The first 60 days: Leukaemia (all types)
Leukaemia means cancer of the blood-forming cells, but the four main types share little beyond the name: acute lymphoblastic and acute myeloid leukaemia are emergencies treated with intensive therapy, while chronic lymphocytic and chronic myeloid leukaemia are slow diseases controlled for years with pills. Each has its own page. Below, week by week, is what OnCo's record of Leukaemia (all types) says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Blood count and film, bone marrow aspirate and biopsy, flow cytometry, cytogenetics and molecular panel; the subtype then sets the pathway.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: Diagnosis.
- Medical oncologistNamed in the standard of care for: Treatment.
- Transplant and cell therapy teamNamed in the standard of care for: Treatment.
- Palliative and supportive care teamNamed in the standard of care for: Supportive care.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
By type on the subtype pages: intensive chemotherapy and transplant for acute leukaemias, tyrosine kinase inhibitors for CML, BTK and BCL2 inhibitors for CLL.
Growth factor support, transfusion, infection prevention and tumour lysis prophylaxis around intensive treatment.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Flow cytometry immunophenotype, Cytogenetics and fusion genes, Mutations, Measurable residual disease by flow or PCR), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Acute lymphoblastic leukaemia, Acute myeloid leukaemia, Chronic lymphocytic leukaemia.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Diagnosis
- For my situation (diagnosis), which of the standard options do you recommend and why?Guideline options include: Blood count and film, bone marrow aspirate and biopsy, flow cytometry, cytogenetics and molecular panel; the subtype then sets the pathway.
Treatment
- For my situation (treatment), which of the standard options do you recommend and why?Guideline options include: By type on the subtype pages: intensive chemotherapy and transplant for acute leukaemias, tyrosine kinase inhibitors for CML, BTK and BCL2 inhibitors for CLL.
Supportive care
- For my situation (supportive care), which of the standard options do you recommend and why?Guideline options include: Growth factor support, transfusion, infection prevention and tumour lysis prophylaxis around intensive treatment.
Any stage
- Are there clinical trials I could join, for example of Menin inhibitors, CAR-T cell therapy?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Adult ALL and TP53-mutated AML still have poor outcomes”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Infant and relapsed childhood leukaemias”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Leukaemia (all types): the full pageLeukaemia means cancer of the blood-forming cells, but the four main types share little beyond the name: acute lymphoblastic and acute myeloid leukaemia are emergencies treated with intensive therapy, while chronic lymphocytic and chronic myeloid leukaemia are slow diseases controlled for years with pills. Each has its own page.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.