Leukaemia

General Information

• Cause: Acquired malignant transformation in the stem cell of the haemopoietic system.
• Course:
  • Acute Leukaemia: Rapidly fatal if untreated.
  • Chronic Leukaemia: Variable chronic course with an inevitable fatal outcome.

Age Ranges

• Acute Lymphatic Leukaemia (ALL):
  • Usual age range: 2–10 years, with a second peak at about 40 years.
• Acute Myeloid Leukaemia (AML):
  • Median age of presentation: 55–60 years.

Acute Leukaemia

Symptoms

• General Constitutional Symptoms:
  • Malaise
• Symptoms of Anaemia:
  • Fatigue
  • Weakness
  • Pallor
• Susceptibility to Infection:
  • Sore throat
  • Mouth ulceration
  • Chest infection
• Easy Bruising and Bleeding:
  • Epistaxis
  • Gingival bleeding
  • Petechiae
  • Ecchymoses
• Bone Pain:
  • Notably in children with ALL
• Joint Pain
• Symptoms Due to Infiltration of Tissues with Blast Cells:
  • Gingival hypertrophy (especially in AML)

Signs

• Pallor of anaemia
• Petechiae, bruising
• Gum hypertrophy/gingivitis/stomatitis
• Signs of infection
• Variable enlargement of liver, spleen, and lymph nodes
• Bone tenderness, especially sternum

Diagnosis

• Full Blood Examination (FBE) and Film:
  • Normochromic/normocytic anaemia
  • Pancytopenia with circulatory blast cells
  • Usually reduced platelets
• Bone marrow examination
• PCR studies
• Cytogenetics

Treatment

• Chemotherapy
• Immunotherapy
• Stem cell therapy

Note: Relapse of acute leukaemia often means imminent death unless bone marrow transplantation is successful. Mean 5-year survival rate:

• Childhood ALL: 75–80%
• Adult ALL: 30%
• AML (varies with age): about 20% over 55 years of age

Chronic Myeloid Leukaemia (CML)

Clinical Features

• Disorder of middle age (typically 40–60 years)
• Insidious onset
• Constitutional Symptoms:
  • Malaise
  • Weight loss
  • Fever
  • Night sweats
• Symptoms of Anaemia:
  • Fatigue
  • Weakness
• Splenomegaly:
  • Very large spleen causing abdominal discomfort
• Priapism
• Gout
• Hematological Findings:
  • Markedly elevated white cell count (granulocytes)
  • Marked left shift in myeloid series
  • Presence of Philadelphia chromosome

Chronic Lymphocytic Leukaemia (CLL)

Clinical Features

• Disorder of late middle age and elderly
• Insidious onset
• Constitutional Symptoms:
  • Malaise
  • Weight loss
  • Fever
  • Night sweats
• Lymphadenopathy:
  • Large rubbery nodes—neck, axilla, groin (80%)
• Moderately enlarged spleen and liver (about 50%)
• Mild anaemia
• Hematological Findings:
  • Lymphocytosis >15 × 10^9/L
  • ‘Mature’ appearance of lymphocytes
• Consider cytogenetics

Note: Most cases, especially early indolent CLL, require no specific therapy but observation.

Summary of Key Features

Aspect	Acute Lymphocytic Leukaemia (ALL)	Acute Myeloid Leukaemia (AML)	Chronic Myeloid Leukaemia (CML)	Chronic Lymphocytic Leukaemia (CLL)
Age Range	2–10 years, second peak at 40 years	Median age 55–60 years	Middle age (typically 40–60 years)	Late middle age and elderly
Onset	Rapid	Rapid	Insidious	Insidious
General Symptoms	Malaise, fatigue, weakness, pallor	Malaise, fatigue, weakness, pallor	Malaise, weight loss, fever, night sweats	Malaise, weight loss, fever, night sweats
Infection Susceptibility	Sore throat, mouth ulceration, chest infection	Sore throat, mouth ulceration, chest infection	—	—
Bleeding	Easy bruising, epistaxis, gingival bleeding, petechiae	Easy bruising, epistaxis, gingival bleeding, petechiae	—	—
Bone Pain	Notable, especially in children	—	—	—
Joint Pain	Present	—	—	—
Tissue Infiltration	—	Gingival hypertrophy	—	—
Splenomegaly	Variable	Variable	Very large, causing abdominal discomfort	Moderate
Lymphadenopathy	Variable	Variable	—	Large rubbery nodes (neck, axilla, groin)
Other Signs	Pallor, petechiae, bruising, signs of infection	Pallor, petechiae, bruising, signs of infection	Priapism, gout, marked elevated white cell count	Mild anaemia
Diagnostic Tests	FBE and film, bone marrow examination, PCR, cytogenetics	FBE and film, bone marrow examination, PCR, cytogenetics	Marked left shift in myeloid series, Philadelphia chromosome	Lymphocytosis, mature appearance of lymphocytes, cytogenetics
Treatment	Chemotherapy, immunotherapy, stem cell therapy	Chemotherapy, immunotherapy, stem cell therapy	—	Observation for early indolent cases
Survival Rate	Childhood: 75–80%, Adult: 30%	Varies with age, poorer over 55 years: 20%	—	—
Prognosis	Relapse often means imminent death without bone marrow transplantation	Relapse often means imminent death without bone marrow transplantation	—	—