Leukaemia – the latest treatment options

Leukaemia literally means 'white blood' and is when there are too many white blood cells in the blood circulation. This can be caused by overproduction of white blood cells in the bone marrow, or by cells not maturing normally in that environment.

What are the different types of leukaemia?

The main types of leukaemia are either chronic, which can develop slowly over months and years, or acute leukaemia which can develop in a few days.

Acute leukaemia, such as acute lymphoblastic leukaemia, tend to occur in younger children, whereas older adults will tend to develop acute myeloid leukaemia.

Chronic leukaemia mainly occurs in adults, the most common type is chronic lymphocytic leukaemia, which may not require any treatment whatsoever.

How is leukaemia treated?

Different leukaemias require different treatments, some chronic leukaemias are simply observed over years and may never require any treatment. Other treatments include tablets, of which some now are targeted at certain abnormal genes in the leukaemia cells. Many patients will stay on these tablets all of their life, with minimal or no side effects and are effectively cured with the use of a tablet.

Other types of treatments involve the use of oral chemotherapy, which can be used for some chronic types of leukaemia.

Acute leukaemias tend to need more intensive treatment, which usually involves treatment in the hospital with intravenous chemotherapy which is intensive and often will require regular antibiotic therapy and transfusions.

What is stem cell treatment?

Some patients will also need a stem cell transplant. Stem cells are the cells in the bone marrow that make all the other cells, and stem cell transplantation can allow for a higher cure rate in some of the aggressive types of the leukaemia.

Stem cells are used to allow the doctors to give higher doses of treatment for patients with leukaemia and lymphoma, allowing for a higher cure rate.

How are stem cells obtained?

Stem cells can be obtained either from the patient themselves, or from a tissue type match donor. In general, using the patient’s own stem cells is called autologous stem cell transplantation, and is mainly used for patients with lymphoma, or multiple myeloma.

For patients with leukaemia, donor stem cells tend to be used, the source of stem cells can either be a brother or sister. There is a roughly one in four chance of any brother or sister being a tissue match with the patient. If the sibling is not a match then alternative donors from either unrelated donor volunteer banks, of which there are now over 25 million people worldwide who are potential donors on those banks.

More recently half-matched family members have been used, which would mean that any parent, or any child of a patient would be a half match, and will therefore be much more likely to find donors for almost every patient.

What happens during a stem cell donation?

The donor needs to be a tissue match with the patient, and therefore routine blood test are done to confirm they are a match. The donor will need to have a routine medical, which is like an insurance medical, to make sure they are fit to be a donor.

Historically, stem cells tend to be collected from the bone marrow where they are in a steady state, but in more recent years they have tended to be collected from the blood, which is a much easier procedure.

Bone marrow collection involves the use of a general anaesthetic and usually a stay in the hospital, whereas collecting stem cells from the blood can be done by giving the donor a blood hormone which moves the stem cells from the bone marrow into the blood, which allows the stem cells to be collected from the blood. This procedure is usually done on a single morning as an outpatient.

Collecting stem cells from a donor is very safe, and usually involves no long-term side-effects.