Question 1

What is leukaemia?

Accepted Answer

Leukaemia is a cancer of the blood and bone marrow — characterised by the abnormal proliferation of blood-forming cells (white blood cell precursors). There are four main types: acute lymphoblastic leukaemia (ALL); acute myeloid leukaemia (AML); chronic lymphocytic leukaemia (CLL — the most common adult leukaemia); and chronic myeloid leukaemia (CML). Leukaemic cells crowd out normal blood cells — causing anaemia, infection susceptibility and bleeding.

Question 2

Which type of leukaemia is most common in children?

Accepted Answer

Acute lymphoblastic leukaemia (ALL) is by far the most common childhood cancer — accounting for approximately 25% of all childhood cancers. B-cell precursor ALL (BCP-ALL) accounts for approximately 85%; T-cell ALL for approximately 15%. Peak incidence is in children aged 2-5 years. It is predominantly a disease of childhood; adult ALL is rarer and carries a worse prognosis.

Question 3

How is childhood ALL treated?

Accepted Answer

Childhood ALL is treated with multiagent systemic chemotherapy — typically lasting 2-3 years in three phases: induction (remission induction — approximately 4 weeks; achieving approximately 98% complete remission); consolidation (preventing CNS relapse, typically with intrathecal chemotherapy and sometimes cranial radiotherapy; intensification courses); and maintenance (daily mercaptopurine + weekly methotrexate for 1.5-2 years). Higher-risk features (Ph+ ALL, T-cell ALL, high WBC, slow response) require intensified regimens and — in Ph+ ALL — TKIs (imatinib, dasatinib). Allogeneic HSCT for highest-risk patients.

Question 4

What happened with CML and imatinib?

Accepted Answer

Chronic myeloid leukaemia was once a disease with median survival of approximately 5 years before blast crisis. The discovery that BCR-ABL1 tyrosine kinase drives CML led to the development of imatinib (Gleevec/Glivec) — approved by FDA in 2001. The IRIS trial showed that imatinib produced complete cytogenetic responses in >85% of newly diagnosed CML patients, with 10-year survival exceeding 85% (vs approximately 20% with prior interferon-based therapy). Imatinib is on the WHO Essential Medicines List; generic imatinib has dramatically improved global access.

Question 5

Why is AML so hard to treat?

Accepted Answer

AML is the most common acute leukaemia in adults and carries the worst prognosis — approximately 45-50% 5-year survival in younger adults in HICs, and approximately 10-20% in older adults (who are unfit for intensive chemotherapy). AML is biologically heterogeneous — driven by dozens of different molecular mutations — making it difficult to treat with a one-size-fits-all approach. Progress has been made with targeted therapies for specific AML subtypes: midostaurin + chemotherapy for FLT3-mutated AML; IDH1/2 inhibitors (ivosidenib, enasidenib) for IDH-mutated AML; and venetoclax + azacitidine for older unfit patients. Bone marrow transplantation is curative for eligible patients.

Question 6

What is CLL and how does it differ?

Accepted Answer

Chronic lymphocytic leukaemia (CLL) — the most common adult leukaemia in Western countries — is a malignancy of mature B lymphocytes accumulating in the blood, bone marrow and lymph nodes. It is typically diagnosed incidentally in older adults (median age 72) on routine blood count. Many patients have indolent disease not requiring immediate treatment ("watch and wait"). Active disease is treated with targeted therapies: ibrutinib/acalabrutinib (BTK inhibitors); venetoclax (BCL-2 inhibitor) ± obinutuzumab (anti-CD20 antibody). CLL is rarely curable without allogeneic HSCT.

Question 7

What is CAR-T cell therapy?

Accepted Answer

CAR-T (chimeric antigen receptor T-cell) therapy involves extracting a patient's T-cells, genetically engineering them to express a CAR targeting a leukaemia cell surface antigen (most commonly CD19 for B-cell ALL), and infusing them back. The engineered T-cells recognise and kill leukaemia cells. FDA-approved tisagenlecleucel (Kymriah) achieves approximately 80-85% complete remission in relapsed/refractory B-cell ALL. Main side effects: cytokine release syndrome (fever, hypotension — managed with tocilizumab); immune effector cell-associated neurotoxicity (ICANS). CAR-T therapy is being studied in AML, CLL and other haematological malignancies.

Question 8

Why do so many children die from leukaemia in LMICs?

Accepted Answer

Childhood ALL survival rates reveal one of the starkest cancer equity gaps globally: >90% in the US, UK and Western Europe vs approximately 20-50% in many LMICs. The gap reflects: delayed diagnosis (weeks to months — causing higher disease burden and risk of early death); chemotherapy abandonment (families stopping treatment because of toxicity, cost or fatalism); insufficient supportive care (blood transfusions, infection management — chemotherapy is toxic without adequate support); treatment toxicity in malnourished children; and data gaps preventing quality improvement. The Global Initiative for Childhood Cancer (GICC) — a WHO/St. Jude Children's Research Hospital partnership — targets 60% childhood cancer survival in 50 LMICs by 2030.

Question 9

How does GMJ News cover leukaemia?

Accepted Answer

GMJ News covers GLOBOCAN leukaemia data, childhood ALL survival gaps, imatinib and CML evidence, CAR-T therapy approvals, venetoclax for AML/CLL, and the GICC initiative. Leukaemia is part of the GMJ's cancer coverage — the paediatric ALL survival gap and the molecular oncology revolution are directly relevant to PHIG's cancer and healthcare quality priorities.

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