The first symptoms of acute myeloid leukaemia are usually related to a decrease in the function of normal blood cells in the bone marrow.

Patients typically present with symptoms related to low red blood cells (anaemia) – such as breathlessness, tiredness, frequent infections (due to lowered or non-functional white cells), and bruising easily (due to low platelet counts). There are also less specific symptoms such as night sweats, unintended weight loss, or swelling of glands in the neck and groin.

Some common risk factors of acute myeloid leukaemia include age, smoking, exposure to certain chemicals, a history of chemotherapy, and specific blood disorders.

For our haematologists to diagnose AML, a series of tests may be ordered. These include blood tests and a bone marrow biopsy, allowing our doctors to detect abnormalities linked to acute myeloid leukaemia.

The symptoms of acute myeloid leukaemia (AML) often develop over a few weeks to a few months before patients actually become symptomatic. Once patients are symptomatic with abnormalities in their blood counts, then treatment for AML is often a medical emergency with urgent stabilisation required.

Depending on the patient’s age, health condition and subtype of cancer, AML treatment may include one or a combination of chemotherapy, targeted therapy, stem cell transplantation.

You can find out more about AML, its symptoms, and treatment options here.

Some common signs and symptoms of ALL include: 

• Fever
• Fatigue 
• Unusual Bruising 
• Prolonged Bleeding 
• Unexplained Weight Loss
• Enlarged Abdomen

Risk factors that may increase your chances of getting ALL include exposure to radiation or certain chemicals, age, gender, specific genetic disorders, and certain viral infections.

Acute Lymphoblastic Leukaemia is not typically hereditary. This means you do not have an increased risk of developing the condition if your family member is diagnosed with it.

However, your risk may increase if you have an identical twin diagnosed with ALL.

Often patients initially present to the doctor with nonspecific symptoms such as tiredness, bruising, recurrent fevers or swelling over the neck, groin or armpit. On other occasions, patients may be referred for investigations after having an abnormal blood test.

The management of ALL can be complex. When deciding the actual treatment pathway required, there are often many factors to consider (such as the patient’s age, physical fitness, and disease status). 

However, all treatment options for acute lymphoblastic leukaemia typically include some combination of chemotherapy, targeted therapy, immunotherapy, CNS treatment, and bone marrow transplantation. 

You can learn more about acute lymphoblastic leukaemia and its treatment here.

Most patients with chronic leukaemia do not develop any symptoms in the initial stages. However, some patients may develop a few nonspecific signs and symptoms such as:

• Enlargement of the Lymph Nodes
• Fevera
• Fatigue
• Pain in the left upper portion of the abdomen due to the enlargement of the spleen
• Unexplained Weight Loss
• Excessive Night Sweats
• Frequent Infections
• Pale Skin
• Shortness of Breath
• Easy Bruising and Bleeding
• Bone Pain

Risk factors for chronic leukaemia may include smoking, a history of radiation therapy or chemotherapy, myelodysplastic syndromes, rare genetic syndromes, and a family history of the disease.

Chronic leukaemia tends to develop over a longer period of time compared to acute leukaemia which develops faster and is generally more aggressive.

To diagnose chronic leukaemia, our haematologists will first perform blood tests including a full blood count. However, you may require further investigations with specialised tests such as a bone marrow assessment and PET-CT/CT scans.

Your treatment options will vary depending on the type of chronic leukaemia that you have been diagnosed with, either chronic myeloid leukaemia or chronic lymphocytic leukaemia. However, treatment options include targeted therapy, chemotherapy, immunotherapy, and a bone marrow transplant. 

You can learn more about chronic leukaemia and its different treatment options here.

Some common symptoms of lymphoma experienced by patients include: 

• Persistent Fatigue
• Fever 
• Night Sweats
• Shortness of Breath 
• Unexplained Weight Loss 
• Painless swelling of one’s lymph nodes in the armpits, neck, or groin

Risk factors of lymphoma may include having a weakened immune system, age, ethnicity, exposure to certain chemicals, radiation, or drugs, and autoimmune diseases.

For our haematologists to diagnose lymphoma, they may order a series of tests, including a physical examination, biopsy, bone marrow aspiration, and blood, urine, and imaging tests.

While high-grade Lymphomas tend to progress more rapidly, a good proportion of high-grade Lymphomas can be effectively treated with a low risk of relapse.

Low-grade Lymphomas often respond well to treatments available. However, they are not usually cured and may recur eventually over time.

