SJMC Cancer and Radiology
24/7 Careline
+603 56391212
+601 93171818
Teleconnect - Connected Care by SJMC

24-Hour Medical Enquiries

+603 5639 1818
+603 5639 1818
24/7 Careline
+603 5639 1212
+601 9317 1818
Teleconnect - Connected Care by SJMC

24-Hour Medical Enquiries

+603 5639 1818
+603 5639 1818
SJMC Teleconnect

24-Hour Medical Enquiries

+603 5639 1818

+603 5639 1818

SJMC Cancer and Radiosurgery Logo

Common types of cancer

Leukaemia

Common types of cancer

Leukaemia

Breast Cancer Brain Tumour Cervical Cancer Childhood Cancers Colorectal Cancer Leukaemia Liver Cancer Lung Cancer Lymphoma Myeloma Nasopharyngeal Cancer Ovarian Cancer Pancreatic Cancer Prostate Cancer
Common Types of Cancer

What is Leukaemia? (Blood Cancer Definition)

Leukaemia is a blood cancer. The term leukaemia is derived from a Greek word which literally means white blood. At SJMC’s Cancer and Radiosurgery Centre, we understand that the root cause of leukaemia is the uncontrolled production of abnormal white cells. These abnormal cells fail to mature properly, leading to various complications. Leukaemia is broadly classified into acute leukaemia and chronic leukaemia

Types of Leukaemia

Acute Leukaemia

In acute leukaemia, the disease progresses quickly, and the leukaemia cells are predominantly immature cells called blasts. Patients become ill within weeks and, if left untreated, will usually succumb to the disease within weeks or months.

There are two types of acute leukaemia:

ALL

Acute Lymphoblastic Leukaemia

AML

Acute Myeloid Leukaemia

The distinction is based on the fact that they arise from different cells.

In ALL, the leukaemic cells are of lymphoid origin, while in AML, the blasts are of myeloid origin.

There are marked differences in the biology and behaviour of these diseases, their treatment regimens and outcomes; hence the importance in differentiating them from each other.

Using the French-American British (FAB) classification, ALL is further subclassified into L1 to L3, while AML has subtypes Mo to M7. FAB classification is based on the morphological appearance of blasts.

It is useful to classify leukaemia as accurately as possible so that we can gain more understanding of each subtype by comparing results between various centres. The latest classification of acute leukaemia is the MIC (morphologic, immunologic, cytogenetic) classification which integrates morphology with the immunology and karyotype of the leukaemic cells.

Chronic Leukaemia Progression and Management

Chronic leukaemia, in contrast, has slow disease progression, and both mature and immature cells are seen. Patients may have symptoms for months, and prolonged survival (years) is possible, sometimes even with no treatment. Chronic leukaemia is similarly divided into two types; Chronic Myeloid Leukaemia (CML) and Chronic Lymphocytic Leukaemia (CLL). Again, the distinction is made on the basis of cell origin and individualised management.

Common Leukaemia Causes and Risk Factors

In the majority of patients with leukaemia, no predisposing causes can be identified.

However, we do know that exposure to radiation, certain chemicals (e.g., benzene) and viral infections (e.g., HTLV I (Human T-Cell Lymphotropic Virus 1)) can cause leukaemia.

It is not inherited except in a few unusual cases, e.g. children with Down's syndrome have an increased risk of getting acute leukaemia. The current concept of leukaemogenesis (how leukaemia arises) is that oncogene and tumour suppressor genes play essential roles, respectively both oncogene and tumour suppressor genes are genes that control cell production and ensure normal synthesis of blood cells.

However, in situations where they are out of control (deregulated) because of damage due to viral infection, chemicals or environmental exposures - the leukaemic process is set in motion. Leukaemia, like any other cancer, is not infectious and cannot be transmitted by any form of contact.

Recognising Leukaemia Symptoms and Signs

The three main blood cells produced by the bone marrow have specific functions:

Red blood cells

Red blood cells (RBC), which number several million in each drop of blood, are responsible for carrying oxygen to various organs together with nutrients and growth factors. They are the most abundant cells in the blood and give blood its red colour.

Platelets

Platelets are the smallest blood cells, but their function is critical as they rush to areas of damaged blood vessels and form a plug (clot) to stop the bleeding temporarily. Eventually, a stable clot forms at the same site with the incorporation of clotting factors.

White blood cells

White blood cells (WBC) (consisting mainly of neutrophils, lymphocytes and monocytes) are our "front-line soldiers" and defend the body against infection from bacteria, viruses and other organisms.

The infographic of blood types

In leukaemia, the "flooding" of the bone marrow by leukaemic cells will interfere with the normal production of blood cells. As a consequence, patients develop symptoms of anaemia (low haemoglobin due to low red cell production) and complain of feeling tired, short of breath on exertion, or palpitations (conscious feeling of their heartbeat). They are also prone to infection due to a lack of normal white cells (even though they may have a high white cell count, these are leukaemic cells and would not fight bacteria well).

