acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL)
Acute leukemia is a malignant disease of the bone marrow. The vernacular speaks of blood cancer. In acute leukemia, the progenitor cells of the white blood cells are malignantly altered. These altered cells increasingly spread uncontrollably throughout the bone marrow and displace the non-pathologically altered blood cells: the red blood cells and the platelets. These two types of blood cells are now present in the blood in much too small amounts. Especially the lack of red blood cells has given the disease its name. Literally translated, leukemia means "white blood". Depending on which cells the acute leukemia emanates, a distinction is made between myeloid and lymphatic forms:
- Myeloid leukemias are caused by precursor cells of the granulocytes.
- Lymphatic leukemias are caused by precursor cells of the lymphocytes.
Granulocytes and lymphocytes are both part of the body's defense system, but perform different tasks.
Other forms of leukemia
In addition to the initial form of cell change, a leukemia is subdivided into acute or chronic courses, so that there are four major types of leukemia:
- acute myeloid leukemia (AML)
- acute lymphoblastic leukemia (ALL)
- chronic myeloid leukemia (CML)
- chronic lymphocytic leukemia (CLL)
Here you will find information on acute leukemia, ie acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL).
In Germany, about 4,000 people develop acute leukemia each year. That's about 1 percent of all cancers a year. This makes acute leukemia a rare cancer.
Acute lymphocytic leukemia affects mainly children between the ages of 2 and 5 years. It is the most common malignant childhood cancer. Adults suffer most from acute myeloid leukemia, with the risk of getting AML increasing with age.
The symptoms of acute forms of leukemia are very nonspecific. So there is no symptom that is characteristic. All complaints or disorders in acute leukemia can also occur in other diseases. Nevertheless, you should be aware of certain symptoms. Significant are above all loss of appetite and unwanted / unclear weight loss as well as fever and nocturnal sweating. Since the number of red blood cells decreases in acute leukemia, it comes to symptoms, as they are known from anemia (anemia).
- general feeling of illness (similar to a flu)
- lack of efficiency
- Shortness of breath during physical exertion.
- The missing platelets are noticeable. Thus, especially the bleeding tendency is increased.
Typical symptoms are:
- Bleeding of the gums when brushing or biting an apple
- bloody urine
- bloody stool (especially when pressing, similar to hemorrhoids)
- flea-stitch-like punctate skin hemorrhages (so-called petechiae)
- unusually easy bruising even in the smallest events
Symptoms due to the weakened immune system
In acute leukemia, the degenerate cancer cells displace functioning immune cells and weaken the immune system. Signs are:
- increased susceptibility to infection, especially for bacterial diseases and fungal infections
- poorly healing inflammations (eg in the oral cavity)
- different infections in different organs, for example in the lungs or on the urinary tract
- swollen lymph nodes
Skin symptoms in acute leukemia
Rarely, malignant leukemia cells also affect the skin. The following changes are often observed:
- Patches on the skin
- skin thickening
- Nodules that are often accompanied by itching.
Cause of acute leukemia is a disorder in the formation of white blood cells. Normally, white blood cells from the stem cells of the bone marrow form, which ripen through different cell intermediate stages. With leukemia, this process is flawed. Scientists have not yet figured out why this defect occurs. Presumably, several factors must come together until acute leukemia develops. However, most sufferers do not know why acute leukemia occurred.
Genetic predisposition may also play a role in the development of acute leukemia. The risk of contracting blood cancer is z. B. is larger if other malignant diseases have already occurred in the family. Also, certain chromosomal disorders are associated with an increased risk of disease.For example, people with Down syndrome (trisomy 21) are particularly likely to develop acute myeloid leukemia.
Risk factors for acute leukemia
Certain risk factors increase the risk of acute leukemia. These include:
- radioactive beams
- chemical substances such as benzene
- certain insect or plant protection products
- chemotherapeutic agents against other cancers (cytostatics)
Unlike many other cancers, such as breast, colon or skin cancer, there are no screening tests for acute leukemia. For most sufferers, the diagnosis is random. If suspected, the doctor first scans the lymph nodes as well as the liver and spleen. They are almost always enlarged in acute leukemia. If that is the case, a blood test follows.
Blood picture in acute leukemia
In acute leukemia, a blood test provides the crucial clues for the diagnosis. In the so-called blood picture, the doctor recognizes, for example, anemia (anemia) and a lack of platelets. In addition, the total number of white blood cells is increased or decreased. In addition, the rate of erythrocyte sedimentation (BSG or BKS) is markedly accelerated in most cases, while blood clotting is reduced. To ensure the diagnosis of acute leukemia, the blood is also streaked. Under the microscope, the typical leukemia cells or leukemic cell precursors can be recognized. Characteristic of acute myeloid leukemia are also reddish-purple inclusions in the cells (so-called Auer rods). To confirm the suspicion of diagnosis, follows the investigations of the blood, a bone marrow examination.
Bone marrow examination (bone marrow biopsy)
In a bone marrow examination, the doctor takes a sample from the bone marrow of the patient, usually from the iliac crest. This sampling is also referred to as bone marrow biopsy. Do not worry, this is usually done with local anesthesia. Smaller children and very anxious patients may also receive a short anesthetic. The removed cell material is examined microscopically. In acute leukemia, a significant number of degenerate cell precursors will be recognized. Mature and healthy white blood cells are almost invisible in acute leukemia.
