Leukemia or blood cancer refers to a group of malignant diseases of the hematopoietic system. In all forms of this cancer, the maturation of white blood cells (leukocytes) is disturbed. As a result, more immature blood cells are formed, which displace the healthy ones. There are several types of leukemia, which are characterized by different symptoms and require different forms of treatment. Thus one differentiates mainly between acute and chronic as well as between myeloid and lymphatic forms of leukemia. We provide information on the symptoms, therapy and chances of cure for leukemia.
Leukemia: recognizing signs
Because the acute forms of leukemia worsen quite quickly, the symptoms are usually more pronounced in this case. Chronic leukemias can go undetected for many years, as those affected often show no signs of blood cancer at all in the beginning. Many symptoms are caused by the suppression of normal blood formation:
- Red blood cells: Anemia with fatigue, tiredness, pallor and palpitations.
- White blood cells: increased susceptibility to infections.
- Platelets: Coagulation disorders, which can be manifested, for example, by increased bruising or small skin bleeding.
Other symptoms of leukemia
Non-specific symptoms of leukemia may also include fever, night sweats, loss of appetite and weight loss. Other symptoms may be manifested by cancer cells settling (metastasizing) to other organs and causing displacement or dysfunction there. For example, there is often an enlargement of lymph nodes, spleen and liver or the settlement of leukemia cells in the brain or spinal cord. Chronic lymphocytic leukemia (CLL) is classified into several stages, depending on whether and which other structures are affected, whether anemia is present, or whether platelets are decreased.
Leukemia: diagnosis and treatment
Often, the symptoms already provide the first clues to a leukemia disease. First of all, the exact blood examination (differential blood count) is important – with the blood count, the diagnosis of leukemia can almost always already be made. An examination of the bone marrow, which is usually taken from the iliac crest under local anesthesia, can determine the exact form of leukemia, which is indispensable for therapy and prognosis. Two principal treatment strategies are available for leukemia, which are often combined and supplemented by other therapies.
Chemotherapy for leukemia
Chemotherapies are used to treat all types of leukemia. The goal is to destroy the cancer cells. Cells that divide frequently are particularly susceptible to cytostatic drugs, which is why leukemia cells can be destroyed very easily. If only a part is destroyed, this is called partial remission. If no more cells are detectable in the blood (which does not mean that there are not still some in the bone marrow), this is called full remission. However, the drugs administered during chemotherapy also damage other cells, so a number of side effects must be expected. Normal blood cells are particularly at risk, which is why there is also a high risk of infection. In recent years, new active substances have been developed that target specific cancer cells and inhibit their proliferation. Some are already on the market (e.g., imatinib for CML – chronic myeloid leukemia), while others are still in the trial phase.
Bone marrow transplantation for leukemia
A bone marrow transplant often increases the chances of recovery from leukemia disease. Before the transplant, the bone marrow is first destroyed by radiation, then bone marrow from a matching donor is transferred by infusion. If all goes well, the stem cells in it settle in the bone marrow and produce healthy blood cells again. The disadvantage of bone marrow transplantation is that the patient must take drugs that suppress the body’s immune system so that the cells are not rejected. This means that there is a great risk of infection, especially at the beginning, which is why leukemia patients often have to spend the therapy in specially protected rooms.
Treatment of different types of leukemia
Depending on the type of leukemia, various forms of therapy are used during the course of the disease:
- ALL (acute lymphoblastic leukemia): several blocks of intensive chemotherapy, then lower-dose maintenance therapy for one to two years; additional radiation to the skull and injection of drugs into the cerebrospinal fluid; possibly bone marrow transplantation.
- AML (acute myeloid leukemia): intensive chemotherapy followed by maintenance therapy; possibly bone marrow transplant, especially in younger patients.
- CLL (chronic lymphocytic leukemia): depends on stage; treatment is given only when certain number of blood cells or complications. Chemotherapy (tablets, infusions), possibly cortisone and local irradiation of lymph nodes. In younger patients possibly bone marrow transplantation.
- CML (chronic myeloid leukemia): first interferon injections in the abdominal wall, then chemotherapy (tablets or injections); special drugs such as imatinib.
In addition, any symptoms or disorders such as anemia or infections are specifically treated.
Leukemia: course and chances of cure.
The prognosis depends on the type of leukemia and age, and whether genetic changes are present. The chances of cure with treatment are particularly good in ALL, especially in children between the ages of 3 and 7 (90 percent). The cure rate for AML is between 50 and 85 percent, and bone marrow transplantation further increases the cure rate. The chances of cure worsen in those over 20 years of age. If acute leukemia is not treated, it leads to death within weeks to months. CML has a five-year survival rate of 60 percent with combination therapy. Bone marrow transplantation can even lead to cure. CLL can remain asymptomatic for more than 20 years. After that, prognosis depends on the organs affected and the cells in the blood.
