Acute leukaemia

Reviewed by Dr Rachel Green, consultant haematologist

What is leukaemia?

Leukaemia, or blood cancer, is a disease of unknown cause where the bone marrow produces large numbers of abnormal cells. This means that the normal marrow is pushed into smaller and smaller areas, which results in fewer cells being produced and leads to some of the symptoms listed below.

There are many types of leukaemia and each of them is classified according to the exact cell type affected by the disease.

Chronic leukaemia is a slowly progressive form of leukaemia and tends to involve more mature cell types.

Acute leukaemia is rapidly progressive if not treated and involves more immature cells. It develops rapidly from the earliest forms of cells in the immature bone marrow cells (blasts). It requires urgent medical treatment but is generally responsive to chemotherapy.

Acute leukaemia is a rare disease that is more common in children and young people. However, their survival rate is better than in older people.

What are the symptoms of acute leukaemia?

Sudden appearance of symptoms.

An unnaturally pale complexion (anaemia).

Fatigue.

Pain in the joints. When children are affected, this is sometimes mistaken for growing pains.

Repeated infections, such as sore throats.

Acute leukaemia is also usually accompanied by nosebleeds and bruising easily, often without any kind of blow or fall.

If any of the above symptoms develop, it is advisable to consult a doctor. Parents are understandably afraid of leukaemia, but fortunately, the diagnosis often turns out to be something else entirely, as many other diseases have similar symptoms.

How is acute leukaemia diagnosed?

Many forms of leukaemia can be diagnosed by blood tests. Commonly, the acute leukaemia cell (blasts) can be seen circulating in the blood.

A bone marrow test will also be performed to diagnose the type of cells involved, as this can help doctors decide on the best choice of treatment.

Acute leukaemia is usually easy to diagnose.

How is acute leukaemia treated?

Most patients with acute leukaemia will be referred to specialist units for investigation and treatment.

These days, medical treatments are extremely effective and an ever-increasing number of children and young people recover completely.

Treatment is usually with chemotherapy given through the veins. In most cases, chemotherapy is given in courses over four to six months. Each course lasts four to five days. Chemotherapy kills all fast dividing cells and this includes normal body cells as well as cancer cells.

The normal bone marrow is sensitive to chemotherapy and the blood counts may drop, making the patient vulnerable to infection and bleeding. This generally means that the patient has to remain in hospital for weeks following chemotherapy. However the blood counts will recover over time. Blood transfusions are likely to be given during this vulnerable period.

Chemotherapy can lead to hair loss, nausea, vomiting and diarrhoea. Doctors will give medicine to prevent or reduce the vomiting and diarrhoea. Hair loss is not permanent and hair re-grows after three to four months.

Sometimes a bone marrow transplant will also be recommended by the doctor. This is a way of giving larger doses of treatment. It is a very aggressive form of treatment and so is only recommended for young, fit patients. The cells used for this sort of treatment may be the patient's own, donated by a brother or sister or by an unrelated donor.

The medical treatment can be unpleasant. Recognising this, specialised hospital staff are trained to give as much help and support to patients as possible.

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