Leukaemia is a type of blood cancer that affects the blood, bone marrow, and lymphatic system. It is often grouped together with lymphoma and myeloma. While the disease can afflict people of any age, it occurs more commonly in adults over 50. Around 700 people in New Zealand are diagnosed with leukaemia each year.
Fortunately, early detection and treatment can improve survivorship outcomes. In this article, we discuss leukaemia’s symptoms, causes, types, and available treatments in New Zealand. Read on to learn more about the condition and how to protect yourself and your loved ones.
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Leukaemia causes and risk factors
Leukaemia is a type of cancer that occurs when abnormal blood cells are produced in the bone marrow and blood. It can be caused by a number of factors, including genetic mutations, exposure to radiation and certain chemicals, chemotherapy, age, gender, family history of leukaemia, and infection. While having one or more of these risk factors does not guarantee that a person will develop the disease, it is important to be aware of them and take steps to reduce exposure to potential triggers.
Symptoms and diagnosis of leukaemia
Early detection of leukaemia is difficult, as the disease can develop without clear symptoms. Regular medical check-ups and cancer screenings are essential, especially for those with risk factors.
If leukaemia is suspected, a doctor will order blood tests, a bone marrow aspiration and biopsy, and imaging tests to confirm the diagnosis and determine the extent of the disease.
Seeking medical attention immediately upon experiencing any symptoms of leukaemia can improve your chances of recovery.
The symptoms of leukaemia can vary depending on the type and stage of the disease. Signs become harder to ignore as the condition advances. Symptoms to look out for:
- Fatigue or weakness;
- Fever or chills;
- Shortness of breath;
- Night sweats;
- Weight loss or loss of appetite;
- Frequent infections;
- Easy bruising or bleeding;
- Pain or swelling in the abdomen, bones, or joints;
- Swollen lymph nodes, especially in the neck or armpits.
Types of leukaemia
Leukaemia is classified as either acute or chronic, depending on the speed of its progression, with the former requiring urgent treatment. It can also be categorised into lymphocytic or myelogenous according to the type of cells affected.
There are four major types:
- Acute lymphocytic leukaemia (ALL) - also known as acute lymphoblastic leukaemia. More prevalent in children.
- Acute myeloid leukaemia (AML) - more common in older adults.
- Chronic lymphocytic leukaemia (CLL) - most prevalent, accounting for approximately two-thirds of all cases. More common among older adults.
- Chronic myeloid leukaemia (CML) - initially progresses slowly but can eventually develop into a rapidly growing form of leukaemia.
Other types of leukaemia include:
- Hairy cell leukaemia (HCL)
- Chronic myelomonocytic leukaemia (CMML)
- Juvenile myelomonocytic leukaemia (JMML)
- Large granular lymphocytic leukaemia (LGL)
- Blastic plasmacytoid dendritic cell neoplasm (BPDCN)
- B-cell prolymphocytic leukaemia (B-PLL)
- T-cell prolymphocytic leukaemia (T-PLL).
Stages of leukaemia
Leukaemia is classified into four stages based on the type and progression of the disease. Each subtype has its unique staging system:
- Acute lymphocytic leukaemia is staged by the maturity of lymphocytes.
- Acute myeloid leukaemia is staged using the French-American-British system, categorising it into eight subtypes (M0 to M7) based on the appearance and lineage of the leukaemia cells when viewed under a microscope.
- Chronic lymphocytic leukaemia is staged using the Rai system, dividing CLL into five stages (Stage 0 to Stage IV) based on the number of lymphocytes in the blood, the number of lymph nodes involved, and the size of the liver and spleen.
- Chronic myeloid leukaemia is staged by the number of diseased cells detected in blood and bone marrow tests.
Leukaemia treatment
Determining the stage of leukaemia is crucial for treatment planning and prognosis prediction. Treatments vary depending on the type and stage of the disease and may include chemotherapy, radiation therapy, stem cell transplant, corticosteroids, and targeted therapy.
Patients with relapsed or refractory CLL and T-PLL may choose to include both Pharmac and non-Pharmac drugs, such as ibrutinib (Imbruvica) and Brentuximab vedotin, as part of their treatment. Each option has its benefits and drawbacks, and treatment depends on several factors, such as the overall health of the patient and the characteristics of the disease.
Follow-up care is necessary to monitor the disease's progression and to manage any side effects. A team of healthcare professionals provide support and guidance throughout the treatment journey.
Integrative medicine and complementary therapies
Integrative medicine combines traditional medical approaches with complementary therapies to address the ‘whole person’. Complementary therapies are non-medical practices that help manage symptoms and improve quality of life. These might include acupuncture, massage therapy, and herbal supplements, and may benefit leukaemia patients during and after treatment.
However, they are not a substitute for traditional medicine. Patients should work with their healthcare providers to ensure complementary therapies are safe to use and do not interfere with standard medical treatments.
Survivorship and follow-up care
Leukaemia survivors require expert medical care and support during the recovery phases, which include the following:
- Acute phase: Patients focus on managing the side effects of treatment and receiving emotional support.
- Extended phase: Includes regular medical check-ups, blood tests, and imaging tests to monitor the patient's health and mitigate recurrence.
- Permanent survivorship phase: Begins after several years of remission. Is focused on maintaining overall health and preventing the recurrence of leukaemia. Follow-up care may include regular medical check-ups, cancer screening, and emotional support.
During these phases, patients work with healthcare providers to create a personalised survivorship care plan that meets their needs and preferences.
Survival rates of leukaemia in New Zealand
New Zealand is ranked 43rd in the world for deaths caused by leukaemia, with 391 recorded in 2020 (accounting for 1.39% of all deaths). Leukaemia is the fifth most common cancer in this country, with around 750 people diagnosed each year and an incidence rate of 8.8 cases per 100,000 people, which is higher than the global average.
Five-year survival rates for the different types of leukaemia in New Zealand vary. Acute lymphoblastic leukaemia and chronic lymphocytic leukaemia have rates of around 80%; acute myeloid leukaemia, 30-40%; and chronic myeloid leukaemia, 80-90%. These statistics highlight the importance of early detection and effective treatment in improving outcomes for leukaemia patients in New Zealand.
Living with leukaemia
Living with leukaemia can cause physical and emotional stress. Managing treatment side effects - such as fatigue, nausea, and hair loss - by choosing healthy lifestyle practices is essential. Mental health issues related to the diagnosis and treatment of leukaemia may also arise, and professional counselling, mindfulness, self-care activities, and therapy can help patients cope with these challenges.
Building a strong network of family, friends, and healthcare providers supplies invaluable emotional support and practical assistance during the treatment and recovery process. With positive systems in place, finding a ‘new normal’ and continuing daily activities while living with leukaemia is absolutely possible.
Conclusion
Leukaemia affects around 1000 New Zealanders each year and has four main types. Although it can affect anyone, it is more common in adults over 50. Survival rates vary based on age, overall health, and the type of leukaemia. Proper treatment and care can allow many patients to live long and healthy lives.
Are you prepared for life’s uncertainties?
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