Leukaemia

Overview

Leukaemia is a cancer that starts in the bone marrow, the soft spongy tissue inside your bones. In leukaemia, the body makes too many abnormal white blood cells. These abnormal cells crowd out healthy blood cells, which can lead to infections, anaemia (low red blood cells), and bleeding problems.

Leukaemia is not extremely common, but it is one of the more common cancers that affect children and older adults. Around 10,000 people are diagnosed in the UK each year.

Leukaemia can affect people of all ages. Some types, like acute lymphoblastic leukaemia (ALL), are more common in children. Other types, like acute myeloid leukaemia (AML) and chronic lymphocytic leukaemia (CLL), are more common in adults over 60.

Symptoms

Common symptoms

• Feeling very tired and weak (fatigue)
• Frequent infections that take a long time to go away
• Easy bruising or bleeding, such as nosebleeds or bleeding gums
• A fever or night sweats with no clear cause
• Unexplained weight loss
• Bone or joint pain
• Swollen lymph nodes (glands) in the neck, armpit, or groin

Symptoms in children

• Pale skin and tiredness
• Bruises or small red spots (petechiae) on the skin
• Irritability or fussiness
• Swollen glands
• Bone pain that may make a child limp or refuse to walk
• Frequent infections

Symptoms in older adults

• Fatigue and weakness that does not get better with rest
• Shortness of breath with mild activity
• Frequent or severe infections
• Unexplained weight loss or loss of appetite
• Night sweats and low-grade fever

Causes

Main causes

• In most cases, the exact cause of leukaemia is not known. It happens when changes (mutations) occur in the DNA of blood-forming cells in the bone marrow.
• These mutations cause cells to grow and divide uncontrollably, crowding out normal blood cells.

Risk factors

• Age – risk increases with age for many types, though some are more common in children.
• Previous cancer treatment with certain chemotherapy drugs or radiation therapy (years earlier).
• Exposure to high doses of radiation, such as from atomic bomb fallout or some medical treatments.
• Certain genetic conditions, such as Down syndrome, Li-Fraumeni syndrome, or Fanconi anaemia.
• Smoking and exposure to benzene (a chemical found in cigarette smoke and some industrial settings).
• Family history – having a close relative with leukaemia slightly increases risk, but most cases occur in people with no family history.

When to see a doctor

See a doctor urgently if:

• Any symptom on the emergency list above – call 999 or go to A&E.
• A fever that does not improve with home care and lasts more than 24 hours.
• Sudden, severe bruising or bleeding for no reason.

Book a routine appointment if:

• If you have persistent fatigue, frequent infections, or unexplained weight loss that lasts more than a few weeks, make an appointment with your GP.
• If your child has ongoing paleness, bruising, or bone pain, see a paediatrician.

Diagnosis

Leukaemia is diagnosed through a series of tests. Your GP will refer you to a specialist doctor called a haematologist, who will perform blood tests and a bone marrow biopsy to confirm the diagnosis.

Tests that may be done

• Full blood count (FBC) – a blood test that counts the number of each type of blood cell. Abnormal levels can suggest leukaemia.
• Blood smear – a sample of your blood is looked at under a microscope to see if the cells look abnormal.
• Bone marrow biopsy – a small sample of bone marrow is taken (usually from the hipbone) using a needle, under local anaesthetic. This is the most important test to confirm leukaemia and determine the type.
• Cytogenetic and molecular tests – using the blood or bone marrow sample to look for specific genetic changes that help guide treatment.

What to expect at your appointment

The diagnosis process can take a few days to a week. You will likely see a haematologist and have the bone marrow biopsy done as an outpatient procedure. It is common to feel anxious while waiting for results. Your healthcare team should explain each step and give you time to ask questions.

Treatment

Treatment for leukaemia depends on the type (acute or chronic), your age, overall health, and the specific genetic features of the leukaemia cells. The goal may be to cure the disease, control it, or manage symptoms. Treatment usually begins soon after diagnosis, especially for acute types.

