Leukaemia

Leukaemia is cancer of the blood-forming cells in the bone marrow. Abnormal white cells crowd out normal blood production. There are four main types: acute lymphoblastic (ALL), acute myeloid (AML), chronic lymphocytic (CLL) and chronic myeloid leukaemia (CML).

The types behave very differently. Acute leukaemias develop over days to weeks and need hospital treatment immediately. Chronic leukaemias progress over years; CML is usually controlled with a daily tablet, and early CLL often needs only monitoring. ALL is the most common cancer of childhood.

Symptoms

• Tiredness, pallor and breathlessness from anaemia
• Frequent or persistent infections and fevers
• Easy bruising, nosebleeds, bleeding gums or tiny red spots on the skin
• Bone or joint pain, particularly in children
• Swollen glands in the neck, armpits or groin
• Fullness or discomfort under the left ribs from an enlarged spleen
• Night sweats and weight loss, or no symptoms at all in chronic forms found on a routine blood count

Causes and risk factors

Leukaemia results from genetic changes acquired in a blood stem cell during life; in nearly all cases these are not inherited and no cause can be found. Known risk factors include previous chemotherapy or radiotherapy, high radiation exposure, benzene, smoking for AML, certain blood disorders such as myelodysplastic syndromes, and Down syndrome. CML is driven by a specific abnormality called the Philadelphia chromosome, which produces the BCR-ABL protein that modern tablets block. CLL is mostly a disease of older adults and sometimes clusters in families.

How it is diagnosed

• Full blood count and blood film: Often the first clue, showing abnormal white cells, anaemia or low platelets.
• Bone marrow aspirate and biopsy: A sample from the back of the hip bone under local anaesthetic confirms the diagnosis and the type.
• Flow cytometry: Identifies the cell lineage precisely from markers on the cell surface.
• Cytogenetic and molecular tests: Detect chromosome and gene changes, such as BCR-ABL, FLT3, NPM1 or TP53, that determine risk group and treatment.
• Lumbar puncture and imaging: Checks for leukaemia in the spinal fluid in ALL, with scans as needed.

Treatment options

• Intensive chemotherapy: For acute leukaemias, starting with induction in hospital over about 4 to 6 weeks, followed by consolidation. Treatment of ALL continues with maintenance for 2 years or more.
• Targeted tablets: Tyrosine kinase inhibitors such as imatinib for CML, taken daily long term, and BTK or BCL2 inhibitors for CLL. Some targeted drugs are added in AML.
• Watchful waiting: Standard for early-stage CLL without symptoms, where starting treatment early has not been shown to help.
• Immunotherapy: Antibody treatments, and CAR T-cell therapy for certain relapsed leukaemias in specialised centres.
• Allogeneic stem cell transplant: Replacement of the marrow with a donor's cells, for high-risk or relapsed disease. It carries substantial risks and needs a matched donor.
• Supportive care: Transfusions, infection prevention and rapid treatment of fever throughout.

When it is urgent

Acute leukaemia is a medical emergency in its own right: if a blood test suggests it, go to the nearest haematology unit the same day and do not travel. At any stage, a temperature of 38 degrees or above, uncontrolled bleeding, severe headache, confusion or breathlessness need immediate hospital care close to home.

Travelling to Türkiye for treatment

Newly diagnosed acute leukaemia must be treated where you are; flying with very low blood counts is unsafe and delay is dangerous. Chronic leukaemias rely on regular blood tests and prescriptions over many years, which belong with a local haematologist. What a visit can sensibly offer is a second opinion with repeat molecular testing, or an evaluation for stem cell transplant once you are in remission. A transplant abroad means staying about 3 to 4 months with a carer, and the donor arrangements and post-transplant follow-up at home must be settled first.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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