The term leukaemia refers to a group of cancers of the white blood cells and bone marrow. Bone marrow produces white blood cells and there are two types – lymphocytes and myeloid cells. Usually these divide in a controlled way and help your body to get rid of infections. If you have leukaemia, your white blood cells start to divide and grow in an uncontrolled way, and don’t develop properly.
Leukaemia can be described as either acute (growing rapidly) or chronic (growing slowly). Acute leukaemia is divided into two main types – ALL and acute myeloid leukaemia (AML). This factsheet focuses on ALL.
In ALL, your bone marrow produces abnormal lymphocytes, which can’t function properly. They also build up in your bone marrow, meaning it can’t make enough of other types of blood cells. Immature lymphocytes are called lymphoblasts – these are the cells that don’t develop properly in ALL.
ALL is the most common type of leukaemia to affect children under 14. About 400 children are diagnosed each year in the UK, and it’s slightly more common in boys than girls. The condition affects about the same number of adults a year, most commonly those under 25 or over 75. The symptoms develop rapidly and need to be treated quickly.
There are several different forms or subtypes of ALL. Your doctor will tell you which type you have. Occasionally, acute leukaemia appears to be a mixture of ALL and AML – this is known as acute biphenotypic leukaemia.
Symptoms of ALL include:
Your symptoms may come on very quickly – over a matter of days or weeks. Some of these symptoms are similar to those for other conditions so it’s easy to confuse them.
Less common symptoms of ALL include:
These symptoms aren’t always caused by ALL but if you have them, see your GP.
The exact reasons why you may get ALL aren't fully understood at present. However, doctors do know that there are a number of things that increase your risk of developing ALL. These include:
Your GP will ask about your symptoms and examine you. If he or she thinks you may have leukaemia, you will be asked to have a blood test. You may then be referred to a haematologist (a doctor who specialises in conditions of the blood).
You will then have some tests to confirm the diagnosis and investigate which type of leukaemia you have. These may include:
If you’re diagnosed with leukaemia, you may have further tests to find out what type it is. This can help to determine the most appropriate treatment for you. Further tests that you may have include:
You may hear your doctor referring to your treatment in three phases. These are:
Treatment for ALL can take two years or more. You’re likely to have some side-effects as a result of treatment, such as hair loss, feeling weak and changes in your appetite and weight.
The main treatment for ALL is chemotherapy, which uses medicines to destroy cancer cells in your bone marrow. Initially, you will probably need to stay in hospital for about a month because larger doses of chemotherapy medicines are used to treat acute leukaemia than other types of cancer.
You’re likely to be given a mixture of chemotherapy medicines because it’s thought that using a combination works better than just one medicine on its own. You will usually have these different medicines in cycles, with rest periods in between.
You will also be given medicines called steroids, such as prednisolone and dexamethasone, given as tablets or injections. These help chemotherapy medicines to work more effectively.
If your leukaemia has a genetic fault involving the Philadelphia chromosome, you may be given a medicine called imatinib. This blocks chemicals that cancer cells use to communicate with each other. Research has shown that the medicine is more effective when it’s given in the first phase of treatment.
Chemotherapy medicines that travel in your blood can’t get to your brain and spinal cord – also known as your central nervous system (CNS). Therefore, you may have additional treatment to inject the medicines directly into the fluid that surrounds your CNS.
Rarely, you may have radiotherapy to your brain to get rid of any cells that are still remaining after chemotherapy, but this treatment isn’t often used now.
Once your leukaemia has gone into remission (this is when there are no longer any leukaemia cells in your bone marrow) you will need to have more chemotherapy to prevent it from coming back. This will also kill any leukaemia cells that may still be in your bone marrow but can’t be detected. You may need to have different medicines to the ones that were used in the remission induction phase.
This phase of treatment can last for several months.
Following consolidation chemotherapy you may be considered for a bone marrow (stem cell) transplant if you’re in general good health. This is when somebody else (preferably a brother or sister) donates healthy bone marrow or stem cells, which are transferred into your body. This aims to keep the leukaemia from coming back in the long term without the need for further therapy.
Maintenance therapy aims to keep your leukaemia in long-term remission. You will need to take lower doses of chemotherapy and steroid medicines, probably in tablet form, for up to three years.
Many possible new treatments for ALL are being tested in clinical trials all the time. These include different biological therapies and chemotherapy medicines, as well as other types of stem cell transplants. You may be able to take part in a clinical trial to test one of these new treatments – speak to your doctor for more information.
Produced by Polly Kerr, Bupa Health Information Team, February 2013.