Leukemia

Leukaemia is cancer of the blood-forming cells in the bone marrow. Abnormal white cells multiply out of control and crowd out normal blood cells. There are four main types — acute lymphoblastic (ALL), acute myeloid (AML), chronic lymphocytic (CLL), and chronic myeloid (CML). Treatment — and outcomes — differ substantially between them.

Symptoms

• Fatigue, pallor, breathlessness (low haemoglobin).
• Frequent or unusual infections (low healthy white cells).
• Bruising, nosebleeds, heavy periods, bleeding gums (low platelets).
• Bone pain, swollen lymph nodes or spleen.
• Unexplained fever, night sweats, weight loss.
• Tiny red spots (petechiae) on skin.
• Children with leukaemia may present with limp, refusing to walk, unexplained bruising, or low-grade fever.

Evaluation

• CBC — often shows abnormal counts.
• Peripheral blood film — abnormal cells.
• Bone marrow aspiration and biopsy — confirms diagnosis and type.
• Flow cytometry, cytogenetics, molecular testing — define sub-type, guide treatment (and prognosis).
• Lumbar puncture — especially in ALL.

Treatment — has improved dramatically

• Childhood ALL — cure rates now well over 80-90% at good centres with complete treatment.
• AML — intensive chemotherapy; stem-cell transplant for higher-risk.
• CML — transformed by targeted tyrosine-kinase inhibitor tablets; a chronic condition for most.
• CLL — often watchful waiting; newer targeted agents have changed treatment.
• Blood product support, infection control, nutrition — as important as the cancer drugs themselves.
• Stem-cell transplantation — available at several Indian centres; match and cost are barriers but improving.

Key practical notes

• Complete the full course — one of the commonest reasons for relapse in Indian children is abandonment of treatment because of cost, travel, or family pressure. Many NGOs and Regional Cancer Centres provide free accommodation and subsidised care — ask.
• Ayushman Bharat PM-JAY and state cancer schemes cover much of leukaemia treatment for eligible patients.
• Do not use unregulated "cure" products — many families have lost children to this. Biomedical treatment works for most leukaemias; most alternatives do not.
• Infection risk is constant during treatment — fever is an emergency; go to hospital immediately.