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Acute leukemia is a fast-growing leukemia that progresses rapidly. Because of its aggressive nature, more intense and timely treatment may be required compared to other leukemia subtypes. Dr Colin Phipps Diong, Senior Consultant, Haematology shares more.

Acute leukemia can be categorised into two main subtypes: acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL). The difference between the two depends on the type of white blood cell affected; while AML involves the overproduction of abnormal myeloblasts, ALL involves the overproduction of lymphoblasts.

Compared to slower-growing chronic leukemia, acute leukemia involves the rapid expansion of leukemia cells in the bone marrow. This causes major problems for the production of other normal cells within the bone marrow, usually with a rapid decline in the production of normal red cells, white cells, and platelets.

This accounts for symptoms that often accompany acute leukemia:

1. Symptoms related to low red blood cell count or anaemia (e.g. fatigue, dizziness, lethargy, or headaches)
2. Symptoms related to low platelets (e.g. spontaneous or easy bruising and/or bleeding)
3. Fever and infection

Management of acute leukemia

Treatment for acute leukemia has to be directed against the disease in order for the normal red blood cells, white blood cells, and platelets to recover. Transfusions can help to support the patient while the acute leukemia treatment is ongoing, but transfusions alone are not a long-term solution.

Acute leukemia is usually treated with intensive chemotherapy aimed specifically at killing the leukemia cells in the bone marrow. The goal of chemotherapy is to put the cancer into remission with remission-induction therapy, and ensure it remains in remission with post-remission therapy.

Generally, patients can expect treatment of acute leukemia to be more intense compared to chronic leukemias because of its more aggressive nature.

Because of this, elderly patients with acute myeloid leukemia (AML) who cannot undergo intense treatment will be managed using a combination of two targeted agents. The latter comprises a newer form of treatment that has completely changed the paradigm of treatment in elderly patients with AML.

In general, the key factors that affect outcome of treatment for acute leukemia include: 1) whether patients are fit enough to receive treatment; and 2) the mutations that the leukemic cells carry. Although it is a challenging disease to manage because of its rapid progression, modern advances in acute leukemia treatment have greatly improved remission rates.

Determining the appropriate treatment plan for acute leukemia

To determine the appropriate treatment plan for acute leukemia, patients will need to undergo bone marrow tests to define the exact type of acute leukemia (e.g. acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL)) and any mutations within the individual patient’s leukemic clone.

Such mutation studies often involve different methodologies including karyotyping tests to look at chromosomal abnormalities, and polymerase chain reaction (PCR) or next-generation sequencing to detect high-risk mutations.

Apart from these investigations, patients also need to be assessed to see if they are suitable to receive the intended treatment. Typically, patients need to be fit and strong enough to receive intensive treatment in order to tolerate its side-effects. In order to determine eligibility for intensive treatment, your doctor may look at your age, current health, and any relevant gene mutations as well as eligible donors in the case of stem cell transplants.

Post-treatment care for acute leukemia

Following treatment, patients need to return for regular appointments and blood tests to monitor the status of their acute leukemia and post-treatment progress.

Apart from this, patients are also encouraged to adopt healthy habits like eating well, getting regular physical activity, staying at a healthy weight and refraining from smoking. While there is no hard evidence that these will reduce the risk of leukemia relapse, healthy changes can still have positive effects on a patient’s overall health and post-treatment recovery.

Furthermore, patients should recognise that treatment for a major illness can take a toll on their psychological well-being and know how and when to seek help. A multidisciplinary care approach that involves dietitians and counsellors are integral to a patient’s post-treatment journey to full recovery.