leukaemia

Leukemia (blood cancer) is a disorder of the formation of blood cells.




 This form of cancer is rare compared to other cancers. In Austria, just under 1,000 people a year suffer from some form of leukemia.

Most common are the forms of acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL). In comparison, about 4 times as many people in Austria develop lung cancer each year. The increased formation of white blood cells causes anemia in leukemia, which is manifested by a deficiency supply of the oxygen-carrying red blood cells. Visible symptoms can be increased fatigue and paleness. The chances of recovery are very different in children and adults and also depend on whether the blood cancer recurs. This can be done in up to 40% of all cases. Healing chances are increased if stem cell transplantation is possible.
How common is leukemia?

In Austria, nearly 1,000 people a year suffer from some form of leukemia. The most common form of leukemia is acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL).
What is leukemia?

Leukemia is a disorder of the formation of blood cells. The blood consists of 3 components:

    red blood cells (erythrocytes)
    white blood cells (leukocytes)
    Platelets (platelets)

The blood cells are formed in the bone marrow by the blood stem cells. The production of white and red blood cells is controlled by a hormonal control circuit. If this is disturbed, it leads to an overproduction of white blood cells and a lack of red blood cells. The white blood cells degenerate, displace healthy bone marrow cells and can no longer perform their original task of protecting the body from infection.

Leukemia can occur at any age, but the individual types are particularly common in a given age. Depending on the type and course of the disease, there are 4 types of leukemia:

    acute lymphoblastic leukemia (ALL)
    acute myeloid leukemia (AML)
    chronic myeloid leukemia (CML)
    chronic lymphocytic leukemia (CLL)

Acute Lymphocytic Leukemia (ALL)

Acute lymphoblastic leukemia (ALL) is a life-threatening malignant disease. Although it occurs rarely, but is the most common cancer in children and adolescents and requires a complicated diagnosis. The therapy, like the diagnosis, must be performed at a specialized center, because the meninges can also be affected during the course of the disease.
Chronic lymphocytic leukemia (CLL)

CLL is a disease of the lymphatic system and is actually a disease group of lymphomas. CLL usually arises after the age of 50 years. The degenerate lymphoma cells are located in the lymphatic organs, e.g. in the bone marrow or in the (enlarged) lymph nodes, the spleen and are also detectable in the blood. The proportion of lymphocytes in the blood can be up to 95% in patients. The disease is therefore often referred to as "lymphoma cancer".
Acute myeloid leukemia (AML)

It is the most common type of leukemia in middle-aged adults. It is characterized in that myeloblasts, or monoblasts, ie precursors of leukocytes, increasingly occur.
Chronic myeloid leukemia (CML)

There are significantly more leukocytes in the blood than in the normal case, the disease occurs almost exclusively in adults.
What causes can cause leukemia?

The causes that promote the development of leukemia are still largely unknown. Some risk factors, such as genetic predisposition or radioactive radiation, are considered assured. Some chemicals are also suspected of causing leukemia. For example, Benzene, contained in fossil fuels or in cigarette smoke, as a risk factor. Pesticides or certain solvents are suspected to promote the development of the disease.
Leukemia - Symptoms

In leukemia it comes u.a. to a disturbed blood clotting, which can be expressed by heavy bleeding (nosebleeds, bleeding gums). If the "immature" cells are flushed out of the bone marrow, they can settle on mucous membranes in other areas of the body and cause bleeding there, as e.g. Bleeding gums or, if they settle in the lymph nodes, lead to enlargement of the lymph nodes. Also complaints such as pressure in the upper abdomen or abdominal pain can be caused by an enlarged spleen, if these cells settle there. Affected persons often complain about

    fatigue
    Fatigue and energylessness
    Even night sweats can be signs of the disease
    exhaustion
    paleness
    fever

A weakened immune system, which can be explained by the erroneous control of the blood corpuscles, can lead to more frequent infections than usual.
diagnosis

In a detailed conversation with the doctor, the medical history is collected (anamnesis). Patients should always talk about symptoms such as swelling of the lymph nodes or discomfort, upper abdominal hardening and frequent infections.
laboratory examination

Leukemia can only be reliably diagnosed with a comprehensive blood test. A blood test shows which form of leukocytes has changed malignantly. The cells are streaked on a glass plate and examined for their exact properties. This process is called cytochemistry. The doctor can tell from the staining of these streaked cells, which type of disease it is, but better the cells can still be assigned by immunophenotyping. If there is a suspicion of this disease, an examination of the bone marrow is also carried out. This is taken from the pelvic bone in local anesthesia and examined whether tumor cells have settled therein.
lumbar puncture

