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 | — | — |