Definition of leukaemia

Blood cancer (leukaemia) is an umbrella term for malignant diseases of the blood-forming system. Blood cells degenerate and crowd out healthy red and white blood cells, as well as the so-called platelets. As a result, the blood can no longer perform its vital functions. Blood cancer includes leukaemias, lymphomas and myelomas.

Symptoms

The symptoms of blood cancer are non-specific, which means they cannot be attributed exclusively and unambiguously to any one disease and may be caused by a variety of conditions.

Symptoms include exhaustion, fatigue, pallor, fever, pain, an increased tendency to bleed or frequent infections. Bone and joint pain, a feeling of pressure or pain in the upper abdomen, headaches, dizziness, sensory disturbances or paralysis may also occur.

The symptoms of acute leukaemia (AML or ALL) usually develop rapidly, over a period of a few days to weeks. Chronic myeloid leukaemia (CML) develops slowly, often over many years. As a result, many of those affected have few or no obvious symptoms at the time of diagnosis. A diagnosis of leukaemia can only be confirmed by examining the blood and bone marrow.

In children and young people, the risk of developing leukaemia decreases with age. After the age of 30 the risk rises steadily, and men are more likely to develop it than women. CLL is the most common form of leukaemia in both sexes.

Diagnosing leukaemia

Your doctor needs to check for signs of leukaemia in your blood or bone marrow. Diagnostics in Switzerland include the following investigations:

  • Blood tests. A complete blood count shows the number and maturity of the different types of blood cells. A blood smear looks for unusual or immature cells.
  • Bone marrow biopsy. This test involves taking bone marrow from the pelvic bone with a long needle. It can tell your doctor which type of leukaemia you have and how serious it is.
  • Lumbar puncture. This involves fluid from your spinal canal. It can tell your doctor whether the leukaemia has spread.
  • Imaging tests. Methods such as CT, MRI and PET scans can reveal signs of leukaemia.

How is leukaemia treated?

The treatment of leukaemia depends on the type of leukaemia, your age and general health, and whether the leukaemia has spread to other organs or tissues.

Common treatments often involve a combination of the following:

  • Chemotherapy: Chemotherapy is the most common form of treatment for leukaemia. It uses chemicals to destroy leukaemia cells or stop them from multiplying. During treatment you may receive the chemicals (medicines) as tablets, as injections into a vein or as injections under the skin. Patients usually receive a combination of chemotherapy drugs.
  • Immunotherapy (biological therapy): this treatment uses certain drugs to strengthen the body’s defence system — the immune system — to fight leukaemia. Immunotherapy helps the immune system identify cancer cells and produce more immune cells to fight them.
  • Targeted therapy: this treatment uses drugs designed to act on specific parts of the leukaemia cell (for example a protein or a gene) that cause it to crowd out normal blood cells. Targeted therapy can stop leukaemia cells from multiplying, cut off their blood supply or kill them directly. Targeted therapy is less likely to damage normal cells. Examples of targeted therapy drugs include monoclonal antibodies and tyrosine kinase inhibitors.
  • Radiotherapy: this treatment uses powerful energy beams or X-rays to kill leukaemia cells or stop them from growing. During treatment, a machine directs radiation precisely at the areas of your body where the cancer cells are, or distributes radiation over the whole body. Whole-body irradiation may be carried out before a haematopoietic cell transplant.
  • Stem cell or bone marrow transplant: this treatment replaces the cancerous blood-forming cells killed by chemotherapy and/or radiotherapy with new, healthy haematopoietic cells. Your doctor may collect these healthy cells from your blood or bone marrow before chemotherapy and radiation, or they may come from a donor. The healthy new cells multiply, forming new bone marrow and blood cells that become the red blood cells, white blood cells and platelets your body needs.
  • Chimeric antigen receptor (CAR) T-cell therapy: this is a new type of therapy in which your body’s infection-fighting T cells (T cells, or T lymphocytes, are a type of immune cell) are engineered to fight leukaemia cells and then infused back into your body.

Clinical trials are also available to test new cancer treatments. Weigh up the potential benefits and risks of taking part in a clinical trial with your doctor.