Leukaemia
Related Subjects:
| Leukaemias in General
| Acute Promyelocytic Leukaemia
| Acute Myeloblastic Leukaemia (AML)
| Acute Lymphoblastic Leukaemia (ALL)
| Chronic Lymphocytic Leukaemia (CLL)
| Chronic Myeloid Leukaemia (CML)
| Hairy Cell Leukaemia
| Differentiation Syndrome
| Tretinoin (ATRA)
| Haemolytic Anaemia
| Immune Thrombocytopenic Purpura (ITP)
🧬 Leukaemia is a malignant disorder of the blood and bone marrow characterised by uncontrolled proliferation of abnormal white blood cells.
This disrupts normal haematopoiesis → causing anaemia, bleeding, and infection.
Different types of leukaemia vary in onset, severity, and prognosis, but all require timely recognition and treatment.
📖 Classification of Leukaemia
- Acute Leukaemia ⚡: Rapid progression, accumulation of immature "blast" cells. Requires urgent treatment.
- Chronic Leukaemia 🐢: Slower progression, abnormal but more mature cells, often discovered incidentally.
- Myeloid Leukaemia 🩸: Involves granulocytes, RBCs, or platelets derived from myeloid stem cells.
- Lymphocytic Leukaemia 🛡️: Involves lymphocytes (B, T, NK cells) derived from lymphoid stem cells.
🔬 Myeloid vs Lymphoid Lineage
- Lymphoid stem cell: B cells, T cells, NK cells
- Myeloid stem cell: RBCs, Platelets, Neutrophils, Monocytes, Eosinophils, Basophils
🧾 Types of Leukaemia
- Acute Lymphoblastic Leukaemia (ALL) 👶 – Most common in children, but also seen in adults.
- Acute Myeloid Leukaemia (AML) 🧓 – More common in adults, rapid onset, associated with myeloid blasts.
- Chronic Lymphocytic Leukaemia (CLL) 👴 – Commonest adult leukaemia in the West, slow progression.
- Chronic Myeloid Leukaemia (CML) 📉 – Driven by the Philadelphia chromosome (BCR-ABL), progresses through chronic → accelerated → blast crisis phases.
📊 Incidence and Notes
| Type | Incidence | Notes |
|---|
| ALL 👶 | ~9% | Most common childhood leukaemia; rapid progression if untreated. |
| CML 📉 | ~10% | Adults; linked to Philadelphia chromosome; average age ~64 yrs. |
| CLL 👴 | ~23% | Slow buildup of abnormal B cells; commonest leukaemia in elderly. |
| AML 🧓 | ~27% | Bone marrow packed with myeloid blasts; most cases >50 yrs. |
| Myeloproliferative Disorders 🔄 | ~31% | Include polycythaemia vera, myelofibrosis, essential thrombocythaemia. |
⚠️ Signs & Symptoms
- Fatigue, weakness, pallor (anaemia) 😴
- Frequent or severe infections 🤒
- Easy bruising, bleeding, petechiae 🩸
- Unexplained weight loss ⚖️
- Bone or joint pain 🦴
- Swollen lymph nodes or splenomegaly 🫁
🧪 Diagnosis
- Blood tests: Abnormal WBC, anaemia, thrombocytopenia.
- Bone marrow aspiration/biopsy: Confirms leukaemic blasts.
- Flow cytometry: Immunophenotyping to classify lineage.
- Genetic tests: e.g. BCR-ABL in CML, FLT3 in AML.
- Imaging: CT/ultrasound for lymphadenopathy or organomegaly.
📚 High-Yield Revision Summary
| Category |
Key Facts |
| 🔬 Definition |
Malignant proliferation of abnormal WBCs in bone marrow → disrupts normal haematopoiesis (anaemia, infection, bleeding). |
| 📖 Classification |
- Acute: Rapid, immature "blasts".
- Chronic: Slow, more mature cells.
- Myeloid: Affects granulocytes, RBCs, platelets.
- Lymphoid: Affects lymphocytes (B/T/NK).
|
| 🧾 Common Types |
- ALL: Children, rapid, good prognosis with treatment.
- AML: Adults >50, rapid, poorer prognosis.
- CLL: Elderly, slow, commonest adult leukaemia.
- CML: Middle-aged, BCR-ABL (“Philadelphia chromosome”), treat with TKIs.
|
| ⚠️ Symptoms |
- Fatigue, pallor (anaemia)
- Infections, fever (neutropenia)
- Easy bruising, bleeding (thrombocytopenia)
- Lymphadenopathy, splenomegaly
|
| 🧪 Key Investigations |
- Blood film: blasts or abnormal WBCs
- Bone marrow biopsy: diagnostic
- Flow cytometry: lineage
- Genetics: BCR-ABL (CML), FLT3 (AML)
|
| 💊 Management |
- Chemotherapy: Mainstay in acute leukaemias.
- Targeted therapy: TKIs (CML), ATRA (APL).
- Immunotherapy: CAR-T, monoclonal antibodies.
- Stem cell transplant: Curative option in selected cases.
- Supportive care: Transfusions, antibiotics, growth factors.
|
| 📈 Prognosis |
- ALL (children): Cure rates >80% 🎉
- CML: Excellent with TKIs, near-normal lifespan.
- AML: Poorer prognosis, especially in elderly.
- CLL: Often indolent, may not require immediate therapy.
|
💡 Exam Tip:
Think “Anaemia, Infection, Bleeding” as the classic triad of leukaemia presentation.
Always mention bone marrow biopsy for diagnosis and TKIs for CML in finals!
💊 Treatment Options
- Chemotherapy 💉: First-line for acute leukaemias.
- Targeted therapy 🎯: e.g. Imatinib for CML (BCR-ABL tyrosine kinase inhibitor).
- Immunotherapy 🛡️: CAR-T therapy, monoclonal antibodies (rituximab in CLL).
- Radiotherapy ☢️: For localised disease or CNS prophylaxis.
- Stem cell transplant 🌱: Potentially curative in high-risk/relapsed cases.
- Supportive care 🤲: Transfusions, antibiotics, growth factors.
📈 Prognosis
Prognosis depends on type, age, and cytogenetics.
✅ Childhood ALL – cure rates >80%.
✅ CML – near-normal life expectancy with tyrosine kinase inhibitors.
⚠️ AML in elderly – poorer prognosis, but improving with novel therapies.
Overall, advances in precision medicine and stem cell transplantation continue to improve survival outcomes.
