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Chronic leukaemiaPublished by BUPA's health information team, healthinfo@bupa.com, February 2008. This factsheet is for people who have chronic leukaemia, or who would like information about it. Chronic leukaemia is a cancer of the blood that develops slowly. There are two main types of chronic leukaemia, depending on the type of cells affected: chronic lymphocytic leukaemia (CLL) or chronic myeloid leukaemia (CML).
About chronic leukaemiaThe term leukaemia refers to a group of cancers of the blood cells. In leukaemia, white blood cells become abnormal, and divide and grow in an uncontrolled way. There are two main types of leukaemia: acute leukaemia and chronic leukaemia. For more information about leukaemia in general, please see Related topics. According to Cancer Research UK, 3,000 people are diagnosed with chronic leukaemia each year. This accounts for around 1 percent of newly diagnosed cancers in the UK. Chronic leukaemia tends to develop slowly, over many months or years. Types of chronic leukaemiaThere are two types of chronic leukaemia, depending on the type of white blood cells affected. The bone marrow produces two main types of white blood cells - lymphocytes and myelocytes - which work together to fight off infections. These two main types of acute leukaemia are as follows. Chronic lymphocytic leukaemia (CLL)This type is where there are abnormal cells in your bone marrow, which mature into slightly abnormal lymphocytes in the bloodstream that don't work properly and live longer than normal lymphocytes. CLL is the most common type of leukaemia. It's most common in people over 60, and is rare in people under 40. Chronic myeloid leukaemia (CML)This type is where there are abnormal cells in your bone marrow, which mature into slightly abnormal myeloid cells (sometimes called granulocytes) in the bloodstream. You may also hear this type of leukaemia referred to as chronic granulocytic leukaemia (CGL). It's most common in people aged between 40 and 60. SymptomsThe symptoms of chronic leukaemia are due to a lack of healthy white blood cells, red blood cells and platelets. Some people with chronic leukaemia - eg with stage A CLL or the chronic phase of CML - won't have any symptoms at first, and many of the symptoms are vague and seem like those of the flu. If you have any of these symptoms you should see your doctor, but it's important to remember that they may indicate other illnesses apart from chronic leukaemia. Symptoms of CML may include:
Symptoms of CLL may include:
CausesThere are different risk factors for CLL and CML. Some of the risk factors for developing CLL are as follows.
Some of the risk factors for developing CML are as follows.
DiagnosisDiagnosis, investigation, treatment and follow-up for people with leukaemia usually take place at specialist centres in hospitals. People with suspected leukaemia are referred to a specialist doctor, usually a haematologist - a doctor that specialises in the treatment of blood disorders. Tests that are often carried out to investigate the type of leukaemia and how far it has progressed include:
Other tests that your doctor may carry out include:
These tests are all very important because they help determine which treatment is best for you. Staging for chronic leukaemiaDoctors use a system called staging to measure how far the leukaemia has progressed. The stages for CML are as follows.
TreatmentIf you have been diagnosed with chronic leukaemia but have no symptoms, you may not need any treatment but will need to go to the hospital for regular check-ups. The treatment options depend on which type of chronic leukaemia you have. Treatments for CLLPeople with more advanced CLL may have the following treatments. ChemotherapyChemotherapy is the first and main treatment used to destroy the abnormal white blood cells in chronic leukaemia. There are over 50 chemotherapy drugs, all with slightly different side-effects. Your doctor will give you advice about the the side-effects of your specific chemotherapy drugs, and may prescribe medicines to help reduce any side-effects. SteroidsSteroid medicines may be prescribed at the same time as chemotherapy. They can reduce the side-effects of chemotherapy as well as treating CLL. Examples of these medicines include prednisolone and dexamethasone. These do have side-effects, and your doctor will give you further advice. Monoclonal antibodiesCertain cancers may also respond to treatment with monoclonal antibodies. Antibodies are molecules that are made naturally by our immune systems. Their role is to seek out foreign cells and kill them off. Monoclonal antibodies (eg rituximab) can be made in a laboratory and be designed to seek out particular cells. These can bind to the CLL cells and destroy them. RadiotherapyRadiotherapy may be used to treat enlarged lymph nodes or spleen. Bone marrow or peripheral stem cell transplantYounger people with CLL may be advised to have a bone marrow or stem cell transplant. A bone marrow transplant is where healthy bone marrow - either from another person (normally a close relative) or from your own bones - is fed into your bloodstream through a drip. High doses of chemotherapy and sometimes radiotherapy are given before the transplant to destroy all the bone marrow, both abnormal and normal. This improves the chance of completely curing the leukaemia. A peripheral stem cell transplant involves transplanting stem cells, rather than bone marrow cells. Stem cells can be collected (harvested) from your own blood or from another person and fed into your bloodstream through a drip. Supportive therapiesThese are other treatments that may be needed to control the symptoms of CLL. These treatments include having antibiotics to treat infections and blood transfusions to increase the number of red blood cells. Treatments for CMLTreatments for CML may include using natural substances such as a protein called interferon alpha that helps the immune system fight leukaemia. Interferon alpha is normally given by an injection every day or three times a week. This medicine can have side-effects, so your doctor will give you further advice. A newer treatment is a medicine called imatinib (Glivec). As the CML becomes more advanced, treatment may consist of mild chemotherapy (which can be in the form of tablets), bone marrow or stem cell transplantation, blood transfusion and antibiotics for infections. Further information
Sources
Related topics
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. Publication date: February 2008. Expected review date: February 2010.
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