Acute Leukaemia: Symptoms, Causes, Treatment, Survival Rate

Acute leukaemia is a fast-progressing cancer that starts in blood-forming tissue i.e., the bone marrow, and causes large numbers of white blood cells to be produced. These cells then enter the bloodstream in large quantities and disrupt the production of healthy blood cells.

The disease manifests quickly, causing individuals to feel sick within weeks of the leukaemia cells forming. Acute leukaemia is more common in children and requires immediate initiation of therapy for the best chance of survival.

Acute leukaemia is a serious disease, but it is treatable. With early detection and treatment, many people with acute leukaemia can go on to live long and healthy lives.

Acute leukaemia can be classified into two main types: Acute Myeloid Leukaemia (AML) and Acute Lymphoblastic Leukaemia (ALL). 

The World Health Organization (WHO) classification system classifies acute leukaemia based on its morphology, immunophenotype, and genetic features. These factors help categorise acute leukaemia into specific types and subtypes, guiding treatment decisions and predicting prognosis. 

Acute Myelogenous Leukaemia (AML)

AML is a rare form of blood cancer that impacts myeloid cells. Myeloid cells play a crucial role in the blood and bone marrow, producing different types of mature blood cells like red blood cells, white blood cells, and platelets. 

In acute myeloid leukaemia, these cells undergo uncontrolled growth, resulting in a decline in healthy blood cells. AML is one of the most common types of leukaemia among adults. 

1. AML with Recurrent Genetic Abnormalities: It is a group of AMLs that are characterised by the presence of specific genetic abnormalities. These abnormalities can be detected by cytogenetic analysis or molecular testing.
   Patients diagnosed with AML who exhibit recurrent genetic abnormalities tend to have a worse prognosis compared to those without such abnormalities.

2. AML with Multilineage Dysplasia: It is a group of AMLs characterised by dysplasia in multiple lineages of blood cells. Dysplasia is a term used to describe abnormal cell development.
   Patients diagnosed with AML who exhibit dysplasia in multiple lineages of blood cells tend to have a worse prognosis than those without dysplasia.

3. Therapy-Related Myeloid Neoplasms: This is a group of AMLs that are caused by exposure to certain chemotherapy drugs or radiation therapy. Patients with therapy-related myeloid neoplasms tend to have a worse prognosis than patients with de novo AML (AML that is not caused by exposure to chemotherapy or radiation therapy).

4. AML, Not Otherwise Specified is a Category: It is for AMLs that do not fit into any of the other categories.
   Patients with AML, not otherwise specified, tend to have a worse prognosis than patients with AML with recurrent genetic abnormalities or AML with multilineage dysplasia.

5. Myeloid Sarcoma: It is a rare type of AML that develops in the soft tissues of the body instead of the bone marrow. Myeloid sarcomas can occur in the skin, liver, spleen, or other organs.

6. Myeloid Proliferations Related to Down Syndrome: It is a group of myeloid disorders that occur in people with Down syndrome. These disorders include AML, acute megakaryoblastic leukaemia, and chronic myelomonocytic leukaemia.

Acute Lymphocytic Leukaemia (ALL) 

ALL is a cancer of the lymphoid blood cells, which include B cells and T cells. ALL is the most common type of leukaemia in children. It is characterised by the production of immature blood cells instead of mature ones.
ALL primarily impacts the white blood cells called lymphocytes.  

1. Precursor B-cell ALL: A type of ALL that starts in the B cells. B cells are a type of white blood cell that helps the body fight infection.

2. Precursor T-cell ALL: A type of ALL that starts in the T cells. T cells are a type of white blood cell that helps the body fight infection.

3. Other Mature B-cell Leukaemia: A group of leukaemia that starts in mature B cells. Mature B cells are B cells that have already developed and are ready to fight infection.

4. Other Mature T-cell Leukaemia: A group of leukaemia that originate in mature T cells. Mature T cells are T cells that have already developed and are ready to fight infection. 

