What is Leukemia?

Leukaemia is a cancer that affects the blood and bone marrow where blood cells are made. Leukaemia causes your bone marrow to produce abnormal white blood cells, which don’t function properly. White blood cells are potent infection fighters, that normally spread throughout your body to where they are needed. Treatment of leukaemia can be extremely complex, with much depending on the type of leukaemia and other varying factors.

There are 4 main types of Leukaemia.

  • Acute lymphoblastic leukaemia (ALL)
  • Acute Myeloid leukaemia (AML)
  • Chronic lymphocytic leukaemia (CLL)
  • Chronic Myeloid leukaemia (CML)

What is acute lymphoblastic leukaemia (ALL)?

All is characterized by an overproduction of immature white blood cells, called lymphoblastic or leukaemia blasts. These cells crowd the bone marrow, preventing it from making normal blood cells. They can also split out into the blood stream and circulate around the body. Due to their immaturity, these cells are unable to properly prevent or fight infection. Inadequate numbers of red cells and platelets being made by the marrow cause anaemia, easy bleeding and bruising.

Who gets lymphoblastic leukaemia (ALL)?

ALL can occur at any age but it is more common in children (10-14 years) who presents close to 60% of all cases. ALL is the most common type of childhood leukaemia, and the most common childhood cancer. It is more common in males than females.

What causes Acute Lymphoblastic leukaemia?

The exact causes of Acute Lymphoblastic Leukaemia remain largely unknown but it is thought to result from mutations in one or more of the genes that normally control blood cell development. Research is ongoing into possible causes of this damage and certain factors have been identified that may put some people at an increased risk. These include:

  • Exposure to very high doses of radiation either accidentally (nuclear accident) or therapeutically (to treat other cancers).
  • Exposure to industrial chemicals like benzene, pesticides and certain types of chemotherapy used to treat other cancers.

What are the symptoms?

The main symptoms of Acute Lymphoblastic Leukaemia are caused by a lack of normal blood cells. These include:

  • Anaemia due to a lack of red cells, causing persistent tiredness, dizziness, paleness or shortness of breath.
  • Frequent or repeated infections and slow healing, due to a lack of normal white blood cells especially neutrophils.
  • Increased or unexplained bleeding or bruising, due to a very low platelet count.

Other symptoms may include bone pain, swollen lymph nodes, chest pain and abdominal discomfort due to a swollen spleen or liver.

How is Acute Lymphoblastic Leukaemia diagnosed?

Acute Lymphoblastic Leukaemia is diagnosed by a full blood count, a bone marrow biopsy and examination.

How is Acute Lymphoblastic Leukaemia treated?

As this disease progresses quickly, treatment needs to begin soon after ALL is diagnosed. The type of treatment used will depend on a number of factors including the sub-type of Acute Lymphoblastic Leukaemia, the genetic make-up of the leukaemia cells, and the age and general health of the person.

Chemotherapy is the main form of treatment for ALL. A combination of drugs, including steroids, is usually given in several cycles with a rest period of a few weeks in between. Initially, the aim of treatment is to destroy Leukemic cells and induce a remission. Remission means that there is no evidence of Leukemic cells in the blood and bone marrow, blood cell production is normal and blood counts are restored. Once a remission has been achieved, further treatment is needed to help destroy any residual disease, and try to prevent Leukaemia from coming back (relapsing) in the future.

Chemotherapy is given in many different ways to treat ALL. This includes an injection into a vain (intravenously), into a muscle (intramuscularly) or swallowed in tablet form.

Treatment is generally ‘risk-based’. This means the person will be assigned to a particular treatment plan (protocol) depending on a number of factors, most importantly the risk of relapse in the future. Treatment can last from two to three months, or longer, depending on the treatment protocol being followed and how well the individual responds and progresses.

What are the side effects of treatment?

  • Feeling sick, nausea and/or vomiting
  • Feeling tired and weak
  • Hair loss and thinning
  • Mouth problems such as microsites or ulcers
  • Diarrhoea or constipation
  • Skin problems such as dryness, rash or sensitivity to sunlight
  • Fertility problems

Side effects of steroids depend largely on how they are used, and the dose. Short-term use may cause increased appetite, restlessness or difficulty sleeping. Long term use may lead to fluid retention, raised sugars and increased susceptibility to infections.