine kinase inhibitors in most cases.

Sources

• NHS — Leukaemia
• Blood Cancer UK
• NICE — Haematological cancers