They may also find that the infections do not seem to resolve, and they have a persistent fever. Due to low platelet count, they suffer from bleeding problems - e.g. easy bruising, bleeding from gums or nose and sometimes severe internal bleeding such as bleeding in the stomach or brain.

Symptoms of Acute Leukemia

the cells affected are very early in cell life; hence, the cells remain immature and do not function well. Patients with acute leukaemia, therefore, are more likely to suffer from anaemia, infections and bleeding.

Symptoms of Chronic Leukemia

the disease progression is slow and the cells affected are more mature cells which retain some of their normal functions. As a result, some patients may have no symptoms initially. As the disease progresses, they can have the symptoms described earlier.

Stages of Leukaemia

Leukaemia is a blood cancer, and its progression is assessed differently from most other cancers. Cancerous white blood cells circulate throughout the bloodstream and bone marrow from the point of diagnosis. Staging is therefore determined through blood cell counts, bone marrow findings, and organ enlargement, not tumour size. Each type of leukaemia has its own classification system.

1
Acute Leukaemia (ALL and AML)

Acute Lymphoblastic Leukaemia (ALL) and Acute Myeloid Leukaemia (AML) do not use a traditional numbered staging system. Instead, doctors classify the disease based on a few factors: 

  • The percentage of blast cells (immature cancer cells) in the blood and bone marrow.
  • Genetic and chromosomal abnormalities found in the cancer cells.
  • The patient's age and overall blood cell counts.
  • The current disease phase: untreated, in remission, or recurrent.

The primary treatment goal for acute leukaemia is remission, a state in which no leukaemia cells are detectable in the body.

1
Chronic Leukaemia (CLL and CML)

Chronic leukaemia progresses more slowly and is classified using established staging systems.

Chronic Lymphocytic Leukaemia (CLL) is staged using the Rai system, ranging from Stage 0 to Stage IV:

  • Stage 0: High lymphocyte count in the blood with no other symptoms.
  • Stage I: Swollen lymph nodes are present.
  • Stage II: The spleen or liver has become enlarged.
  • Stage III: Anaemia (low red blood cell count) has developed.
  • Stage IV: An excessive number of lymphocytes in the blood and platelet count has dropped, increasing bleeding risk.

Chronic Myeloid Leukaemia (CML) is classified into three phases based on the percentage of blast cells:

  • Chronic Phase: Fewer than 10% blast cells. Symptoms are mild and respond well to treatment.
  • Accelerated Phase: 10% to 19% blast cells. Disease progression is faster and harder to control.
  • Blastic Phase: 20% or more blast cells. Requires intensive clinical care.

Leukaemia Diagnosis: Blood Tests and Examinations

Doctor discussing leukemia treatment with a smiling patient.

Blood test 

The attending doctor would need a sample of blood. A blood cell counter machine is used to measure the blood count consisting of haemoglobin, white cell count and platelet count. If healthy, the blood count falls within a range known as the normal range. Abnormalities in the blood count would alert the doctor that something is amiss. In acute leukaemia, the haemoglobin and the platelet count tend to be low, while the white cell count could be high, normal or even low.

The next step is to examine the stained blood film under the microscope. The presence of abnormal white cells or blasts and abnormal blood count.

Bone marrow examination

This is the procedure where a small sample of bone marrow is obtained from the iliac crest or sternum using a specially designed needle. The bone marrow aspirates are smeared and stained. The marrow slides are then examined by a haematologist or hematopathologist using a microscope, and a formal written report will follow.

Acute Leukaemia Treatment and Induction Therapy

The aim of the treatment is to restore the normal synthesis of blood cells (haematopoiesis). At SJMC, our goal is to eliminate the predominant abnormal cells, which are the leukaemic cells or blasts, and allow normal cells to re-populate the marrow. This is achieved through the use of cytotoxic drugs, administered under the close supervision of our experienced specialists.

1ST
STEP

THE FIRST STEP WILL BE TO ACHIEVE REMISSION, WHICH MEANS THERE IS NO MORE EVIDENCE OF LEUKAEMIA

THIS WILL USUALLY TAKE 4-6 WEEKS, AND THIS PERIOD OF TREATMENT IS CALLED INDUCTION THERAPY.

As patients have minimal normal marrow reserve, the induction period is the most dangerous treatment period. This is because they tend to have low blood counts and are prone to life-threatening infections or bleeding even with supportive therapy. Failure to achieve remission despite adequate treatment is a poor prognostic feature, though about 15% of such patients could be salvaged with "early" allogeneic bone marrow transplant.

AFTER A MONTH

About a month after the initiation of induction therapy, a repeat marrow examination is done to assess the response to chemotherapy.

A complete remission (CR) means the return of normal blood count with a normocellular marrow with blast constituting less than 5% of the nucleated cells in the marrow.

