Leukaemia

What is Leukaemia?

Leukaemia is a type of cancer that affects the body's blood-forming tissues, particularly the bone marrow and blood. It usually involves abnormal white blood cells that multiply or accumulate abnormally and do not function properly. As these cells increase, they can crowd out healthy red blood cells, white blood cells and platelets in the bone marrow. This can contribute to anaemia, infections and abnormal bleeding.

Leukaemia is not one single disease. It includes several types that differ according to the blood cell affected and how quickly the condition progresses. Some forms develop rapidly and require prompt treatment, while others progress more slowly and may initially cause few or no symptoms.

What are the Types of Leukaemia?

Doctors generally classify leukaemia according to how quickly it progresses and which type of blood-forming cell is affected. Check out the various types of leukaemia below:

How Common Is Leukaemia in India?

Leukaemia affects both children and adults, but its occurrence varies depending on the subtype, age and sex of the individual. It is one of the leading blood cancers worldwide and contributes significantly to the overall burden of cancer in India.

As per a 2024 study analysing data from the Global Burden of Disease (GBD) reported that leukaemia accounted for approximately 6.8% of all malignancy-related disability-adjusted life years (DALYs) between 1990 and 2019, ranking sixth among all cancers in terms of disease burden.

The study also found that leukaemia was more common among males than females, with males showing a slightly higher prevalence. Leukaemia accounted for around 7.1% of all malignancies among men and 6.4% among women during the study period.

What are the Symptoms of Leukaemia?

Leukaemia symptoms can develop gradually or appear more quickly, depending on the type and progression of the disease. Early symptoms may be subtle and can resemble common infections, anaemia or other health conditions. As the disease progresses, reduced production of healthy blood cells can cause more noticeable problems with immunity, oxygen delivery and blood clotting.

Some of the early and advanced symptoms of leukaemia are as follows:

Diseases Similar to Leukaemia

People may sometimes confuse leukaemia with other blood and bone marrow disorders because several conditions can cause symptoms such as fatigue, weakness, frequent infections, easy bruising or abnormal blood counts. However, these conditions differ in how they develop, the blood cells they affect, their progression and treatment options.

Below is a comparison to help distinguish conditions such as lymphoma, myelodysplastic syndrome and aplastic anaemia from leukaemia:

Leukaemia vs. Lymphoma vs. Myelodysplastic Syndromes vs. Aplastic Anaemia

What Causes Leukaemia?

The exact cause of leukaemia is not known. It generally develops after genetic changes occur in blood-forming cells, causing them to grow and divide abnormally or survive when they normally would not. Over time, abnormal cells can interfere with the production of healthy blood cells.

These genetic changes may arise during a person's lifetime or, in some cases, be associated with inherited genetic conditions. Having a risk factor does not mean that leukaemia will definitely develop.

What are the Risk Factors for Leukaemia?

Several factors have been associated with an increased risk of particular types of leukaemia. The most common risk factors for leukaemia are as follows:

• Previous Cancer Treatment: Certain chemotherapy medicines and radiation therapy used to treat earlier cancers can increase the risk of developing some forms of leukaemia later.

• Exposure to Radiation: High levels of ionising radiation have been linked with an increased risk of certain leukaemias.

• Benzene Exposure: Long-term or significant exposure to benzene is associated with an increased risk of some types of leukaemia, particularly AML.

• Smoking: Smoking is an established risk factor for AML.

• Certain Genetic Conditions: Some inherited conditions are associated with an increased risk of leukaemia. Down syndrome, for example, is associated with a higher risk of certain childhood leukaemias.

• Previous Blood Disorders: Some blood or bone marrow disorders, including myelodysplastic syndromes, may increase the risk of developing AML.

• Age: The risk for people of different ages varies considerably according to the leukaemia type. Some forms are more common in children, whereas chronic leukaemias are more frequently diagnosed in adults.

Importantly, many people who develop leukaemia have no identifiable risk factor.

What are the Complications of Leukaemia?

Leukaemia can cause complications because abnormal blood cells interfere with the normal production and function of red blood cells, white blood cells and platelets. Some complications may also develop as a result of treatment. Common complications associated with leukaemia are given below:

• Infections: Reduced numbers or impaired function of normal white blood cells can weaken the immune system, increasing the risk of bacterial, viral and fungal infections.

• Anaemia: A shortage of healthy red blood cells can cause tiredness, weakness, dizziness, shortness of breath and pale skin.

• Bleeding and Bruising: Low platelet levels may lead to easy bruising, frequent nosebleeds, bleeding gums, prolonged bleeding from minor injuries or small red or purple spots on the skin.

• Severe Bleeding: Very low platelet counts can occasionally result in serious internal bleeding, including bleeding in the gastrointestinal tract or brain.

