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Leukaemia

White blood cells are made in your bone marrow - the soft, spongy centre of your bones. They are involved in your immune system, which defends your body against infection and other harmful substances. There are two main types of white blood cell. These are myeloid cells and lymphocytes.

The term leukaemia refers to a group of cancers of the white blood cells. If you have leukaemia, some of your white blood cells don't grow properly. They stay in your bone marrow and reproduce in an uncontrolled way. These abnormal white blood cells fill up your bone marrow and prevent it from making the normal blood cells (white blood cells, red blood cells and platelets). This means your body may be less able to fight off infections and you may develop anaemia or bruise and bleed abnormally.

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

There are several types of leukaemia. They are named according to the type of white blood cells (myeloid or lymphoid) that are affected and whether the disease is acute or chronic.

Acute leukaemia

If you have acute leukaemia, symptoms develop quickly and the condition can become life-threatening at an early stage if it's not treated.

The most common type of acute leukaemia in children affects lymphocytes and is called acute lymphoblastic leukaemia (ALL). ALL usually affects children aged between two and 10.

The most common type of acute leukaemia in adults affects myeloid cells and is called acute myeloid leukaemia (AML).

Chronic leukaemia

If you have chronic leukaemia, symptoms develop slowly and your white blood cells are almost fully grown and normal when they leave your bone marrow and enter your bloodstream. They can function, but not as well as they should.

Chronic myeloid leukaemia (CML), affects your myeloid cells. It has two phases, a chronic phase that can last for several years, during which symptoms develop slowly, followed by a more aggressive phase (accelerated phase), where symptoms quickly get worse.

Chronic lymphocytic leukaemia (CLL) affects lymphocytes, and is most common in people aged between 30 and 60.

The symptoms vary, depending on the exact type of leukaemia you have and how advanced it is. You may have no symptoms in the early stages, especially if you have chronic leukaemia. Your symptoms may be mild at first and then get worse and you may feel as if you have flu. Many of the symptoms are vague, and can include:

  • tiredness, breathlessness and pale skin (due to anaemia - a reduction in number of red blood cells)
  • fever (high temperature)
  • infections that don't get better
  • abnormal bruising or bleeding
  • red or purple spots on your skin - called a petechial rash
  • bone and joint pain (due to the pressure of a build-up of cells in your bone marrow)
  • swollen lymph nodes (glands found throughout your body, including your neck, groin and under your arms, that are part of your immune system)
  • feeling full or a tender lump on the left side of your tummy due to an enlarged spleen.
  • loss of appetite and weight loss
  • swollen gums, and occasionally, swollen testicles
  • headaches and vision problems
  • itchy skin
  • very rarely, a painful erection that won't go away - this is called priapism

These symptoms aren't always caused by leukaemia but if you have them, see your GP.

The exact causes of leukaemia aren't known, although there are some risk factors that increase your chances of developing it. These include:

  • a weakened immune system - for example if you have HIV/AIDS or are taking medicines that suppress your immune system
  • age - AML and CLL are more common in people over 40
  • gender - slightly more men than women are affected by leukaemia
  • smoking
  • certain genetic conditions, such as Down's syndrome
  • other blood disorders, such as aplastic anaemia - a rare condition where your bone marrow fails to produce any of the blood cells
  • contact with a chemical called benzene
  • autoimmune conditions such as rheumatoid arthritis, autoimmune haemolytic anaemia and ulcerative colitis, although doctors aren't sure if it's the actual condition or the medicines taken for the condition that increases your risk of leukaemia

There is some evidence that there is an increased risk of leukaemia in some families. However, most leukaemias don't have a family link.

Your GP will ask you about your symptoms and examine you. If your GP thinks you may have leukaemia, he or she will refer you to a haematologist (a doctor who specialises in conditions of the blood) who will examine you fully.

You will need to have a blood test. Your blood sample will be sent to a laboratory for testing, to look for deficiencies of normal blood cells and for the presence of abnormal white blood cells. Depending on the results of the blood test, you may need to have further tests, which may include the following.