ONCE REMISSION IS ACHIEVED,

it is mandatory for patients to have follow-up therapy (post-remission treatment). It has been estimated that 1012 leukaemic cells are present at disease presentation, and after remission has been achieved, there is still 108 leukaemic cells present in the body. Hence, if no post-remission treatment is given, the disease invariably returns. This is an important point that cannot be overemphasised, as occasional patients still opt to stop treatment because they feel 'normal' after attaining CR.

The treatment of acute leukaemia should be started as soon as possible. Sometimes, cytotoxic treatment is withheld for a day or two to ensure any concurrent infection or bleeding are under control. Withholding treatment to wait for a 'better' blood count is unwise as the blood count will not improve unless the underlying problem, i.e. leukaemia, is tackled. Patients with low blood counts would need to be supported with blood products during the treatment period.

Patients are usually admitted for the period of intensive induction chemotherapy. This is to allow close monitoring of patients to treat complications related to the disease, and urgent treatments such as administration of IV antibiotics or blood transfusions are necessary as some patients can deteriorate very quickly. Once remission is achieved, some of the remaining treatments can be done as an outpatient/daycare setting.

FAQs About Leukaemia

How much does leukemia treatment cost in Malaysia?

Leukemia treatment costs in Malaysia vary widely based on the required medical modalities. Some factors influencing the total cost include the number of induction and consolidation chemotherapy cycles, the use of targeted therapy medications, the need for a bone marrow transplant, and the length of hospital stay. Patients should consult directly with Subang Jaya Medical Centre (SJMC) hematologists for a personalized financial estimate.

What are the symptoms of leukaemia?

The symptoms of leukaemia often develop as abnormal white blood cells crowd out healthy blood cells in the bone marrow. Common early warning signs of leukaemia include:
• Persistent fatigue and weakness.
• Frequent or severe bacterial/viral infections.
• Easy bruising or bleeding (e.g., bleeding gums or frequent nosebleeds).
• Unexplained fever or severe night sweats.
• Swollen lymph nodes, or an enlarged liver or spleen.

How is leukaemia diagnosed?

Diagnosing leukemia requires a step-by-step clinical evaluation by a hematologist to confirm the presence and exact type of cancer cells. The process typically involves:
1. Physical Examination: Checking for physical abnormalities like pale skin, swollen lymph nodes, or an enlarged spleen.
2. Complete Blood Count (CBC): A comprehensive blood test to detect abnormal levels of white blood cells, red blood cells, and platelets.
3. Bone Marrow Biopsy: Extracting a small sample of bone marrow (usually from the hip bone) for microscopic laboratory analysis to definitively identify leukaemia cells and their genetic mutations.

Who is most at risk for developing blood cancer?

Individuals most at risk for developing blood cancer (leukaemia) include those with a history of prior cancer treatments (such as radiation or chemotherapy), prolonged exposure to high levels of radiation or certain industrial chemicals like benzene, a history of smoking, and those with specific pre-existing genetic or blood disorders.

How can leukaemia be cured?

Leukaemia can often be cured or put into long-term remission, depending heavily on the specific type, subtype, and the patients age. Treatment strategies for leukaemia typically involve intensive chemotherapy to destroy cancer cells, targeted therapies to block cancer growth, and in severe or relapsed cases, a bone marrow (stem cell) transplant to restore healthy blood production.

What are the main types of leukaemia?

Leukemia is broadly categorized into four main types based on its progression rate (acute vs. chronic) and the type of white blood cell affected (lymphoid vs. myeloid). The four primary types of leukaemia are:
• Acute Lymphoblastic Leukemia (ALL)
• Acute Myeloid Leukemia (AML)
• Chronic Lymphocytic Leuemia (CLL)
• Chronic Myeloid Leukemia (CML)

How do hematologists determine the best chemotherapy plan for acute myeloid leukaemia?

Hematologists determine the optimal chemotherapy plan for Acute Myeloid Leukaemia (AML) through a multi-step evaluation. First, they conduct genetic profiling on the leukaemia cells to identify targetable vulnerabilities. Next, they evaluate the patients age and overall organ function. Finally, they structure the treatment into an aggressive "induction phase" to achieve rapid remission, followed by a customized "consolidation phase" to destroy any remaining microscopic cancer cells.

Why is a bone marrow transplant recommended for certain types of leukemia?

A bone marrow transplant (stem cell transplant) is recommended for high-risk or relapsed leukemia because the necessary high-dose chemotherapy destroys both the leukemia cells and the patients healthy bone marrow. The transplant is a critical rescue procedure that replaces the destroyed marrow with healthy stem cells, allowing the body to rebuild a functional, cancer-free blood and immune system.

When should a patient seek immediate medical attention for suspected leukaemia?

A patient should seek immediate medical attention if they experience a sudden onset of severe, unexplained symptoms that do not resolve with standard rest or basic medication. Critical red flags include uncontrollable bleeding, sudden and extreme fatigue preventing daily activities, persistent high fevers, or the rapid appearance of multiple unexplained bruises or petechiae (tiny red spots under the skin).

Watch more videos on our YouTube Channel

Let us journey with you

Make an appointment
Enquire more