A lumbar puncture may be required if it is an acute form of leukemia and there is a suspicion that the meninges are also affected. In this study, cerebrospinal fluid (CSF) is taken from the spine in the lumbar region. Close examination shows whether tumor cells are present in the CSF.
immunophenotyping

This procedure is a special laboratory test. The surface characteristics of a cell are precisely examined by staining them with fluorescent antibodies. This will determine the exact type of disease. Especially acute lymphatic, acute myeloid and chronic lymphocytic leukemia can be reliably diagnosed with this procedure. What's more, immunophenotyping also helps determine which subgroup of white blood cells has malignantly changed. With this diagnosis, it is possible to initiate an individual therapy for each type of tumor and each patient.
Imaging studies
Computed tomography (CT)

A computed tomography is needed to determine if the abdomen, or whether organs such as liver, spleen or kidney are affected by tumor cells. The organs are enlarged in this case, by the CT this is clearly visible.

If the person complains of bone pain, a combination of MRI and CT or a scintigraphy is needed to visualize any changes. A scintigraphy is a nuclear medical examination in which radiopharmaceuticals, so slightly radioactive substances are introduced into the area to be examined.

Genetic examination

Another, very special procedure is the cytogenetic examination. Here, the chromosomes of the leukemia cells and their genetic material are examined. For example, affected persons suffering from chronic myeloid leukemia usually have the so-called Philadelphia chromosome. If this is found in an investigation, it is possible to prescribe specially tailored therapies. Also in acute myeloid leukemia, chromosomal abnormalities often occur, which can be determined by cytogenetic examination, thus enabling adequate, tailor-made treatment.
Therapy of leukemia
Acute leukemia

The standard therapy for every leukemia is chemotherapy. Therapy for acute leukemia, such as ALL and AML, initially very intense. The first cycle, the "induction chemotherapy" has the goal to push back the diseased cells so that after 4 cycles they are no longer detectable in the blood and in the bone marrow. Statistically, the diseased cells are no longer detectable in 80% of ALL sufferers after only 2 cycles. However, to ensure the success of the therapy, 2 more chemotherapy cycles are performed.

In about 50% of the persons under 60 years of age, this succeeds within 5 years, in the over-60s no tumor cells are detectable after every 5 years after the age of 60 years. In the case of ALL, leukemia cells can infect the brain, so in addition to the chemotherapeutic treatment, cytostatics are injected directly into the spinal cord water. Irradiation of the head is also indicated.

Cytostatic drugs are also used to treat CLL, now routinely combined with antibody therapy. The treatment is less aggressive in these forms, but it usually results in a long-term treatment. The disease can not be cured from today's perspective, but the symptoms can be mitigated largely and in the long term.
Chronic leukemia
Chronic Myeloid Leukemia (CML)

This can be treated by high-dose chemotherapy with stem cell transplantation. For this purpose, a bone marrow or blood stem cell transplantation, which can lead to healing. However, the procedure is risky and only possible for a part of those affected. Patients must take lifelong immunosuppressive drugs after a bone marrow transplant.

Golden standard, however, is the treatment with targeted therapeutics, more specifically with the tyrosine kinase inhibitor imatinib. This drug inhibits the activity of the enzyme tyrosine kinase. This enzyme is only produced by leukemia cells. This drug can inhibit the progression of the disease and prevent new malignant cells from forming. Meanwhile, several similar substances are available that can be successfully used in mutation-induced primary treatment failure.

Interferons can also inhibit the growth of malignant tumor cells. Interferons are messenger substances that enable "communication" of the body's own defense cells.

ATRA (All-trans-retin-acid), a vitamin A derivative, is the active ingredient with which u.a. a special form of acute lymphoblastic leukemia has been treated: acute promyelocytic leukemia (APL) is the result of a defective gene and causes a "gene fusion", which in turn leads to degeneration of the bone marrow cells. A combination of ATRA and arsenic trioxide (ATO) can increase the survival rate to 98%.
Chronic lymphocytic leukemia (CLL)

Chronic lymphocytic leukemia (CLL) usually progresses very slowly. Often, a diagnosis is made only when the blood levels deteriorate and the person feels tired and ill. For the treatment of CLL chemotherapy is still standard. A special feature of the disease is B-cell chronic lymphocytic leukemia (B-CLL).

For these patients, chemotherapy alone does not make sense because they do not respond adequately to the medication. A further therapy option in this case offer combinations with so-called monoclonal antibodies, for example rituximab or alemtuzumab. This drug binds to the surface of the diseased lymphocytes, causing the death of the tumor cells and can thus stop the progression of the disease. A cure of the CLL is not yet possible from today's point of view, however, the complaints can be well managed over a long time.