  • Bone marrow biopsy, to examine all the blood cells under a microscope.
  • Analysis of the chromosomes and DNA of the abnormal cells found in your blood and bone marrow (cytogenetics).
  • Analysis of the antigens present on the leukaemic cells (immunophenotyping).
  • CT, MRI, X-ray or ultrasound scans to look for enlarged lymph nodes, an enlarged spleen or other tumours.
  • An echocardiogram to check that your heart is healthy.
  • Tissue typing of yourself and your siblings to see if you have a suitable bone marrow donor. 

Treatment varies considerably, depending on the type of leukaemia you have, but may involve:

  • chemotherapy - medicines that destroy cancer cells
  • radiotherapy - X-rays that target cancer cells
  • a bone marrow or stem cell transplant - transferring somebody else's (preferably your brother or sister) healthy bone marrow or stem cells into your body biological therapies, such as a medicine called a tyrosine kinase inhibitor if you have CML
  • monoclonal antibody therapy - monoclonal antibodies are medicines that are designed to recognise and target markers that are commonly carried by cancer cells medicines called steroids, if you have ALL or CLL

You may need to have other treatment, possibly including antibiotics, blood transfusions, platelet transfusions and growth factor injections.

How well treatment for leukaemia works depends on the type and stage of the disease. Acute leukaemia often goes into remission. This is when your symptoms go away and the disease is under control, but not necessarily cured. Unfortunately, for many people with acute leukaemia, remission is followed by a relapse - when the disease returns.

You may feel confused and overwhelmed when you're told you have leukaemia. It can be a very distressing time for both you and your family. An important part of cancer treatment is learning how to talk about how you're feeling, and getting support for your physical and emotional symptoms. It's also important to find out as much as possible about your type of leukaemia because this will help you feel more in control.

Once your treatment is over, you may feel frustrated that you can't get back to normal straightaway. Many people feel very tired, even months after their treatment. You need to be realistic about how long it may take you to recover and plan ahead with school or work, perhaps going back part-time at first.

Gentle walking is a good way of easing yourself back into exercise and increasing your energy. Once your appetite returns, try to eat a healthy balanced diet with at least five portions of fruit and vegetables a day.

For more advanced cancer, you can receive extra support known as palliative care. This involves treatment that aims to reduce the severity of your symptoms or slow the disease's progress, rather than providing a cure. Doctors and nurses at hospitals, hospices and pain clinics specialise in providing the support you need, and can also visit you at home.

1. Will treatment for leukaemia make my hair fall out?

It depends on the type of treatment you have. Chemotherapy can sometimes make your hair fall out, but complete hair loss is unlikely if you're having other types of treatment. Ask your doctor or specialist cancer nurse to explain the side-effects of your leukaemia treatment.

One type of treatment you may have for leukaemia is chemotherapy, which uses medicines to destroy cancer cells. One of the side-effects of some chemotherapy medicines is hair loss or hair thinning. Not all chemotherapy medicines cause hair loss - some don't cause any hair loss at all. Others cause only mild hair thinning and some cause complete hair loss. Ask your doctor or specialist nurse whether hair loss is a possible side-effect of your treatment.

If complete hair loss is a possible side-effect of your treatment, you may like to think about having your hair cut short before your treatment starts or about getting a wig. If you think you would like a wig, speak to your nurse. There will usually be someone who visits the hospital and can give you advice on choosing a wig.

If your hair does fall out, it will usually grow back after your treatment has finished. However, your hair may be a slightly different colour, softer or more curly than it was before.

2. Will I be sick if I have chemotherapy?

Not all chemotherapy medicines make you feel or be sick, and if this does happen, there are medicines that can treat any sickness you have.

Chemotherapy affects everyone in different ways. You may not have any sickness at all. You may be sick immediately after treatment, with the nausea usually disappearing after a day, or you may experience sickness one day after your treatment. Some people are sick before any treatment.

