For GPs


Leukaemia is a cancer of blood-forming tissues, including bone marrow. It is caused by circulating abnormal immature white blood cells which are multiplying in an uncontrolled manner. They are further classified as acute or chronic, and the most common types arise from blood stem cells known as either myeloid or lymphoid.

Leukaemia can also arise in children where the commonest form is Acute Lymphoid Leukaemia (ALL). Acute lymphomas multiply within the bone marrow (inside our bones) and then flow through the blood stream.

If not treated urgently, the normal circulating cells can be overwhelmed with these abnormal cells.
This can lead to problems with increased susceptibility to infections, impaired blood clotting and a reduced capacity to carry oxygen.

Chronic leukaemia develops when old white blood cells refuse to die, and continue to build up in the blood stream. Here they slow the blood flow down, then block blood vessels, bone marrow and organs, which can lead to limited functioning of these tissues.

    • What are the Symptoms of Leukaemia?

      Common symptoms of leukaemia are severe tiredness, bleeding, easy bruising, fever and an increased risk of infection. In acute leukaemias, these symptoms may worsen very rapidly, and, as a result, treatment needs to start urgently, often within 24 hours.

      Many chronic leukaemias are picked up incidentally on blood tests completed for other reasons.
      They are often observed if the patient doesn’t have specific symptoms, and only treated if problems develop, or if the white cell count rises too high.

    • What are the Treatments for Leukaemia?

      Most leukaemias are treated with combination chemotherapy to put the leukaemia into remission (induction) and then keep it there (maintenance). Remission means the bone marrow contains fewer than 5% blast cells, the blood cell counts return to within normal limits, and there are no signs or symptoms of the disease. The chemotherapy used is tailored to the specific subtype of leukaemia.

      Acute lymphomas (ALL or AML) need to start urgent treatment as an inpatient with chemotherapy, whereas the chronic lymphomas (CLL or CML) can be observed with regular blood checks and treatment can be deferred until progression.

      Radiation therapy is used in very specific settings only.

      In some cases of childhood acute lymphoblastic leukaemia, radiation therapy is used to treat the cerebrospinal fluid in and around the brain (prophylactic cranial irradiation), to prevent leukaemia cells from “hiding” there, where many chemotherapy agents cannot cross into.

      Total Body Irradiation (TBI) is an essential part of preparation for bone marrow transplant, where the radiation therapy helps clear out the bone marrow before the donor marrow is infused.

      Radiation therapy may also be used to treat symptomatic deposits of both acute and chronic leukaemias in bone or soft tissue, when the leukaemia is no longer responding to chemotherapy (this is palliative radiation therapy, which usually involves external beam).

    • What are the Side Effects of Radiation Therapy?

      Prophylactic cranial irradiation has fallen out of common use recently, in favour of intrathecal or intravenous methotrexate for CNS prophylaxis. This is because there are fewer problems with late developmental delay or neurocognitive changes, especially in children.

      In other respects, leukaemia is very sensitive to radiation, and only low doses are required for local control and palliation of symptoms such as pain, bleeding, or obstruction. Therefore if low doses of radiation therapy are used, there are usually only mild side effects such as tiredness, or no side effects at all.

How Do I Enquire About Radiation Therapy with My Healthcare Professional?

The best person to discuss radiation therapy with for Lymphoma is a Radiation Oncologist. You can ask your Haematologist or General Practitioner for a referral to a Radiation Oncologist for a discussion about whether radiation therapy is a suitable treatment for you.

Visit ‘For GPs and other Health Professionals’ and ‘Talking to your doctor’ sections for further information.

Find your closest radiation oncology Treatment Centre

Page last updated: 24/11/2020