• Enlarged Organs: Leukaemia cells may accumulate in the spleen, liver or lymph nodes, causing swelling or discomfort.

• Bone and Joint Pain: Accumulation of abnormal cells in the bone marrow can cause pain or tenderness in the bones and joints.

• Central Nervous System Involvement: In some types of leukaemia, abnormal cells may spread to the brain or spinal cord, potentially causing headaches, vomiting, seizures or neurological symptoms.

• Tumour Lysis Syndrome: Rapid destruction of large numbers of leukaemia cells, particularly after treatment begins, can release substances into the blood and disturb electrolyte levels, potentially affecting the kidneys, heart and other organs.

• Blood Clots: Certain forms of leukaemia and some treatments can increase the risk of abnormal blood clot formation.

• Treatment-related Complications: Chemotherapy, targeted therapy, radiation therapy and stem cell transplantation can cause complications such as infections, organ damage, infertility or secondary cancers, depending on the treatment used.

The type and likelihood of complications vary according to the type of leukaemia, its severity, the person's overall health and the treatment received. Regular monitoring helps doctors identify and manage complications early.

When Should I See a Healthcare Provider?

Consider consulting a doctor if you experience persistent or unexplained symptoms such as:

• Tiredness that does not improve with adequate rest

• Repeated infections

• Unexplained bruising or bleeding

• Frequent nosebleeds

• Persistent fever

• Unexplained weight loss

• Persistent bone or joint pain

• Swollen lymph nodes

• Breathlessness or unusual paleness

Since these symptoms overlap with many other conditions, they cannot confirm leukaemia by themselves. A doctor may recommend blood tests to investigate the cause.

Acute leukaemia can progress quickly, so symptoms that appear suddenly or worsen rapidly should not be ignored.

How is Leukaemia Diagnosed?

A diagnosis usually involves a combination of medical history, physical examination, blood tests and, when required, examination of the bone marrow. The common diagnostic tests used to detect leukaemia are as follows:

Diagnostic Summary Table

How is Leukaemia Treated and Managed?

Leukaemia treatment depends on several factors, including the type and subtype of leukaemia, genetic and molecular characteristics, age, overall health, disease phase or risk category, response to previous treatment and whether the central nervous system or other areas are affected.

Treatment may involve one approach or a combination of therapies. The common treatments recommended by doctors are as follows:

Treatment should always be individualised by a haematologist or oncology team because the same treatment is not appropriate for every type of leukaemia.

Common Medicines Used to Treat Leukaemia

Medications for leukaemia vary according to the type of leukaemia, disease characteristics, age, overall health and response to previous treatment. In India, chemotherapy remains important for acute leukaemias, while targeted medicines and monoclonal antibodies are increasingly used for conditions such as CML and CLL.

Some commonly used medicines to treat leukaemia are given below:

• Cytarabine: A chemotherapy medicine commonly used for acute myeloid leukaemia (AML) and also included in some acute lymphoblastic leukaemia (ALL) treatment protocols.

• Daunorubicin: An anthracycline chemotherapy medicine frequently combined with other drugs during induction treatment for AML and ALL.

• Idarubicin: An anthracycline that may be combined with cytarabine as part of AML chemotherapy.

• Azacitidine: A hypomethylating medicine used particularly for AML patients who may not be suitable for intensive chemotherapy.

• Decitabine: Another hypomethylating medicine that may be used as a less-intensive treatment option for selected AML patients.

• Venetoclax: A targeted BCL-2 inhibitor used in AML and chronic lymphocytic leukaemia (CLL), usually in combination with other medicines.

• All-Trans Retinoic Acid (ATRA): A key medicine for acute promyelocytic leukaemia (APL) that helps abnormal leukaemia cells mature into more normal cells.

• Arsenic Trioxide (ATO): Commonly used with ATRA to treat APL and has an established role in APL treatment in India.

• Vincristine: A chemotherapy medicine widely included in combination treatment protocols for ALL.

• Corticosteroids: Prednisolone and dexamethasone are commonly included in ALL treatment regimens to help destroy leukaemia cells.

• Asparaginase: An important component of many ALL treatment protocols, particularly in children, adolescents and young adults.

• Imatinib: A targeted BCR::ABL1 tyrosine kinase inhibitor widely used for chronic myeloid leukaemia (CML) and Philadelphia chromosome-positive ALL.

• Dasatinib: A BCR::ABL1-targeted medicine used for CML and Philadelphia chromosome-positive ALL, including in some patients who cannot continue imatinib.

• Nilotinib: A tyrosine kinase inhibitor used for the treatment of BCR::ABL1-positive CML.

• Ibrutinib: A Bruton tyrosine kinase (BTK) inhibitor used as a targeted treatment for CLL and certain other B-cell cancers.

• Acalabrutinib: A newer BTK inhibitor used for CLL, including as a treatment option available to patients in India.

