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LEUKAEMIA : ACUTE

How does Acute Leukaemia occur ?

The bone marrow normally produces three types of cells. Red cells carry oxygen, white cells fight infection, and platelets help blood clotting. Mature cells are produced from primitive cells. In acute leukaemia the primitive white cells (called blast cells) grow in an uncontrolled way. They fill up the bone marrow and overflow into the blood. The marrow cannot make normal mature white cells, red cells or platelets. The lack of red cells causes anaemia and the lack of platelets can cause bruising and bleeding. The lack of normal white cells means that the body cannot fight infection. The common symptoms of acute leukaemia are therefore tiredness, fever, infections and bruising or bleeding. The blast cells may also invade tissues outside the bone marrow, usually the lymph glands (glands which fight infection), the spleen and the liver. The patient may notice large glands or a swollen abdomen.

Why does Acute Leukaemia occur ?

Exposure to excessive irradiation (x-rays or radioactivity) can damage the bone marrow and may eventually lead to leukaemia. Leukaemia can also sometimes occur after treatment with chemotherapy drugs for other kinds of cancer. Viruses can cause leukaemia in animals but probably not so in humans. In the vast majority of cases we do not know the reason why leukaemia occurs.

Treatment Involved for Acute Leukaemia

This will depend on the exact type of leukaemia and on other factors such as age. There are two main types of acute leukaemia, acute lymphoblastic leukaemia (ALL) and acute myeloblastic leukaemia (AML). ALL is the commonest type in children and AML is commoner in adults. However, the principles of treatment are the same for both and involve various stages. Induction treatment uses a combination of anti-cancer drugs (combination chemotherapy) to kill the leukaemia cells and allow the normal cells to repopulate the bone marrow. The leukaemia is then said to be in remission. Until the leukaemia cells have been cleared from the marrow and the normal cells have recovered, the patient remains anaemic and is at risk of infection and bleeding. To prevent these problems, regular transfusions of blood and platelets are given and antibiotics are used to prevent and treat infection. When the bone marrow has returned to normal, further courses of anti-cancer drugs are usually given. This is called consolidation treatment and is designed to try to kill any remaining leukaemia cells which may still be present even though the marrow looks normal. The drugs given during induction and consolidation treatment do not penetrate into the brain and spinal cord. Especially in ALL there is a risk that leukaemia cells may persist here. This could cause the disease to flare up. To prevent this, additional treatment consisting of a combination of radiotherapy to the head and injections of drugs into the fluid surrounding the spinal cord is usually given (maintenance treatment). In ALL it is usual to give low dose anti-cancer drugs by mouth for 2 3 years. In AML, however, it is more usual to give particularly intensive treatment at the start instead. In some cases of acute leukaemia, the best chance of cure is with a bone marrow transplant. The risks and benefits of this approach depend very much on the individual patient.

During Treatment for Acute Leukaemia

Anti-cancer drugs will tend to cause nausea and vomiting with the high doses used at the start of treatment. Soreness of the mouth and diarrhoea are also common side-effects, and patients may not feel like eating. All these problems can be helped by other drugs. There is also loss of hair, but this will grow again normally when all treatment has been completed. Patients will start to feel better as the normal bone marrow recovers. Radiotherapy to the head is painless and causes no discomfort. About two months afterwards it is common to feel very tired and sleepy. This lasts about 2 3 weeks and is a normal reaction. The anti-cancer drugs used during maintenance therapy are given in low doses and do not usually cause sickness or other side-effects. The effect on blood count will be carefully watched. During maintenance therapy patients are more susceptible to infection than usual even though the white cells are normal. This is because the drugs suppress the body's immunity. Any fever, cough, or other symptoms should be reported to the doctor immediately. Patients should also tell the doctor if they have had contact with infectious diseases like measles or chickenpox, so that protective treatment can be given.

After Treatment for Acute Leukaemia

One can lead a normal life after treatment for leukaemia. An increasing number of patients with leukaemia are now cured of their disease. However, it can flare up or relapse even after the best available treatment. The doctor will therefore examine and check the blood count regularly. There are no special precautions to take to prevent relapse. Keeping in good health by eating well, taking regular exercise, and giving up smoking will improve chances of responding to treatment again if this should be necessary.

If Acute Leukaemia is Left Untreated

Survival in untreated acute leukaemia is usually short. Death can occur as a result of severe anaemia, bleeding or uncontrolled infection.

Effects on Family of Acute Leukaemia

Family and friends can help greatly in coping with all the treatment needed for leukaemia. Some hospitals restrict visiting while intensive treatment is being undertaken because of the risk of infection. Most units will allow visitors if they do not have any infection themselves. Leukaemia is not inherited or infectious and cannot be passed on to family or friends.