Leukaemia

How is Leukaemia Diagnosed?

Leukaemia is a complex and aggressive blood cancer, requiring precise diagnostic tests and careful treatment planning. Early diagnosis is essential for effective management, enabling tailored treatment options to improve patient outcomes.

At Subang Jaya Medical Centre (SJMC), we use advanced diagnostic technologies, guided by an experienced and caring multidisciplinary team.

What Tests Are Necessary for the Diagnosis of Leukaemia?

The diagnosis of leukaemia involves several diagnostic procedures to confirm the presence of abnormal blood cells and to determine the severity and type of the disease.

Blood Tests

Blood tests are the first step in diagnosing leukaemia. A blood sample is analysed using a blood cell counter machine, which measures levels of haemoglobin, white blood cells, and platelets

• Normal vs Abnormal Blood Count: In healthy individuals, these counts are within a normal range. In cases of acute leukaemia, the haemoglobin and platelet counts are typically low, while the white blood cell count may vary (it could be high, low, or normal).
• Genetic Disorders: Certain genetic conditions, such as Down syndrome, are linked to a higher risk of developing leukaemia.
• Stained Blood Film Examination: After staining, the blood sample is examined under a microscope. The presence of abnormal white cells or immature cells (blasts) alongside an abnormal blood count is a strong indicator of leukaemia.

These tests help identify any abnormalities in the blood and can indicate the presence of leukaemia, providing crucial information for the next diagnostic steps.

Bone Marrow Examination

• Procedure: A small sample of bone marrow is extracted from the iliac crest (hipbone) or sternum using a specialised needle. , while the white blood cell count may vary (it could be high, low, or normal).
• Analysis: The bone marrow sample is examined by a haematopathologist who stains and analyses the cells under a microscope. The report generated helps confirm the diagnosis and classify the leukaemia type.

Bone marrow tests are vital not just for diagnosing leukaemia, but also for helping determine the exact characteristics of the disease, which will guide the treatment plan.

Treatment Principles for Acute Leukaemia

The primary goal of acute leukaemia treatment is to restore normal blood cell production (haematopoiesis) by eliminating abnormal leukaemic cells and allowing healthy blood cells to repopulate the bone marrow. The treatment process is structured in phases.

Step 1: Induction Therapy

The first phase of treatment, known as induction therapy, aims to achieve complete remission (CR) — the absence of detectable leukaemia.

• Duration: Induction therapy typically lasts 4–6 weeks.
• Risks: This is the most critical phase, as patients often have low blood counts, making them vulnerable to life-threatening infections or bleeding. Supportive care, including blood transfusions and antibiotics, and close monitoring is essential during this period.
• Prognosis: If remission is not achieved after induction therapy, the prognosis is poor. However, about 15% of patients may benefit from an early allogeneic bone marrow transplant.

Step 2: Post-Remission Therapy

Achieving remission is only the first step. Follow-up therapy, or post-remission treatment, is mandatory to prevent relapse.

• Residual Leukaemic Cells: Even after remission, approximately 10⁸ leukaemic cells may remain in the body. Without further treatment, the disease is likely to return.
• Importance of Continuation: Some patients may feel "normal" after achieving CR and opt to stop treatment. However, this decision significantly increases the risk of relapse.

Monitoring During Treatment

• Repeat Bone Marrow Examination: About a month after induction therapy, a repeat bone marrow test is conducted to assess the response to treatment. A CR is confirmed if the bone marrow shows less than 5% blasts and a return to normal blood counts.
• Hospitalisation: Patients undergoing intensive induction chemotherapy are usually hospitalised to allow close monitoring and immediate management of complications, such as infections or bleeding.

Outpatient Care After Remission

Once remission is achieved, some treatments can be administered in an outpatient or daycare setting. This reduces the need for prolonged hospital stays while ensuring patients receive the necessary follow-up care.

Other Treatment Options for Leukaemia

In addition to the principles outlined for acute leukaemia, other treatment modalities are available depending on the type and stage of the disease:

Chemotherapy

Chemotherapy remains the cornerstone of leukaemia treatment. Cytotoxic drugs are used to kill cancerous cells, with treatment regimens varying in complexity and administered either orally, intravenously, or intrathecally (into the cerebrospinal fluid).

Targeted Therapy

Targeted therapy focuses on specific genetic or molecular abnormalities in leukaemia cells. By blocking these abnormalities, the therapy effectively halts cancer cell growth while minimising damage to healthy cells.

Bone Marrow Transplant (Stem Cell Transplant)

A bone marrow transplant replaces diseased bone marrow with healthy stem cells capable of regenerating normal blood cells. This procedure is often used for patients who do not respond to initial treatments or have a high risk of relapse.

Immunotherapy

Immunotherapy enhances the body’s immune system to identify and destroy leukaemia cells. Advanced forms, such as CAR-T cell therapy, involve engineering the patient’s T cells to target and kill cancer cells.

Radiation Therapy

Radiation therapy uses high-energy beams to destroy leukaemia cells. It is often used to prepare the body for a bone marrow transplant or to target specific areas affected by leukaemia.

Clinical Trials

Clinical trials offer access to experimental treatments and innovative therapies. Patients should discuss the potential benefits and risks of participating in clinical trials with their healthcare provider.

Coping and Support for Leukaemia Patients and Families

A diagnosis of leukaemia can be overwhelming. At SJMC, we offer holistic support through our oncology care team, psychologists, and social workers to guide you through the emotional and psychological challenges of the disease.

Building a Support Network

• Family and Friends: Lean on your loved ones for emotional and practical support, whether it's accompanying you to appointments or assisting with daily tasks.
• Support Groups: Joining a leukaemia-specific support group provides the opportunity to connect with others who understand the challenges, fostering empowerment through shared experiences.

Emotional and Psychological Support

• Counselling: Professional counselling or therapy can help you navigate the emotional challenges of a leukaemia diagnosis. This is especially helpful for managing anxiety, depression, or fear of the unknown.
• Mindfulness and Relaxation: Practices like meditation, yoga, or deep breathing exercises can reduce stress and improve mental well-being.

Practical Tips for Coping

• Educate Yourself: Understanding your specific type of leukaemia and treatment options can give you a sense of control. Ask your doctor for reliable resources to avoid misinformation.
• Maintain a Healthy Lifestyle: Focus on eating a balanced diet, staying active within your limits, and getting enough rest.
• Take Breaks: It’s easy to get caught up in treatment schedules, but make time for hobbies or activities that bring you joy.

Resources for Families

• Caregiver Support: Family members often play a vital role in caregiving. Organisations like the Leukaemia & Lymphoma Society offer resources for caregivers to manage their responsibilities effectively.
• Talking to Children: If you have children, use age-appropriate language to explain the diagnosis. Reassure them and encourage open communication.

What to Expect from Your Doctor

During consultations, your doctor will:

• Review your test results and overall health
• Explain treatment options and their benefits or side effects
• Answer your questions and help you make informed choices
• Arrange regular follow-ups to monitor progress and adjust care as needed

You are encouraged to ask as many questions as you like — we want you to feel informed, involved, and supported throughout your journey.

A Closing Word

Leukaemia is a life-changing diagnosis, but it is not a journey you take alone. With today’s treatments, many people recover fully, and even those with chronic forms can live long and meaningful lives.

At SJMC, we believe in treating more than the illness — we care for the person, the family, and the hope that carries them forward.

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