Leukaemia

Risk Factors of Leukaemia

While the exact cause that triggers the mutations in the stem cells that result in leukaemia remains unknown, certain risk factors have been identified to increase the likelihood of developing the disease. Some of the critical risk factors associated with leukaemia include:

Genetic predisposition: Inherited genetic mutations or syndromes, such as Down syndrome, Li-Fraumeni syndrome and Fanconi anaemia, can increase the risk of leukaemia.
Radiation exposure: Exposure to ionising radiation, such as that from medical treatments (radiation therapy) or nuclear accidents, is another well-established risk factor for leukaemia.
Exposure to certain chemicals: Prolonged exposure to benzene and other chemicals in the workplace or environment may increase the risk of developing leukaemia.
Previous cancer treatment: Previous cancer treatments, such as chemotherapy or radiation therapy for other cancers, can increase the risk of developing leukaemia later in life.
Age: While leukaemia can occur at any age, it is more common in older adults to have leukaemia.

It is important to note that having one or more risk factors does not necessarily mean that a person will develop leukaemia. Conversely, some individuals may develop leukaemia without any known risk factors. Regular medical check-ups and awareness of personal risk factors can help individuals and healthcare providers monitor for signs of leukaemia and take proactive measures for early detection and prevention.

Types Of Leukaemia

Based on their clinical presentation and cell of origin (myeloid or lymphoid), leukaemia can be broadly divided into acute and chronic. Acute leukaemia is clinically aggressive and rapidly progressive. The onset of chronic leukaemia is gradual and progresses slower than acute leukaemia.

Acute Myeloid Leukaemia (AML)

In AML, immature myeloblast cells divide uncontrollably, crowding out healthy blood cells in the bone marrow and decreasing the number of normal healthy white blood cells, clotting cells and red blood cells, leading to impaired ability to fight infections, anaemia, and bleeding. This aggressive form of leukaemia can manifest with symptoms such as fatigue, fever, easy bruising or bleeding, and frequent infections.

Acute Lymphoblastic Leukaemia (ALL)

Acute Lymphoblastic Leukaemia (ALL) is a fast-growing blood cancer that starts in immature lymphoid cells. Like AML, when these immature cells grow uncontrollably, they crowd out normal blood cells in the bone marrow, leading to anaemia, bleeding, and low white blood cells. ALL often occurs in two age groups: children and adolescents, and older adults. Symptoms of ALL can include fatigue, fever, easy bruising or bleeding, frequent infections, and swollen lymph nodes.

Chronic Leukaemia

Chronic leukaemia is a type of blood cancer characterised by the overproduction of myeloid and lymphoid cells in the bone marrow, which then spill over into the bloodstream. This usually leads to a high white blood cell count, often detected during routine health screenings. In the early stages, chronic leukaemia is often clinically silent, meaning patients typically do not have any symptoms. As the disease progresses, patients may experience fatigue, increased susceptibility to infections, low blood counts, and enlarged liver, spleen, or lymph nodes. The two main types of chronic leukaemia are chronic lymphocytic leukaemia (CLL) and chronic myeloid leukaemia (CML).

Leukaemia Symptoms

Leukaemia often presents with a range of symptoms that can vary depending on the type and stage of the disease. Some common signs and symptoms of leukaemia include:

Fatigue and weakness
Frequent infections
Easy bruising or bleeding
Unexplained weight loss
Fever or night sweats
Enlarged lymph nodes
Bone pain or joint pain
Pale skin
Shortness of breath
Tiny red spots on the skin
Swollen abdomen (from enlarged spleen or liver)

Diagnosing Leukaemia

Patients must undergo blood tests and a bone marrow biopsy to diagnose leukaemia. Additional tests might be needed to check your overall health before starting treatment, depending on any other health issues you may have.

Blood tests

Blood tests are crucial in diagnosing and monitoring leukaemia.

Full Blood Count (FBC): This test measures the number of different types of blood cells. In leukaemia, there may be an abnormally high number of white blood cells, or they may be immature and not functioning properly.
Blood Smear: This test examines the shape and appearance of the blood cells under a microscope. It can help identify leukaemia cells, which often have abnormal features.

Bone marrow biopsy

A small sample of bone marrow is extracted from the pelvic bone using a special needle. This sample is then subjected to several tests, including gene and molecular testing, and is examined under a microscope. These tests help your doctor determine the type of leukaemia you have and identify any poor prognostic markers. These markers indicate whether the leukaemia might be challenging to treat and if more intensive treatments are needed.

Treatments for Leukaemia

Effective treatment for leukaemia involves a multi-faceted approach tailored to the patient’s fitness and co-existing medical conditions. These treatments aim to eliminate cancer cells, restore normal blood cell production, and improve overall health and quality of life.

Chemotherapy

Chemotherapy is the treatment of cancer using drugs that stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given orally or intravenously and is often used as the primary treatment for leukaemia.

Targeted Therapy

Targeted therapy uses treatments that specifically act on cancer cells or the pathways they use to grow. There are two main methods used in targeted therapy:

Monoclonal Antibodies: These are lab-made antibodies that attach to specific proteins on cancer cells. This can either directly kill the cancer cells or mark them for destruction by the immune system.
Small Molecule Inhibitors: These drugs block specific molecules or pathways within cancer cells that are crucial for their growth and survival.

Transplantation

After using chemotherapy or targeted therapy to clear the cancer cells, a transplantation is needed to prevent future relapses. This step helps fully eradicate any remaining leukaemia cells and repopulate the patient’s bone marrow with healthy, functional cells. A stem cell donor is required for this process and can be a parent, sibling, relative, or an unrelated donor.

Immunotherapy

Immunotherapy utilises the body’s immune system to recognise and destroy cancer cells, enhancing the body’s natural defences against leukaemia.

Chimeric Antigen Receptor T-Cell Therapy

Chimeric Antigen Receptor T-cell therapy treats B-cell Acute Lymphoblastic Leukaemia by modifying a patient’s own immune cells to target and destroy cancerous B cells.