Acute leukemia

Acute leukemia

Basics

The diagnosis "acute leukemia" is probably something shocking for everyone. You may know that it has something to do with the blood and that it is a cancer, but how exactly what is not working is usually unclear. Often all that is known is that it is a dangerous and threatening disease.

Disease of the haematopoietic system

The basic features of the disease already lie in its name. The term leukaemia is derived from the Greek "leukós" for white and "haima" for blood. This indicates that something is wrong with the white blood cells, the leukocytes. However, it is not the blood itself, but rather the blood-forming organs that are abnormally changed.

In the hematopoietic system, the most diverse cells of the blood grow and mature. These include not only several types of white blood cells (leukocytes), but also red blood cells (erythrocytes) and platelets (thrombocytes).

Too many leukocyte stem cells

In leukemia, the stem cells in a leukocyte population no longer function. Because of this, either too many or too few or immature blood cells are made and leaked into the blood. The maturation of other blood cells can thus be suppressed. The blood count then shows a very large number of immature leukocyte populations, while the other cell types are reduced.

Acute leukaemia is a disease that develops very rapidly. A distinction can be made between acute myeloid leukaemia (AML) and acute lymphoblastic leukaemia (ALL). ALL is often found in children, while adults tend to have AML.

Causes

The exact causes of acute leukemia have not yet been determined. In most cases, it remains unclear why the disease developed, but only in the rarest cases can one at least name factors that have promoted the disease.

Ionising radiation as a risk factor

These include, for example, ionising radiation. These include not only X-rays, but above all the radiation emitted during atomic explosions. Nevertheless, there is no need to fear that you will develop acute leukaemia as a result of taking X-rays, even if the effects of radiation add up over the course of your life.

Chemicals as a promoting factor

The effect of certain chemicals is similarly unclear. But it may consistently be the case that substances such as benzene and certain drugs, in combination with other factors, can promote leukaemia.

Genetic predispositions

The most clearly defined factor is the influence of genetics on the development of leukemia. While there is no leukemia gene that indicates the onset of the disease, there are certain genetic gene defects that are often associated with leukemia. For example, people with Down syndrome or Fanconi anemia are also more likely to suffer from leukemia than the healthy normal population.

Symptoms

The symptoms of acute leukemia are usually very undifferentiated and non-specific. Most patients experience mainly general symptoms of the disease such as fatigue, fever and night sweats. In addition to these non-specific symptoms, there are usually a number of directional symptoms.

Symptoms due to the suppression of normal blood formation

As normal blood formation is displaced by the overshooting of leukocyte formation, the typical symptoms of anaemia (lack of erythrocytes) often occur. These include pallor, breathing difficulties and also fatigue.

As a result of a reduction in certain leukocyte populations, there can also be a general susceptibility to various infections. Not only bacterial infections play a major role, but also fungal infections in particular.

The lack of platelets leads to increased bleeding, which is particularly evident in the form of punctiform bleeding into the skin (petechiae), haematoma, bleeding from the gums and nose.

Enlargement of lymphatic organs

Especially in acute lymphatic leukemia (ALL), there is a change in the lymphatic system. This is manifested by swelling of the lymph nodes and enlargement of the spleen.

Neurological deficits

Especially in ALL, the so-called meningeosis leucaemica can occur. In this case, leukaemic cells reach the central nervous system and lead to deficits that primarily affect the cranial nerves and the eye.

Diagnosis

The diagnosis of acute anemia is made by examining the blood. There are both specific and non-specific changes that can indicate leukemia. Therefore, further examinations are usually required to confirm the diagnosis of acute leukaemia.

Changes in the blood count

The blood count shows an unspecific decrease in red blood cells and platelets. The white blood cell count may be either too low, normal or too high. The only specific indication from the blood count is the presence of so-called blasts in the peripheral blood. These are precursors of leukocytes that should actually only be found in the blood-forming organs.

Analysis of the bone marrow

If leukaemia is suspected, the bone marrow as a blood-forming organ must also be examined. This examination also helps, above all, to be able to distinguish AML from ALL.

Therapy

The therapy of acute leukaemia must be tailored precisely to the case at hand. In principle, there are two different ways to fight blood cancer. These include chemotherapy and the transplantation of bone marrow or stem cells. In addition, supportive measures must be taken.

Chemotherapy

Chemotherapy with so-called cytostatics aims to destroy the degenerated cells. Since not only the malignant cells are attacked, but also healthy body cells are damaged, there are usually severe side effects such as nausea, vomiting and hair loss.

The therapy is very demanding and stressful, which is why it is carried out in several intervals, between which there are always rest periods in which the body can recover. The number of cycles required depends on the type and severity of the existing leukaemia and must be determined individually.

The goal of chemotherapy is complete remission. This means that the cell counts in the blood-forming organs normalise to such an extent that leukaemia can no longer be detected. However, this does not mean that all leukaemic cells are killed, which is why a relapse, i.e. a new outbreak of the disease, can always occur.

Bone marrow or stem cell transplantation

An alternative to chemotherapy is the transplantation of bone marrow or blood stem cells. In this case, the entire bone marrow is killed by an extremely strong chemotherapy. This should also destroy all leukemia cells, or at least that is the hope.

After the destruction of all blood-forming cells, healthy stem cells are transplanted from a suitable donor. This donor is usually found within the family, as the tissue characteristics must match very well. If the donor does not match the recipient very well, a rejection reaction will occur, which should be prevented by all means.

Especially if several relapses have already occurred or if the chemotherapy does not respond at all, this therapy approach is probably the best chance for a cure of the leukemia.

Supportive therapies

As leukaemia affects the whole organism, it is important that various supportive measures are also taken. These include, for example, careful hygiene and the reduction of germs in order to prevent infections.

If necessary, the displaced blood cells can be replaced with infusions to alleviate deficiency symptoms. Especially red blood cells and the platelets are replaced in this way, because this can greatly improve the quality of life.

In addition, one should of course also pay attention to a healthy lifestyle, which above all includes sufficient fluid intake.

Forecast

In the case of acute leukaemia, it is almost impossible to make a meaningful prognosis. This is because it always depends on the respective type of disease and the response to therapy.

Good prognosis for young AML patients

In general, it can be said that in AML patients under 60 years of age, a complete remission can be achieved in 65-70% of cases. However, the recurrence rate is relatively high depending on age and genetic factors.

Complete remission likely in ALL

In ALL, the prognosis is even slightly better, as complete remission can be achieved in 80% of cases. Only in 30-50% of patients a relapse occurs within the first five years.

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