Is leukemia curable?
In principle, the question of the curability of leukemia is not so easy to answer. Firstly, there are many different forms of leukemia. They differ both in therapy and in their curability.On the other hand, many individual factors, such as patient age or genetic changes, determine the success of a therapy.
In principle, however, acute leukemias are curable in principle. Especially in children, acute lymphatic leukemia, or ALL for short, has very good chances of being cured nowadays. Chronic leukemias, on the other hand, can usually only be cured by a bone marrow transplant.
Chemotherapy alone is not sufficient here. Nevertheless, they are usually less aggressive than acute forms, so that those affected can live well with the disease even without a definitive cure. In addition, modern studies show that leukemia therapy is subject to constant change: the human blood formation system is hierarchically structured.
From a so-called stem cell, several cell rows develop in several intermediate stages until the mature white blood cell (leukocyte) or the mature red blood cell (erythrocyte) is formed. Just like a “normal” tumor, such as breast cancer or colon cancer, which is based on degenerated cells, these cells can also degenerate and grow uncontrolled in the various developmental stages or intermediate stages, i.e. not adapted to the needs of the body, and thus displace other cell lines. These increased produced cells are functionally inoperative.
The maturation of a cell is called differentiation. Leukemias are classified according to their differentiation characteristics, among other things. The degenerated cells can originate from a so-called myeloid or a so-called lymphatic precursor cell.
The myeloid cell line (starting from the bone marrow) contains the precursor cell of the red blood cells (erythrocytes), the blood platelets (thrombocytes) and the granulocytes, which play an enormously important role in the defence against pathogens such as bacteria and owe their name to the property that they have so-called granules (“granules”) in their cell bodies, which contain substances necessary for defence. The term lymphatic means that the cells of the affected leukemias are degenerated precursor cells of mature lymph cells (lymphocytes). A further classification system is the degree of maturity of the affected cells, i.e. whether mature (late developmental stages) or immature (early developmental stages) cells are degenerated.
It is also important for the classification whether the disease shows an acute course, i.e. whether it has appeared within a few weeks or months and got worse, or whether it was a rather chronic, slow course. However, the latter classification is no longer frequently used. Nevertheless, this classification is very helpful for understanding the disease, because acute leukemias usually originate from immature cells, which are then all the more unable to function, whereas chronic leukemias originate from mature cell precursors.
The most common and best known leukemias are ALL (Acute Lymphocytic Leukemia), AML (Acute Myeloid Leukemia), CLL (Chronic Lymphocytic Leukemia) and CML (Chronic Myeloid Leukemia). AML is an abbreviation and stands for Acute Myeloid Leukemia. It is the most common form of leukemia in adults.
In Germany, 3.5 new diagnoses are made every year 100,000 inhabitants. This makes AML one of the rare diseases. The disease has its origin in the blood-forming cells of the bone marrow.
Normally, our blood cells are formed there in complicated steps and sequences. In AML, the process is out of balance and individual, “degenerate” cells multiply uncontrolled. As a result, the blood is flooded with immature, functionless leukemia cells.
When cells from the myeloid series degenerate, this is called AML. These cells include the red blood cells (erythrocytes), blood platelets (thrombocytes) and parts of the white blood cells (leukocytes). The cause of the disease is largely unknown, but radiation exposure and individual chemical substances play an important role.
In addition to rather unspecific, flu-like symptoms, those affected suffer from an increased susceptibility to infection, chronic fatigue, weakness or paleness. Often, an accumulation of bruises, nosebleeds and small skin bleedings can be observed. In principle, however, the leukemia cells can attack all organs and cause various symptoms.
The leading finding is the presence of leukemia cells, also called blasts, in the blood and/or bone marrow. Blood platelets and red blood cells are often severely reduced at diagnosis. AML, like all acute forms of blood cancer, is a very aggressive disease.
Therefore an immediate start of treatment is essential! In order to achieve a complete destruction of the leukemia cells, various chemotherapeutic agents are combined. This is also called polychemotherapy.In certain cases, bone marrow transplantation can increase the chances of recovery.
Numerous side effects occur under the therapy. These may include nausea, vomiting, hair loss, inflammation of the oral mucosa or infections. The chances of cure for AML vary and depend, among other things, on the stage of the disease, form and age of the patient.
CLL stands for chronic lymphatic leukemia. In Germany, approximately 18,000 people suffer from the disease. Typically, older people suffer from CLL.
The average age at diagnosis is between 70 and 72 years. The cause of CLL is the uncontrolled growth of B-lymphocytes, a subgroup of white blood cells. In contrast to healthy white blood cells, the diseased B-lymphocytes have a significantly longer survival time.
As a result, the functionless leukemia cells “flood” the blood system and infiltrate organs, especially lymph nodes, spleen and liver. In about half of the cases, CLL progresses unnoticed and without symptoms over a long period of time. Often the disease is even discovered only by chance!
Possible, rather unspecific symptoms can be fatigue, fever, weight loss or night sweats. Painless swelling of lymph nodes, chronic itching or hives can be observed in many patients. The most serious of these can be a disease-related restriction of the immune system.
Severe bacterial or viral infections can be the result. Diagnostically groundbreaking is a persistent increase in lymphocytes, as well as the typical appearance of leukemia cells under the microscope. Further examinations, such as an ultrasound image of the abdomen or a biopsy of the lymph nodes, can substantiate the diagnosis.
According to current knowledge, CLL cannot be cured causally without a bone marrow transplant. The tumor cells divide only very slowly, which is why the disease progresses very slowly. Therefore, regular check-ups are sufficient in the beginning.
In advanced stages, drug treatment is used. It consists of a combination of chemotherapy and antibodies. In principle, the patient’s age and general condition are the main factors that determine the type of therapy.
Thus, symptomatic CLL is always treated. If the diagnosis is rather accidental and the patient is asymptomatic, treatment is not necessary. Chronic myeloid leukemia, or CML for short, is a rare form of blood cancer.
Only 1-2 people are diagnosed each year, 100,000 inhabitants. In principle, people of any age group can fall ill. Nevertheless, an accumulation between the ages of 50 and 60 years can be observed.
Interestingly, CML is based on a typical genetic change. This is because the so-called “Philadelphia chromosome” can be detected in almost all CML patients. CML, like all forms of leukemia, originates from the blood-forming cells of the bone marrow.
Typically, the disease leads to an uninhibited proliferation of granulocytes, a subtype of white blood cells. In contrast to acute leukemias, CML progresses slowly and begins with insidious symptoms. Altogether, the course can be divided into 3 phases: First of all, the massively increased number of granulocytes leads to the symptoms of CML.
In the course of the therapy, a reduction of these blood cells is therefore aimed at. Chemotherapeutic agents as well as modern antibodies are used. Often mild cytostatic drugs are sufficient after diagnosis, so that patients rarely have to expect serious side effects.
In order to closely monitor the blood count changes, CML patients must be closely monitored. In the case of advanced disease progression, a bone marrow transplantation can be considered.
- Chronic phase: The diagnosis is often made in this phase.
It is often “silent” and can last up to 10 years. Typical symptoms can be chronic fatigue, weight loss or night sweats. Patients often complain of pain in the upper abdomen, which can be explained by severe enlargement of the liver and spleen.
- Acceleration phase: This is when the blood count deteriorates. Those affected can suffer from anemia, bleeding tendency and infarcts.
- Blast crisis: The blast crisis is the final stage of CML and resembles the severe symptoms of acute leukemia.