Clinical Review

Leukaemia update. Part 1: diagnosis and management

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1660 (Published 28 March 2013) Cite this as: BMJ 2013;346:f1660
  1. Nicholas F Grigoropoulos, clinical research fellow1,
  2. Roger Petter, general practitioner2,
  3. Mars B Van ‘t Veer, consultant haematologist3,
  4. Mike A Scott, clinical director3,
  5. George A Follows, consultant haematologist3
  1. 1Department of Pathology, Division of Molecular Histopathology, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  2. 2Linton Health Centre, Cambridge, UK
  3. 3Department of Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
  1. Correspondence to: G A Follows george.follows{at}addenbrookes.nhs.uk
  • Accepted 21 February 2013

Summary points

  • Chronic lymphocytic leukaemia is the most common leukaemia in adults

  • Patients with acute leukaemia can deteriorate rapidly—urgent discussion with a haematologist is recommended if acute leukaemia is suspected

  • Risk is best stratified according to the genetic abnormalities of the leukaemia

  • Diagnosis of leukaemia requires a multidisciplinary approach

  • Most chronic leukaemias are not curable but can be treated with non-intensive chemotherapy

  • Acute leukaemias are curable if patients are fit enough for intensive chemotherapy; palliation is indicated for frail patients

About 8000 people in the United Kingdom are diagnosed with leukaemia each year, and in 2010, 4504 people died in the UK from this disease.1 Leukaemia encompasses a clinically and pathologically diverse set of conditions whose incidence and prevalence are rising. In the past, leukaemia was classified on the basis of the morphological characteristics of abnormally proliferating leucocytes in the blood and bone marrow. Emerging genetic data, however, have shown genomic heterogeneity in what were thought to be homogeneous disorders, prompting the World Health Organization to revise the classification.2 Despite these advances, the profound immunological and haematological disturbances inherent in most leukaemias and the systemic side effects of chemotherapy remain complex challenges. This is a two part review with the first part focusing on the current diagnosis and management of leukaemia. The second part will consider the types of support patients need in the community.

Sources and selection criteria

We searched PubMed for clinical trials and the Cochrane Library for meta-analyses. We also sought expert opinion from experienced consultant haematologists. Keywords used were leuk(a)emia, chemotherapy, supportive care, and community care. We also reviewed guidelines from the British Committee for Standards in Haematology and the National Institute for Health and Clinical Excellence.

What is leukaemia?

Leukaemia is a cancer of circulating white blood cells. Leukaemias are divided into acute and chronic types. When immature white blood cells or …

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