5. Acute Lymphoblastic Leukaemia, not otherwise specified: A category for ALLs that do not fit into any of the other categories. Patients with ALL, not otherwise specified, tend to have a worse prognosis than patients with precursor B-cell ALL or precursor T-cell ALL.

Acute Leukaemia Stages

There is no standard staging system for acute leukaemia. Instead, doctors describe the disease as an untreated, active disease, in remission, measurable residual disease (MRD), relapsed (also called recurrent) or refractory.

1. Untreated: It means that the leukaemia is newly diagnosed and hasn't been treated yet.

2. Active Disease: Active disease is when leukaemia is not in remission. This means that there are still leukaemia cells in the blood and bone marrow.

3. In Remission: Remission is when there are no detectable leukaemia cells in the blood and bone marrow.

4. Measurable Residual Disease (MRD): MRD is when there are very small numbers of leukaemia cells in the blood or bone marrow that cannot be seen with a microscope.
   MRD can be detected with special tests like flow cytometry or polymerase chain reaction (PCR).

5. Relapse: Relapse is when leukaemia comes back after it has been in remission.

6. Refractory: Refractory is when the leukaemia does not respond to treatment.

The symptoms of acute leukaemia can vary from person to person and may depend on the type of leukaemia and how far it has spread. Some common symptoms include:

1. Bleeding from the gums

2. Bone pain

3. Fever

4. Frequent bacterial and viral infections 

5. Frequent or severe nosebleeds

6. Lumps caused by swollen lymph nodes in the neck, armpits, abdomen, or groin

7. Pale skin

8. Shortness of breath

9. Weakness/fatigue 

Symptoms of AML: Additional symptoms may include lethargy, easy bruising, and unusual bleeding, such as frequent nosebleeds and bleeding from the gums. 

Symptoms of ALL: Additional symptoms may include easy bruising and frequent or severe infections.

Acute Leukaemia, including AML and ALL, is the development of DNA mutations in bone marrow cells. These mutations can occur spontaneously or be caused by certain environmental factors, such as exposure to radiation or chemicals. 

Acute Leukaemia Risk Factors

While the causes of acute leukaemia are not fully understood, certain risk factors have been identified that may increase the likelihood of developing AML or ALL. Some common risk factors include: 

1. Age: The risk of developing acute leukaemia increases with age.

2. Family History: People with a family history of acute leukaemia are at an increased risk of developing the disease.

3. Certain Genetic Disorders: People with certain genetic disorders, such as Down syndrome, are at an increased risk of developing acute leukaemia.

4. Exposure to Radiation: People who have been exposed to high levels of radiation, such as those who have survived a nuclear disaster, are at an increased risk of developing acute leukaemia.

5. Exposure to Certain Chemicals: People who have been exposed to certain chemicals, such as benzene, are at an increased risk of developing acute leukaemia.

6. Smoking: Smoking is a major risk factor for developing acute leukaemia.

7. Previous Cancer Treatment: People who have been treated for cancer with certain types of chemotherapy or radiation therapy are at an increased risk of developing acute leukaemia.

There is no sure way to prevent acute leukaemia, but there are some things that one should consider to reduce the risk of developing acute leukaemia. These include:

1. Avoid Smoking: Smoking is a well-established risk factor for AML. Cigarette smoking is consistently linked to an increased risk of different leukaemia types, particularly those with specific morphologic and chromosomal characteristics. The association varies with age.

2. Limiting Radiation Exposure: For individuals with jobs involving radiation exposure, discussing ways to minimise exposure with a healthcare professional is crucial.

3. Avoiding Exposure to Certain Chemicals: Those working with chemicals, such as benzene, should explore ways to reduce exposure through consultation with a doctor. 

4. Eating a Healthy Diet: A diet rich in fruits, vegetables, and whole grains may contribute to lowering the risk of developing leukaemia.

5. Regular Exercise: Engaging in moderate-intensity exercise for at least 30 minutes most days of the week can help reduce the risk of various diseases, including leukaemia.

