What the diagnosis means
Leukaemias are grouped by how fast they develop (acute or chronic) and by the type of cell involved (myeloid or lymphoid):
- Acute myeloid leukaemia (AML) and acute lymphoblastic leukaemia (ALL) develop over days to weeks, with tiredness, infections, bleeding or bruising, and need treatment to start promptly. ALL is the commonest childhood cancer but also affects adults.
- Chronic myeloid leukaemia (CML) is driven by the BCR-ABL fusion gene and is now controlled for most people with a daily targeted tablet.
- Chronic lymphocytic leukaemia (CLL) often needs no treatment for years and is treated with targeted tablets or immunotherapy-based regimens when it progresses.
Diagnosis needs a blood count and film, a bone-marrow test, flow cytometry, and genetic/molecular studies — the results define the subtype, the risk group and the treatment.
Where medical oncology fits
This is a medical specialty's disease. Medical and haemato-oncologists diagnose, risk-stratify and treat leukaemia; surgery and radiation have very limited roles (radiation is occasionally used to the brain in ALL or for transplant conditioning). Dr Atreya is a medical and haemato-oncologist and treats leukaemia at Medanta Lucknow, including stem-cell (bone-marrow) transplantation where it is part of the plan.
Treatment by type
- Acute leukaemias: intensive chemotherapy in phases — induction to achieve remission, then consolidation; targeted drugs added for specific mutations (for example FLT3 in AML, BCR-ABL in Ph-positive ALL); immunotherapies for ALL; and a stem-cell transplant for higher-risk disease in remission. Older or less fit patients may be treated with lower-intensity combinations.
- CML: a daily tyrosine-kinase-inhibitor tablet with regular blood tests measuring BCR-ABL levels; treatment is usually long-term, and some patients eventually stop under close monitoring.
- CLL: "watch and wait" until treatment is needed, then targeted tablets (BTK or BCL-2 inhibitors) or chemo-immunotherapy depending on genetics and fitness.
What to expect
Acute leukaemia treatment usually starts in hospital and involves weeks with low blood counts: strict infection precautions, transfusions, and rapid treatment of any fever. Chronic leukaemia treatment is mostly outpatient with tablets and blood tests. Fertility preservation is discussed before intensive treatment where time allows.
Questions to ask
- Which exact type and subtype of leukaemia do I have, and what did the genetic tests show?
- What is the goal — cure, long-term control, or symptom control — and what are the phases of treatment?
- Is a stem-cell transplant likely to be part of my treatment, and where would it be done?
- What infection precautions do we need at home, and what is a fever emergency?
- For CML/CLL: what do the monitoring tests mean and how often are they needed?
Preparing for your consultation
Bring all blood count reports, bone-marrow, flow cytometry and cytogenetic/molecular reports, any transfusion records, and a medicine list. If you have fever, bleeding or severe weakness, say so when booking — acute leukaemia can be urgent.