Your doctor will usually give you anti-sickness (anti-emetic) injections or tablets if your chemotherapy makes you feel or be sick. These medicines work well in most people, but this does depend on several things. The combination of medicines you're taking, the dose, your reaction to the medicines and other factors (such as your age and medical history) can influence how the medicines make you feel. They may stop you feeling sick altogether or make your symptoms milder. If anti-sickness medicines don't work, tell your doctor. He or she will usually be able to change your medicine to a different type.

3. Could I pass leukaemia on to my children?

In extremely rare cases, leukaemia can be passed on to an unborn baby from his or her mother. However, it's not possible for children to 'catch' leukaemia from their parents.

In 2009, scientists found that very rarely, cancer cells can be transferred from a mother to her unborn baby through the placenta. They discovered, via tests known as genetic fingerprinting, that a 28-year-old Japanese mother had passed leukaemia cells on to her baby while she was in the womb. However, this is extremely rare and very unlikely to happen to most mothers and babies.

Some genetic conditions that are passed from parent to child can increase the risk of some forms of leukaemia, but they don't directly cause leukaemia. These conditions include Down's syndrome, Fanconi's anaemia and ataxia telangiectasia.

Sources

  • Simon C, Everitt H, and Kendrick T, Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2005: 530-33
  • Leukaemia FAQs. Association for International Cancer Research. www.aicr.org.uk, accessed 10 March 2010
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  • UK Leukaemia incidence statistics. Cancer Research UK. www.cancerresearchuk.org/info, accessed 4 November 2009
  • Children's cancers. Cancer Research UK. www.cancerhelp.org.uk, accessed 4 November 2009
  • The bone marrow. Macmillan Cancer Support. www.macmillan.org.uk, accessed 4 November 2009
  • The blood and acute myeloid leukaemia. Cancer Research UK. www.cancerhelp.org.uk, accessed 4 November 2009
  • Leukaemia. Cancer Research UK. www.cancerhelp.org.uk, accessed 4 November 2009
  • Chronic myeloid leukaemia (CML). Cancer Research UK. www.cancerhelp.org.uk, accessed 4 November 2009
  • Acute myeloid leukaemia symptoms. Cancer Research UK. www.cancerhelp.org.uk, accessed 4 November 2009
  • Symptoms of chronic myeloid leukaemia. Macmillan Cancer Support. www.macmillan.org.uk, accessed 4 November 2009
  • Symptoms of chronic myeloid leukaemia (CML). Cancer Research UK. www.cancerhelp.org.uk, accessed 4 November 2009
  • Chronic myeloid leukaemia (CML) risks and causes. Cancer Research UK. www.cancerhelp.org.uk, accessed 4 November 2009
  • Acute myeloid leukaemia risks and causes. Cancer Research UK. www.cancerhelp.org.uk, accessed 4 November 2009
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  • Tests for chronic myeloid leukaemia (CML). Cancer Research UK. www.cancerhelp.org.uk, accessed 4 November 2009
  • Cancer tests. Cancer Research UK. www.cancerhelp.org.uk, accessed 4 November 2009
  • Treating acute myeloid leukaemia. Cancer Research UK. www.cancerhelp.org.uk, accessed 4 November 2009
  • Treating chronic myeloid leukaemia (CML). Cancer Research UK. www.cancerhelp.org.uk, accessed 4 November 2009
  • Living with and after cancer. Macmillan Cancer Support. www.macmillan.org.uk, accessed 4 November 2009
  • Chronic lymphocytic leukaemia (CLL) risks and causes. Cancer Research UK. www.cancerhelp.org.uk, accessed 9 February 2010
  • Hair loss, hair thinning and cancer drugs. Cancer Research UK. www.cancerhelp.org.uk, accessed 2 February 2010
  • Sickness (nausea) and cancer drugs. Cancer Research UK. www.cancerhelp.org.uk, accessed 4 November 2009
  • Chronic myeloid leukaemia (CML). Leukaemia & Lymphoma Research Fund. www.lrf.org.uk, accessed 4 November 2009
  • Immunologically silent cancer clone transmission from mother to offspring. PNAS 2009; 106(42): 17882-85. doi: 10.1073/pnas.0904658106

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