Leukemia – symptoms and treatment

Leukaemia, or blood cancer, is a group of malignant diseases of the blood-forming system. In all forms of this cancer, the maturation of the white blood cells (leukocytes) is disturbed. As a result, immature blood cells are increasingly formed, crowding the healthy ones. Different symptoms characterize several types of leukaemia and require different forms of treatment. One differentiates mainly between acute and chronic and between myeloid and lymphatic forms of leukaemia. We provide information about the symptoms, therapy and chances of recovery from leukaemia.

Leukaemia: Recognizing the Signs

Since the acute forms of leukaemia deteriorate quickly, the symptoms are usually more pronounced. Chronic leukaemia can go undetected for many years because those affected often show no signs of blood cancer at all at the beginning. Many complaints are caused by suppressing normal blood formation:

• red blood cells: anaemia with exhaustion, tiredness, paleness and tachycardia
• white blood cells: increased susceptibility to infections
• Platelets: coagulation disorders that develop, e.g. B. by increased bruising or minor skin bleeding

 

Other symptoms of leukaemia

Fever, night sweats, loss of appetite and weight loss can also occur as non-specific symptoms of leukaemia. Other symptoms can be expressed by the fact that the cancer cells settle in other organs (form metastases) and cause displacement symptoms or functional disorders. This often leads to an enlargement of the lymph nodes, spleen and liver or the colonization of leukaemia cells in the brain or spinal cord.

In the case of chronic lymphocytic leukaemia (CLL), a distinction is made between several stages, depending on whether and which other structures are affected, whether anaemia is present or whether the blood platelets are reduced.

Leukaemia: diagnosis and therapy

The symptoms are often the first indications of leukaemia. First, the exact blood test  (differential blood count) is essential – the blood count can almost always be used to diagnose leukaemia. With an examination of the bone marrow, which is usually removed from the iliac crest under local anaesthesia, the form of leukaemia can be precisely determined, which is essential for therapy and prognosis.

Two basic treatment strategies are available for leukaemia, which are often combined and supplemented by other therapies.

 

chemotherapy for leukaemia

Chemotherapy is used to treat all types of leukaemia. The aim is to destroy the cancer cells. Cells that divide frequently are particularly susceptible to cytostatics, so that leukaemia cells can be destroyed very quickly. If only a part is destroyed, one speaks of partial remission. If no more cells are detectable in the blood (which does not mean that there are no more cells in the bone marrow), this is called complete remission.

However, the drugs administered during chemotherapy also damage other cells, so several side effects must be expected. Normal blood cells are particularly at risk, which is why there is a high risk of infection. Recently, new active ingredients have been developed that attack specific cancer cells and inhibit their proliferation. Some are already on the market (e.g., imatinib for CML – chronic myeloid leukaemia); others are still in the trial phase.

Bone marrow transplantation for leukaemia

A bone marrow transplant often increases the chances of a cure for leukaemia. Before transplantation, the bone marrow is destroyed using radiation; then, the bone marrow is transferred by infusion from a matched donor. If all goes well, the stem cells settle in the bone marrow and produce healthy blood cells again.

The disadvantage of bone marrow transplantation is that the patient has to take medication that suppresses the body’s immune system so that the cells are not rejected. This means that there is a significant risk of infection, especially at the beginning, which is why leukaemia patients often have to spend their therapy in specially protected rooms.

Treatment of various types of leukaemia

Depending on the type of leukaemia, various forms of therapy are used during the disease:

• ALL (acute lymphoblastic leukaemia): several blocks of intensive chemotherapy, then maintenance therapy at a lower dose for one to two years; additional irradiation of the skull and injection of drugs into the cerebrospinal fluid; possibly bone marrow transplant.
• AML (acute myeloid leukaemia): intensive chemotherapy followed by maintenance therapy, possibly bone marrow transplantation, especially in younger patients.
• CLL (chronic lymphocytic leukaemia) depends on the stage; treatment is only carried out when the number of blood cells reaches a certain level or when there are complications: chemotherapy (tablets, infusions), possibly cortisone and local irradiation of the lymph nodes. In younger patients, bone marrow transplantation may be considered.
• CML (chronic myeloid leukaemia): First, interferon injections into the abdomen, then chemotherapy (tablets or injections), and particular drugs like imatinib.

In addition, any symptoms or disorders that may occur, such as anaemia or infections, are specifically treated.

 

Leukaemia: course and chances of recovery

The prognosis depends on the type of leukaemia and age and whether there are genetic changes. The chances of recovery under treatment are particularly good for ALL, especially in children between the ages of 3 and 7 (90 per cent). The healing rate for AML  is between 50 and 85 per cent; a bone marrow transplant increases this further. The chances of recovery worsen in those over 20 years. If acute leukaemia is not treated, it leads to death within weeks to months.

With combination therapy, CML  has a five-year survival rate of 60 per cent. A bone marrow transplant can even lead to a cure. CLL  can remain asymptomatic for over 20 years. After that, the prognosis depends on the affected organs and the cells in the blood.