Treatment of lymphoma can be given via different modalities of therapy. First line treatment of lymphoma is usually given in cycles of therapy. Each cycle is typically 3-4 weeks in duration, with treatment given over a few days as a combination of different chemotherapy drugs (sometimes with targeted therapy). In patients who have relapsed following initial lymphoma therapy, there are now several treatment options avaliable, including salvage chemotherapy, targeted immuno-chemotherapy, stem cell transplantation, and novel cellular therapies such as CAR-T cell therapy

You can find out more about lymphoma and its treatment options here.

The common signs and symptoms of myeloma include:

• Pain in the bones, particularly the spine and ribs
• Unusual Tiredness
• Recurring Infections
• Mental disorientation, fogginess, and confusion
• Kidney Damage
• Unexplained Weight Loss
• Numbness or weakness in the legs
• Increased Thirst

Several factors can increase your risk of myeloma, including age, race, gender, family history, personal history of MGUS, obesity, and exposure to toxic elements.

Some tests and procedures that can help our haematologists diagnose multiple myeloma include blood and urine tests, imaging tests, and bone marrow tests.

The life expectancy of someone diagnosed with myeloma depends on the stage of their myeloma, and in addition prognostic markers such as the presence of poor risk or good risk genetic abnormalities will influence the outcomes.

The diagnosis and monitoring of myeloma during treatment has become increasingly sophisticated, and we are now able to detect presence of myeloma at very low levels in the bone marrow (known as detecting minimal residual disease – MRD). Patients who are able to attain MRD negativity with myeloma treatment have a significantly improved overall survival.

In general, for myeloma patients at diagnosis, around 50% of patients will be alive and well at 5 years. However, these numbers do not factor in all variables, such as age and overall health. Additionally, treatment options for myeloma are continuously improving. Speak to our doctor for a better understanding of the success rates of your treatment plan.

Most patients with myeloma are given a combination of drugs and treatment. The choice of drugs depends on the patient’s physical status, including age and overall health, the extent of renal impairment or organ damage, and the specific sub-type of myeloma.

Treatment options include chemotherapy, corticosteroids, immunotherapy, targeted therapy, radiation therapy, and stem cell transplantation. 

You can learn more about myeloma, its symptoms, and treatment options here.

Some common symptoms of myeloproliferative neoplasms include: 

• Night Sweats
• Blurred Vision
• Weakness 
• Itchiness 
• Headaches 
• Raised Blood Pressure

Lifestyle factors such as smoking, diet and obesity have been implicated with a higher risk of MPN, but there are no clear risk factors specifically associated with MPN.

The diagnosis of MPN is made based on physical signs and symptoms, blood counts, and specific diagnostic tests. The diagnostic tests that can help detect MPNs include routine blood tests, specialised molecular tests, and a bone marrow biopsy.

The aim of the treatment is to minimise the risk of complications associated with MPN and to improve quality of life. Treatment options for myeloproliferative neoplasms (MPN) may include antiplatelet therapy, venesection, cytoreductive therapy, interferon, targeted therapy, and stem cell transplantation. 

You can find more information on myeloproliferative neoplasms, their diagnosis, and the treatment options available here.

Myelodysplastic syndromes may not cause any signs and symptoms in the initial stages. As the disease progress, patients may experience symptoms related to impaired function of the blood, such as:

• Difficulty in breathing
• Persistent weakness and tiredness
• A tendency for bruising or bleeding due to thrombocytopenia or a low blood platelet count. 
• Unusual paleness of the skin due to anaemia or a low red blood cell count.
• Frequent infections due to a low white blood cell count.

Some risk factors that may increase the chances of developing MDS include age, exposure to toxic chemicals, and cancer treatment drugs.

At CFCH, our haematologists may order several tests to diagnose MDS. These include blood tests and a bone marrow biopsy.

The prognosis of MDS is determined by several factors, including the risk category, the presence of other medical conditions, and age.

The IPSS-R (International Prognostic Scoring System – Revised) helps determine if a patient has low-risk or high-risk MDS. Patients with low risk MDS tend to live for longer without the need for intervention. However, patients with high risk MDS generally require treatment sooner and may have a shorter life expectancy.

The IPSS-R gives a general estimate of the time/risk of a patient to 1) develop acute myeloid leukaemia and 2) overall survival.

The treatment for Myelodysplastic syndromes depends on the stage of the disease, your age, and your performance status. It may involve one or a combination of therapies such as growth factor injections, blood transfusions, immune modulating agents, epigenetics agents, and stem cell transplantation. 

You can find more information on MDS, its diagnosis, and the treatment options available here.