Leukaemia is a type of blood cancer that affects white blood cells in the bone marrow - where blood cells are made. It is caused by an abnormal increase in white blood cells, which can crowd out other healthy cells in the body. There are several different types of leukemia, each with its own set of symptoms and treatments.

Types of Leukaemia

There are two broad classifications of the various types of leukaemia based on first, the rate of disease progression, and then, the type of white blood cells affected.

  • Rate of disease progression

    Acute (fast-growing) leukaemia and Chronic (slow-growing) leukaemia. Acute leukaemia develops rapidly and requires immediate medical attention, while chronic leukaemia progresses slower and over a longer period of time.
  • Types of white blood cells affected

    Lymphocytic leukaemia and Myeloid leukaemia.

Different subtypes of leukaemia are derived based on the above broad classifications, each with its own set of symptoms and treatments.

  • Acute Lymphoblastic Leukaemia (ALL)

    ALL is the most common type of leukaemia in young children which can also occur in adults. It begins in the lymphoid cells, which are responsible for the immune system's functioning.
  • Chronic Lymphocytic Leukaemia (CLL)

    CLL primarily affects adults and is characterised by the accumulation of abnormal lymphocytes in the blood, bone marrow, and lymph nodes. It is usually a slow-progressing form of leukaemia. Symptoms often appear at an advanced stage.
  • Acute Myeloid Leukaemia (AML)

    AML is a type of leukaemia that starts in the myeloid cells, which give rise to red blood cells, white blood cells, and platelets. It mainly affects adults but can occur in children as well.
  • Chronic Myeloid Leukaemia (CML)

    CML is characterised by the overproduction of myeloid cells, leading to the accumulation of immature white blood cells. It mainly affects adults and has a slow progression initially.

Causes & Symptoms

Leukaemia Causes & Risk Factors

The exact causes of leukaemia are still unknown, but several risk factors have been identified. These risk factors include:

  • Previous Cancer Treatment

    Individuals who have undergone certain types of chemotherapy or radiation therapy for other cancers have an increased risk of developing leukaemia.
  • Genetic Disorders

    Some genetic abnormalities, such as Down syndrome, Li-Fraumeni syndrome, and Bloom syndrome, are associated with a higher risk of leukaemia.
  • Exposure to Chemicals

    Long-term or large amount exposure to certain chemicals, such as benzene, which is found in gasoline and used in the chemical industry, has been linked to an increased risk of leukaemia.
  • Radiation Exposure

    High levels of radiation exposure, such as from atomic bomb explosions or therapeutic radiation, can increase the risk of developing leukaemia.
  • Smoking

    Smoking cigarettes has been found to be a risk factor for acute myeloid leukaemia (AML).
  • Family History

    Having a family history of leukaemia, particularly in first-degree relatives, may slightly increase the risk of developing the disease.

It is important to note that many patients with leukemia also have no identifiable risk factors.

Signs & Symptoms of Leukaemia

Symptoms of leukaemia can vary depending on the type of leukaemia and how far it has progressed. Common symptoms include:

  • Fatigue and feeling short of breath
  • Fever, chills and bone pain
  • Weight loss
  • Night sweats
  • Easy bruising or bleeding
  • Swollen lymph nodes

Diagnosis of Leukaemia

If there are signs and symptoms suggesting leukemia, more diagnostic tests may be required:

  • Blood Tests

    Blood samples are analysed to evaluate the number and appearance of blood cells, including white blood cells, red blood cells, and platelets.
  • Bone Marrow Aspiration and Biopsy

    A small sample of bone marrow is extracted from the pelvic bone or sternum using a needle. The sample is then examined under a microscope to identify any abnormal cells.

Treatment of Leukaemia

The treatment approach for leukaemia depends on several factors, including the type and subtype of leukaemia, the patient's age and overall health, and the stage of the disease. Some treatment options include:

  • Chemotherapy

    Chemotherapy drugs are used to destroy cancer cells and prevent their growth. Different combinations of drugs may be used depending on the type of leukaemia.
  • Targeted Therapy

    Targeted therapies specifically target cancer cells while sparing healthy cells. These treatments work by interfering with specific molecules or pathways involved in cancer growth.
  • Immunotherapy

    Immunotherapy helps to stimulate the body's immune system to recognise and destroy cancer cells. CAR-T cell therapy, for example, an immune-based treatment that allows patient's cells to identify and destroy cancer cells.
  • Stem Cell Transplantation

    Stem cell transplantation, also known as a bone marrow transplant, involves replacing damaged or destroyed bone marrow with healthy stem cells.
  • Supportive Care

    This includes treatments aimed at managing symptoms and side effects through blood transfusions, antibiotics, and / or pain management.

The leukaemia treatment plan may differ from patient to patient, depending on various factors such as type leukaemia, age and health. Personalised treatment programmes have been successful in the treatment of some leukaemia even at advanced stages. To achieve that, a multidisciplinary team of healthcare professionals at PCC, including oncologists, hematologists, and supportive care specialists, collaborate closely to provide suitable and individualised cancer care for each patient.

Prognosis of Leukaemia

The outcomes for many patients with leukaemia have significantly improved with advancements in treatment modalities, such as immunotherapy and targeted therapy. The prognosis however still depends on several factors, including the type and subtype of leukaemia, and the patient's overall health.

Children and young adults typically have higher survival rates compared to older adults. It is important to note that advancements in medical technology and treatment methods have significantly improved the prognosis and survival rates for many forms of leukaemia. Some types of leukaemia have a higher likelihood of achieving remission and long-term survival, while others may have a more aggressive course.

Prevention & Screening for Leukaemia

There is no routine screening for leukaemia although blood tests may help to indicate abnormality. While there is no guaranteed way to prevent leukaemia, certain lifestyle choices may help to reduce the risk. These include:

  • Eating a healthy diet rich in fruits and vegetables
  • Avoiding exposure to harmful chemicals, such as benzene
  • Quitting smoking and avoiding secondhand smoke
  • Limiting alcohol consumption
  • Maintaining a healthy weight
  • Participating in regular physical activity

Frequently Asked Questions (FAQ)

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Leukaemia is a relatively common cancer in Singapore. According to International Agency for Research on Cancer by World Health Organisation, there are approximately 684 cases leukaemia in Singapore across both sexes and all ages. It is also the most common childhood cancer in the world. In Singapore, about 150 children are diagnosed with cancer every year of which two-thirds are leukaemia cases.

There has been a steady increase in patients with blood cancers in Singapore. The latest figures from SEER, supported by National Cancer Institute in the US, show that the 5-year survival rate for all subtypes of leukemia is 65.7% . A 5-year survival rate looks at how many people are still alive 5 years after their diagnosis.

In addition to standard treatment approaches, ongoing research is focused on developing new and innovative treatment options for leukaemia. Experimental treatments, such as targeted therapies, immunotherapies, and CAR-T cell therapies, are being studied to improve outcomes and provide more effective and less toxic treatments for patients.