• Rituximab: A monoclonal antibody targeting CD20 that may be incorporated into treatment regimens for certain B-cell leukaemias, particularly CLL.

• Obinutuzumab: A CD20-targeting monoclonal antibody that may be combined with medicines such as venetoclax or acalabrutinib for selected patients with CLL.

Note: The exact medicine or combination is selected by a haematologist or oncologist based on the specific type and genetic characteristics of the leukaemia, the person's health, previous treatment and response to therapy.

Living With Leukaemia: Challenges and Caregiving

Leukaemia treatment can be physically and emotionally demanding, particularly when treatment involves prolonged chemotherapy, hospital stays or stem cell transplantation.

Some of the common challenges and caregiving requirements of patients living with leukaemia can include:

What is the Prognosis for Leukaemia?

The prognosis varies substantially according to the type of leukaemia and individual patient conditions. It cannot be predicted from the diagnosis alone.

Factors that can influence prognosis include:

• Type and subtype of leukaemia

• Age at diagnosis

• Genetic and molecular characteristics

• White blood cell count and other laboratory findings

• Response to initial treatment

• Presence of disease in the central nervous system or other areas

• Whether the disease has returned after treatment

• Overall health

Some leukaemias can be cured, while others can be controlled for many years with ongoing treatment. For example, some people with chronic leukaemia may require long-term treatment or monitoring rather than immediate intensive therapy.

For childhood cancer, access to timely diagnosis and appropriate treatment has a major influence on outcomes. The WHO reports that more than 80% of children with cancer can be cured in high-income countries, while survival remains substantially lower in many low- and middle-income countries because of barriers to diagnosis, treatment access and supportive care.

Can Leukaemia Be Prevented?

Most cases of leukaemia cannot be prevented because the condition often develops due to genetic changes in blood-forming cells that occur randomly. These changes are usually not caused by anything a person has done, and there are currently no guaranteed methods to prevent leukaemia.

However, certain measures may help reduce exposure to some known risk factors associated with specific types of leukaemia. These include:

• Avoid Unnecessary Radiation Exposure: Exposure to high levels of ionising radiation is associated with an increased risk of leukaemia. Medical imaging tests should only be performed when recommended by a doctor.

• Reduce Exposure to Harmful Chemicals: Long-term exposure to certain chemicals, such as benzene, has been linked to an increased risk of leukaemia. Following workplace safety measures can help reduce exposure.

• Avoid Smoking: Smoking is associated with an increased risk of several cancers, including some forms of leukaemia, such as acute myeloid leukaemia (AML). Avoiding tobacco use may help lower this risk.

• Maintain Workplace Safety: People working in industries involving chemicals, radiation or other potentially harmful exposures should follow recommended protective measures.

Leukaemia Treatment Cost in India

The treatment cost of leukaemia in India can vary considerably depending on the type of leukaemia, treatment protocol, medicines used, duration of therapy, hospital, and whether a stem cell transplant is required for the patient. The overall treatment cost may range from around ₹5 lakh to ₹40 lakh, while some patients with standard non-transplant treatment may incur lower costs.

The table below provides the estimated costs of leukaemia treatment in India:

Note: These are indicative costs rather than fixed prices. Actual costs may vary as per hospital, particularly for chemotherapy and stem cell transplantation.

Does Health Insurance Cover Leukaemia in India?

Yes. Leukaemia is covered under health insurance plans in India, including hospitalisation expenses, ICU charges, ambulance charges, stem cell transplantation and chemotherapy. OPD expenses are covered if the policy comes with an OPD benefit. A waiting period of up to 2 years may apply before cancer coverage can be claimed.

Leukaemia is also covered under critical illness insurance plans and cancer insurance plans. These plans generally provide a lump sum benefit after diagnosis of leukaemia, subject to the policy's terms and conditions.

Critical illness insurance policies usually have a waiting period of up to 90 days before coverage becomes applicable. Moreover, a survival period of up to 30 days may apply.

Policyholders should check the policy documents for the terms and conditions, applicable waiting period, exclusions, and claim conditions before purchasing or making a claim.

How Much Health Insurance Coverage is Needed for Leukaemia Treatment?

Leukaemia treatment can involve prolonged chemotherapy, targeted therapy, hospitalisation, blood transfusions and, in some cases, stem cell transplantation. Considering the potential cost of long-term care, a health insurance cover of around ₹10 lakh to ₹25 lakh should be considered, depending on the type of leukaemia, treatment plan and expected healthcare needs.

A higher sum insured of up to ₹50 lakh or more may be more suitable for patients requiring intensive treatment, prolonged hospitalisation or stem cell transplantation, as these treatments can involve significant medical expenses. However, the appropriate coverage amount should be decided based on the individual's condition, treatment duration, hospital costs and policy benefits.