Self-care at home

• Rest when you feel tired. Fatigue is common, especially during treatment.
• Protect yourself from infections: wash your hands often, avoid crowded places when your immune system is weak, and stay up to date with recommended vaccinations (like the flu jab).
• Eat a balanced diet with plenty of protein and calories to help maintain strength. If mouth sores or nausea make eating hard, ask your team about soft foods or supplements.
• Keep a record of symptoms and side effects to share with your healthcare team.

Medical treatments

Medical treatment usually involves several phases. Chemotherapy is the main treatment for most types; it uses medicines that kill fast-growing cells, including leukaemia cells. Targeted therapy uses medicines that attack specific proteins or genetic changes in cancer cells. Immunotherapy helps your own immune system fight the leukaemia. Some patients may receive a stem cell transplant (also called bone marrow transplant) after high-dose chemotherapy to replace the diseased bone marrow with healthy donor cells. Treatment may also include steroids to help reduce swelling and kill leukaemia cells. Your haematologist will explain the plan in detail.

When is surgery considered?

Surgery is not a standard treatment for leukaemia itself. However, you may have a minor procedure to place a central line (a thin tube into a large vein) for easier delivery of chemotherapy and blood transfusions.

Living with this condition

Living with leukaemia involves balancing treatment side effects with daily life. You will have frequent hospital visits for blood tests, transfusions, and treatment. Many people continue working or studying with adjustments. It helps to plan around your energy levels and rest when needed.

Lifestyle tips

• Stay active with gentle exercise like walking, yoga, or stretching – it can help reduce fatigue and improve mood.
• Practice good hand and oral hygiene to lower infection risk.
• Avoid smoking, limit alcohol, and protect your skin from the sun, especially if you have had radiation or a transplant.
• Use a thermometer to check for fever regularly – an early sign of infection.

Diet and exercise

Eat a variety of foods to get enough calories and nutrients. If you have a low appetite, try eating small, frequent meals. Ask your doctor about safe exercise – many people can do light activity like walking. Avoid activities that may cause injury or bleeding (like contact sports) if your platelet count is low.

Mental health and emotional wellbeing

A leukaemia diagnosis can be very stressful. It is normal to feel scared, sad, angry, or overwhelmed. Depression and anxiety are common. Talk to your doctor or a counsellor about how you are feeling. If thoughts of self-harm or suicide arise, seek help immediately – call your local emergency number or a crisis helpline.

Prevention

In most cases, leukaemia cannot be prevented because the cause is not known. But you can lower your risk by avoiding known risk factors such as smoking, excessive exposure to benzene and other industrial chemicals, and unnecessary radiation exposure.

Vaccines

There is no vaccine to prevent leukaemia. However, staying up to date with recommended vaccines (like the flu shot and pneumonia vaccine) is important to prevent infections, especially if you have leukaemia or are receiving treatment that weakens the immune system.

Screening programmes

There is no routine screening test for leukaemia in people without symptoms. If you have a condition that increases your risk (like certain genetic disorders), your doctor may recommend periodic blood tests.

Complications

If left untreated

• Without treatment, leukaemia cells continue to multiply and crowd out healthy blood cells. This can lead to life-threatening infections, severe anaemia (causing extreme fatigue and shortness of breath), and serious bleeding (such as internal bleeding or stroke).
• Other organs may become affected, causing liver, spleen, or kidney problems.
• Acute leukaemia can progress rapidly and can be fatal within weeks or months if not treated.

Long-term outlook

The outlook for leukaemia has improved greatly over the past few decades. For children with the most common type (acute lymphoblastic leukaemia), cure rates are now over 90%. For adults, many forms of leukaemia can be successfully treated or controlled for many years. The type of leukaemia, your age, and your overall health all affect the prognosis. Even if a full cure is not possible, treatments can keep the disease in remission (no signs of cancer) for a long time. Your haematologist will give you a clearer picture based on your situation.

Find support

International organisations

• Leukaemia & Lymphoma Society ↗
• Cancer Research UK ↗

Local organisations

• Leukaemia Care ↗ · UK
• Macmillan Cancer Support ↗ · UK
• Blood Cancer UK ↗ · UK
• Anthony Nolan (stem cell transplant support) ↗ · UK

Helplines

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