Leukaemia can occur at any age and affects children and adults in different ways. In the adult there are two main forms of leukaemia depending on which of the two kinds of white cells the cancer affects, the lymphocytes or the leucocytes. There is also a chronic and an acute form of each.

Symptoms

Chronic lymphocytic leukaemia develops slowly, mainly in elderly people. Symptoms are so mild that the diagnosis is usually a chance finding, discovered during a routine blood test. When symptoms do occur they are both vague and generalised in nature- such as fatigue, lack of energy, fever, loss of appetite and weight, night sweats or anaemia. These can be associated with enlarged lymph nodes in the neck or groin and an enlarged spleen, which can be felt under the left ribs.

The signs of chronic myeloid leukaemia which arises in the other white cells, the leucocytes, are similar to those of chronic lymphatic leukaemia. They are usually more pronounced, but as a rule the disease is again discovered accidentally.

The symptoms of the two acute forms progress far more rapidly; there is bone pain, paleness, a tendency to bleed or bruise and lymph node or spleen enlargement.

Diagnosis

The diagnosis of all four forms is made on a blood test which usually shows blast cells (immature cells), as well as a low red and white blood cell count. An aspiration biopsy of the bone marrow (withdrawal of blood cells through a needle from the breastbone or pelvic bone) will be necessary to confirm the type of leukaemia and its degree of malignancy It also is used to monitor the progress of treatment.

Treatment

The acute forms of leukaemia are treated by combination chemotherapy, using a number of drugs simultaneously. This achieves destruction of cancer cells without permanent drainage to the normal blood constituents. Unfortunately, the advances made in the successful treatment of children’s acute lymphoblastic leukaemia have so far not been emulated in the adult leukaemias.

When malignant cells accumulate in the brain (where due to the unique properties of the blood vessels they might be safe from the drugs), radiotherapy to the brain is used to destroy them. If the disease recurs, the original abnormalities reappear and then it is common for a tendency for bruising and bleeding to develop. Chronic lymphocytic leukaemia has the better prognosis and such patients may be left untreated without risk for many years.

Side-effects from the drugs used may introduce a number of complicating problems. If the reproduction of platelets in the bone marrow has been damaged by the drugs, a platelet transfusion may occasionally be necessary to prevent bleeding. Sometimes platelets are withdrawn from a recovering patient and these are then frozen. If they are required after a relapse, they are re-injected into the patient.

Similarly, in case of a low white count, and associated proneness to infection, a transfusion of white cells can be given with beneficial effect. It is difficult, however, to obtain these cells in adequate amounts from normal blood donations. To control this increased liability to infection patients are now isolated in special germ-free rooms.