Leukaemia treatment journey overview in older adults

Overview

Leukaemia is a cancer that starts in the bone marrow, where blood cells are made. It causes large numbers of abnormal white blood cells to grow and crowd out healthy blood cells. The treatment journey for older adults focuses on controlling the disease, managing symptoms, and protecting quality of life.

Leukaemia is not as common as breast or lung cancer, but it is still a significant disease. In the UK, around 10,000 people are diagnosed with leukaemia each year, and the risk of developing it increases with age.

It mainly affects people over 60. The average age at diagnosis is around 65 for certain types, such as chronic lymphocytic leukaemia. However, it can occur at any age.

Symptoms

Common symptoms

• Feeling very tired that does not improve with rest
• Repeated infections or fevers that do not clear
• Unexplained weight loss
• Pale skin or breathlessness
• Bruising or bleeding easily
• Bone or joint pain

Symptoms in children

• Paleness, tiredness, and frequent infections
• Easy bruising, or small red or purple spots on the skin
• Fever with no clear cause
• Bone pain or a limp
• Swollen glands in the neck, groin, or armpits

Symptoms in older adults

• Persistent fatigue and weakness
• Shortness of breath with light activity
• Infections that are slow to heal
• Loss of appetite
• Night sweats
• New or worsening bruising

Causes

Main causes

• The exact cause is unknown. Leukaemia happens when a blood cell in the bone marrow develops DNA changes that make it produce many abnormal cells.
• It is not inherited from your parents in most cases, and it cannot be caught or spread.
• Most people with leukaemia have no known risk factors.

Risk factors

• Older age — most common after 60
• Previous cancer treatment with radiotherapy or chemotherapy
• Exposure to high levels of radiation
• Smoking
• Certain blood disorders or genetic conditions

When to see a doctor

See a doctor urgently if:

• If you have new, unexplained bruising or bleeding
• If you have a fever that isn't settling
• If you are breathless or much more tired than usual

Book a routine appointment if:

• If you have felt unwell for more than 2–3 weeks
• If you have persistent night sweats or weight loss
• If you are having frequent mild infections

Diagnosis

A blood test that shows abnormal cells is usually the first step. A specialist doctor (called a haematologist) will then examine a small sample of bone marrow to confirm the diagnosis, find the exact type of leukaemia, and plan the best treatment.

Tests that may be done

• Full blood count (FBC/CBC)
• Blood smear and flow cytometry
• Bone marrow biopsy
• Imaging scans such as CT or ultrasound
• Genetic tests on the leukaemia cells

What to expect at your appointment

If your doctor suspects leukaemia, you will be referred to a haematology team. They will explain everything and arrange the needed tests. A bone marrow biopsy is usually done under local anaesthetic, is quick, and causes little discomfort. The team will go through the results with you and discuss what they mean for your care.

Treatment

Treatment is tailored to your general health, the type of leukaemia you have, and your own goals. The aim may be to get rid of the leukaemia completely, or to keep it under control for as long as possible while protecting your quality of life. Older adults are often treated with gentler, more supportive approaches that focus on symptom control.

Self-care at home

• Rest when you need to, and pace yourself throughout the day.
• Protect yourself from infections with regular hand-washing and avoiding crowds when your immunity is low.
• Keep a diary of symptoms and side effects to discuss with your healthcare team.

Medical treatments

Treatment approaches for leukaemia may include chemotherapy, targeted therapy, immunotherapy, and sometimes a stem cell transplant (also called a bone marrow transplant). For some older adults, the best approach is watchful waiting — staying under close review and only starting treatment when symptoms appear. Your haematology team will outline the options, explain possible side effects, and support you in shared decision-making. They can also provide supportive care, such as blood transfusions, growth factors, antibiotics, and medicines to reduce nausea, to help you feel better during treatment.

When is surgery considered?

Surgery is not usually part of the treatment for leukaemia, because the disease is in the blood and bone marrow rather than a solid organ. In rare cases, if an enlarged spleen is causing symptoms, an operation to remove it might be considered. Your surgeon will explain the possible risks and benefits.

Living with this condition

Living with leukaemia means learning to adapt. You may have weeks for treatment and recovery, and other weeks where you feel more like yourself. Be gentle with yourself and let friends and family help. Keep your healthcare team informed about how you are feeling, both on good days and bad days.

Lifestyle tips

• Keep your home clean and stay away from people who are unwell.
• Find moments of rest and relaxation during the day.
• Continue doing the things you enjoy, when you feel able.

Diet and exercise

Eat a healthy, balanced diet that suits your appetite. If you lose your appetite, try smaller meals and snacks throughout the day. Gentle activity — such as short walks — can help with energy, mood, and sleep. Always check with your doctor before starting any new exercise routine, especially if your blood counts are low.

Mental health and emotional wellbeing

A cancer diagnosis can bring worry, stress, and sadness. It is completely normal to feel overwhelmed. Talk to your team if you are struggling emotionally; they can connect you to a counsellor or psychologist. Sharing your feelings with family, friends, or a support group can also make a real difference.

Prevention

There is no proven way to prevent leukaemia. However, you can lower your risk of some cancers by not smoking, keeping to a healthy weight, and avoiding unnecessary exposure to radiation. Taking care of other health conditions can also help you stay stronger if you ever need treatment.

Vaccines

While leukaemia itself is not preventable, keeping your immunisations up to date can help protect you from infections when your immune system is weaker. Your doctor will advise which vaccines are safe for you at different stages of your treatment.

Screening programmes

There is no national screening programme for leukaemia. Regular check-ups with your GP are still useful, especially if you notice new or changing symptoms.

Complications

If left untreated

• Anaemia, causing worsening tiredness, weakness, and shortness of breath
• Serious or life-threatening infections due to low levels of healthy white cells
• Abnormal bleeding, such as from your gums or as persistent bruises
• Weight loss and progressive loss of strength
• Very high abnormal white cell counts can thicken the blood and reduce blood flow to organs

Long-term outlook

Leukaemia can often be treated successfully. Treatments have improved greatly, even for older adults, and many people live with the disease for years. The long-term outlook depends on the exact type of leukaemia, your overall health, and how well the disease responds to treatment. Your healthcare team will always focus on the best possible quality of life for you, whatever your journey brings.

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