6. Maintaining a Healthy Weight: Obesity and being overweight increase the risk of leukaemia, so seeking guidance from a doctor on safe weight loss strategies is advisable.

7. Regular Checkups: Consulting a doctor about any health concerns allows for early detection and treatment, improving the chances of successful outcomes in leukaemia cases.

There is no single test that can diagnose acute leukaemia. Instead, doctors use a combination of tests to make the diagnosis. 

Healthcare providers evaluate symptoms, review medical history, perform a physical exam, and conduct genetic tests to diagnose ALL. Providers use tests, including genetic tests, and perform a physical examination to diagnose AML, checking for symptoms and enlarged organs.

The common diagnostic tests for AML and ALL include:

1. Complete Blood Count (CBC): This test measures the number of red blood cells, white blood cells, and platelets in the blood. People with leukaemia often have low levels of red blood cells (anaemia), low levels of white blood cells (neutropenia), and high levels of immature white blood cells (blast cells).

1. Differential Test: This part of a CBC looks at the different types of white blood cells and their percentages. In AML, there is an increase in immature white blood cells called blasts.
   In ALL, there is an increase in lymphoblasts, which are a type of immature lymphocyte.

2. Bone Marrow Aspiration and Biopsy: This procedure is used to collect a sample of bone marrow. Bone marrow is the soft tissue inside bones that makes blood cells.
   The sample is examined under a microscope to look for abnormal cells.

3. Flow Cytometry: This test uses lasers to measure the proteins on the surface of cells. This can help to identify the type of leukaemia and to determine the exact subtype of leukaemia.

4. Genetic Testing: This test can be used to look for changes in genes that are associated with leukaemia. This information can help to guide treatment decisions.

5. Imaging Tests: Imaging tests, such as a CT scan or MRI, may be used to look for signs of leukaemia outside of the bone marrow, such as in the liver, spleen, or central nervous system.

The diagnosis of leukaemia is made based on the results of these tests. A diagnosis of AML requires the presence of at least 20% blasts in the bone marrow. A diagnosis of ALL requires the presence of at least 25% lymphoblasts in the bone marrow. 

How to Prepare for Doctor’s Consultation? 

Before the visit, one must keep the following tips in mind to prepare for the doctor’s consultation.

1. List down all the symptoms that one experiences. Be it due to the medical condition or not.

2. Make a list of all the medications and supplements that the patient is taking.

3. Research and gather information about the condition online.

4. Write down the questions that the patient would want to clarify with the doctor.

5. Bring a family member or a colleague during the visit with the doctor to offer emotional support, take notes, and help one remember important details discussed during the appointment.

What to Expect During Doctor’s Consultation? 

One can expect the following during a doctor’s consultation.

1. Patient History: The doctor may ask for the medical background, including previous illnesses, treatments, and family history of leukaemia. 

2. Physical Examination: The doctor will thoroughly examine the lymph nodes, spleen, and liver for signs of infection or abnormalities.

3. Diagnostic Tests: If leukaemia is suspected, the doctor may order blood tests to assess cell counts and identify abnormal cells. 

1. A bone marrow biopsy may also be performed to confirm the diagnosis and determine the leukaemia type. 

2. Additional tests like a spinal tap or CT scan may be recommended to check for leukaemia in other areas.

4. If the diagnosis of acute leukaemia is confirmed, the doctor will discuss the available treatment options and their potential benefits and risks.

What Questions to Ask the Doctor?

Here are a few of the important questions to be asked the doctor if acute leukaemia is diagnosed:

1. What type of leukaemia do I have developed?

2. How much cancer has spread in my body?

3. What are the best available treatment modalities and their associated risks and side effects for my condition?

4. What are the chances of my recovery?

5. What are the ways to improve my well-being and quality of life during treatment? 

It is important to note that each individual's experience with acute leukaemia is different. Doctors will customize a treatment plan based on the specific circumstances and needs of the patient.

There are many factors that a doctor considers when choosing treatment options for patients diagnosed with acute leukaemia. These include the patient's age and overall health, type of leukaemia, patient's risk group, and patient's response to treatment. 