After the diagnosis of acute leukemia, your doctor will check to see if the cancer cells, other than the bone marrow, have already affected other organs. Corresponding imaging methods are z. As ultrasound examinations (sonography), X-ray and, where appropriate, cross-sectional examinations such as computed tomography (CT) or magnetic resonance imaging (MRI).
If it is suspected that the meninges are affected by leukemia cells, the nerve water (the so-called cerebrospinal fluid) is examined. This is usually done at the level of the lumbar spine with a small hollow needle in the spinal canal (lumbar puncture). A few drops of the escaping nerve water flow over the needle into a sterile tube. The CSF is then tested for cancer cells in the laboratory.
In the treatment of acute leukemia, a complete cure of the blood cancer is aimed first and foremost. Treatment should begin as soon as possible, ie a few days after diagnosis.
Targets of leukemia therapy
- Healing of the blood cancer
- Restore a healthy blood cell formation
- Relief of discomfort
- Protection against infectious diseases
Chemotherapy in acute leukemia
The focus of every treatment for leukemia is chemotherapy. Chemotherapy takes the form of infusions, sometimes it is also given as a tablet. Chemotherapy should destroy as much as possible all malignantly altered cells in the body. Leukemia cells commonly infect the brain, especially in acute lymphoblastic leukemia (ALL). Therefore, chemotherapy is also preventive in the central nervous system (CNS). For this purpose, small doses of the chemotherapeutic agent are injected directly into the spinal fluid (so-called intrathecal chemotherapy).
Stem cell therapy and radiation
If no tumor cells are detectable, especially in young patients after chemotherapy, a transplantation of healthy donor cells into the bone marrow (so-called stem cell transplantation) follows. This is useful to get back to normal blood cell formation. The healthy stem cells are transmitted via an infusion. However, for stem cell transplantation to be successful, the body must be as free of tumor cells as possible. Therefore, a radiation therapy is first applied to destroy any remaining cancer cells. Stem cell therapy (blood stem cell transplantation) can also be used to relieve acute leukemia.
Serious side effects of the treatment of acute leukemia
The therapy of acute leukemia is very stressful for the body. For example, throughout the treatment there is an increased risk of infection and bleeding. After stem cell transplantation, the main fear is the rejection of the transplanted cells.In chemotherapy, most sufferers are afraid of hair loss, nausea and vomiting, and physical fatigue. The worries are not entirely unfounded. However, your doctor will try to minimize these side effects as much as possible. However, hair loss is unavoidable. But good news: Almost all patients grow their hair after completing chemotherapy - often even fuller and more beautiful than before.
Reduce side effects of the blood cancer therapy
In order to reduce the side effects of the blood cancer therapy, the doctor has different methods available, for example:
- preventive administration of antiulcer drugs
- Transfusions of red blood cells (erythrocyte concentrates)
- Transfusions of platelets (platelet concentrates)
- Administration of antibiotics and antifungal agents
- Administration of growth factors that stimulate the formation of white blood cells after intensive chemotherapy
Medical cannabis against side effects of chemotherapy
Since March 2017, medical cannabis is available for the seriously ill on prescription. According to current knowledge, main constituents of cannabis, such as tetrahydrocannabinol (THC) and cannabidiol, may help alleviate nausea, vomiting, and loss of appetite during chemotherapy (Cridge & Rosengren, 2013, Velasco et al., 2012). Despite the release of medical cannabis by the legislature and the associated reimbursement ability, the statutory health insurance funds are not ready to take over the costs of several hundred euros per month actually.
The ingredients of the cannabis plant may not only alleviate the side effects of chemotherapy. British physicians published a study in 2013, according to which various ingredients (cannabinoids) in the laboratory test could clearly slow down leukemia cells in their growth.
In addition to the standard therapy, some doctors and naturopaths recommend supplementary treatment with mistletoe preparations. This alternative therapy should reduce the side effects of chemotherapy, improve the quality of life of the patient and normalize or activate the functions of the body's own defense system. In this therapy, extracts of mistletoes from various host trees (such as apple trees, oaks) are injected into or under the skin. Also possible are infusions of mistletoe extracts into a vein or direct injection into the cancerous area itself. Mistletoe preparations are rarely taken.
Mistletoe therapy is one of the alternative remedies. Among cancer researchers and doctors and there are both supporters and opponents of mistletoe. A benefit of mistletoe therapy is not proven according to current scientific findings. For this reason, mistletoe preparations are also not recommended in the German guidelines for scientifically based cancer treatment.
The chance of recovery (prognosis) in acute leukemia depends strongly on different factors. It depends, for example, on the age of the patient, the comorbidities and the type of leukemia cells. Basically, the chances of recovery from acute leukemia are not too bad. So healthy adult patients with acute myeloid leukemia (AML) in about 60 to 70 percent of cases. Children still have a much better prognosis.
In acute lymphoblastic leukemia (ALL), the chances of recovery are about 45 percent in adults and 80 percent in children. In the remaining 55 and 20 percent of patients, it comes in the course of life to a relapse, ie a recurrence of acute leukemia.
There is no real prevention of acute leukemia. It makes sense to carry an X-ray pass with you. This helps to avoid unnecessary or double X-ray examinations and thus to keep the radiation exposure as low as possible. Furthermore:
- Avoid contact with benzene-containing substances.
- Do not smoke or stop smoking.
- Unclear symptoms such as tiredness, fever, loss of appetite and unwanted / unclear weight loss should be quickly brought to the doctor.