Common treatment options for AML and ALL 

1. Chemotherapy: This therapy uses drugs to kill cancer cells. Chemotherapy can be given alone or in combination with other treatments. It is usually given in cycles, and the cycle usually lasts for a few weeks, and there is a break between cycles so that the body can recover. 

1. Chemotherapy can have many side effects, including fatigue, nausea, vomiting, hair loss, and infection.

2. Targeted Therapy: Targeted therapy is usually given in combination with chemotherapy. In this therapy, a drug (designed to target specific cells) is administered to kill the cancer cells.

1. Targeted therapy can also have side effects, but they are usually not as severe as the adverse effects of chemotherapy.

3. Radiation Therapy: Radiation therapy is usually used to treat AML and ALL that have spread to the brain or spinal cord. This uses high-energy beams to kill cancer cells. It is usually not the first treatment used. 

1. Radiation therapy can also have side effects, including fatigue, hair loss, and skin burns.

4. Stem Cell Transplant: This is a procedure in which healthy stem cells are transplanted into the body. Stem cells are the cells that make blood cells. A stem cell transplant can help to replace the damaged or destroyed bone marrow. It is a major surgery involving risks but is very effective in curing AML and ALL. 

5. Supportive Care: This treatment is given to help manage the side effects of other treatments. Supportive care can include things like blood transfusions, antibiotics, and pain medication.

Specific Treatment Options for ALL

1. Immunotherapy: It is a relatively new treatment option for ALL. This is a type of cancer treatment that uses the body's own immune system to fight cancer cells. Immunotherapy works by helping the body's immune system fight cancer cells. This can be done in a variety of ways, including:

1. Monoclonal Antibodies: These are proteins that are designed to attach to specific molecules on cancer cells. Once attached, the monoclonal antibody can either kill the cancer cell directly or signal the immune system to attack the cancer cell.

2. Chimeric Antigen Receptor (CAR) T-cell Therapy: This is a type of immunotherapy that uses a patient's own T cells to fight cancer. The T cells are genetically modified to express a chimeric antigen receptor (CAR), which allows them to recognize and attack cancer cells

Immunotherapy has shown promise in treating a variety of cancers, including ALL. In some cases, immunotherapy has been able to cure cancer or prolong the lives of patients with advanced cancer. 

2. Clinical Trials: New treatments are being tested in clinical trials. These trials offer potential for new treatments and closer monitoring, but there are risks. It is important to talk to the doctor about the risks and benefits of taking part in a clinical trial before making a decision. 

Cost of Acute Leukaemia Treatment

The cost of acute leukaemia treatment depends on several factors, including the stage of cancer, the type of treatment technique, the patient’s age, the patient’s comorbidities, the hospital type and location, the doctor’s experience, insurance coverage and much more.

To know the exact treatment cost of acute leukaemia, one must visit a reputed doctor, or the below table provides an approximate cost of various treatment modalities for acute leukaemia.

Acute Leukaemia Survival Rate

It is crucial to remember that the survival rate statistics for individuals diagnosed with acute leukaemia are estimates and cannot predict the impact of cancer on an individual's lifespan.
These statistics reflect patterns observed in groups of people diagnosed with the same disease, considering various stages of the condition.

1. For ALL: The 5-year relative survival rate for people age 20 and older is 43%. The 5-year relative survival rate for people under age 20 is 90%.

2. For AML: The 5-year relative survival rate for people 20 and older with AML is 28%. For people younger than 20, the 5-year relative survival rate is 69%.

The survival rate for acute leukaemia has improved with advancements in treatment, but it's important to understand that individual survival rates can vary. Age, overall health, leukaemia type, and response to treatment can influence the survival rate.

Acute leukaemia is a serious type of cancer that needs to be treated right. If left untreated, the risk of death increases. The treatment can be tough, but if it's started early, many people can get better and live a long and healthy life. 

Complications related to acute leukaemia, including AML and ALL, involve various systems in the body and can pose additional challenges. Here are some common complications associated with acute leukaemia that one should know about:

1. Infections: One may be more prone to bacterial, viral, and fungal infections, which can cause illness.

2. Bleeding and Bruising: One might experience easy bruising, prolonged bleeding, and a higher risk of bleeding from minor injuries.

3. Anaemia: This condition can lead to fatigue, weakness, shortness of breath, and pale skin due to decreased red blood cell production.

4. Organ Dysfunction: Some organs, such as the liver, spleen, lymph nodes, and central nervous system, may enlarge and not function properly.

5. Tumour Lysis Syndrome: During treatment, rapid cell destruction can cause metabolic imbalances, kidney problems, and cardiac complications.

6. Neurological Complications: One may encounter balance problems, blurred vision, seizures, headaches, and weakness in facial muscles.

7. Secondary Cancers: There is an increased risk of developing other types of cancer due to treatment or genetic factors.

Risks if Not Treated on Time 

When left untreated, AML and ALL can have serious consequences and become life-threatening. The risk of death increases the longer the cancer goes untreated. Here are the risks associated with untreated acute leukaemia: 

1. Increased risk of life-threatening complications.

2. Higher chances of severe infections.

3. Excessive bleeding and bruising.

4. Organ dysfunction and enlargement.

5. Potential development of other health problems.

6. Elevated risk of mortality with time.

7. Decreased chances of successful treatment outcomes.

When to See a Doctor?

Knowing when to see a doctor for AML and ALL is important for early detection and treatment. Here are some signs that indicate seeking medical attention:

1. Persistent Symptoms: If one has persistent fatigue, unexplained weight loss, frequent infections, easy bruising or bleeding, or unusual pain, see a doctor.

2. Family History: If the family has a history of AML or ALL, consult the doctor. They can assess the risk and suggest screenings or preventive steps.

3. Health Concerns: If one notices worrisome health changes, seek medical advice. Discuss the worries with a healthcare professional.

4. Age and Risk Factors: If an individual is over 65 or has diabetes or heart disease, they may face higher AML and ALL risks. Regular check-ups and discussions with the doctor can monitor the health and catch any problems.  

While there is no specific diet mandated for individuals with acute leukaemia, following these general dietary guidelines can contribute to improved well-being and faster recovery: 

Foods to Eat

1. Stay hydrated by drinking fluids like water, juice, and milk.

2. Fruits and Vegetables: Packed with vitamins, minerals, and antioxidants.

3. Whole Grains: Provide important nutrients and fibre.

4. Lean Protein: Fish, chicken, tofu, meat, eggs, dairy products and beans are good sources.

5. Healthy Fats: Omega-3 fatty acids from fish, nuts, and seeds.

Foods to Avoid

1. Foods High in Sugar: Can cause weight gain and hinder nutrient absorption.

2. Foods High in Fat: Can hinder nutrient absorption and increase the risk of weight gain.

3. Foods High in Sodium: Can cause fluid retention and increase the risk of high blood pressure.

4. Alcohol: Irritates the stomach and intestines and affects nutrient absorption.

5. Caffeine: Dehydrates the body and affects nutrient absorption.

Remember, these guidelines are general, so it's important to consult your doctor for personalized advice and diet plan based on your specific condition, medical history, and preference.

In conclusion, acute leukaemia is a complex and aggressive form of blood cancer that requires prompt diagnosis and appropriate treatment. The staging of acute leukaemia helps guide treatment decisions and determine the extent of the disease. By working closely with a healthcare team, individuals with acute leukaemia can receive the necessary care and support to achieve remission and improve their overall prognosis.
Early detection, timely intervention, and ongoing monitoring are crucial for optimizing outcomes in acute leukaemia patients.

At HexaHealth, we help you not just find the root causes of health problems but also with the diagnosis and treatment of the same. Our medical experts are available round the clock to clear yours. Contact HexaHealth right now to find out more about the meaning of specific symptoms, how to address them, and which doctors are ideal for a given issue. 

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