What are the Symptoms of Leukemia

leukemia

Leukemia: Quick Reference

  • What is leukemia Group of cancers of the hematopoietic system. Also called "blood cancer" or "leukosis".
  • Common forms: Acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML), chronic lymphocytic leukemia (CLL; actually a form of lymphatic cancer)
  • Possible symptoms:Fatigue and exhaustion, reduced performance, easy fatigue, pale skin, tendency to bleeding and bruising (hematomas), tendency to infections, fever of unknown cause, weight loss, night sweats, etc.
  • Frequency: Every year 13,700 people in Germany develop leukemia, mostly between the ages of 60 and 70 years. Men are affected slightly more often than women. About four percent of the patients are children under the age of 15.
  • Treatment: depending on the type and stage of leukemia; e.g. chemotherapy, tyrosine kinase inhibitors, interferons, monoclonal antibodies, radiation therapy, stem cell transplantation, etc.
  • Forecast: Acute leukemia can often be cured if it is recognized and treated in good time. In chronic leukemia, therapy can extend the survival time of many patients. A high-risk stem cell transplant can only be cured here.

Leukemia: symptoms

Leukemia can manifest itself suddenly with symptoms and progress quickly. Doctors then speak of acute leukemia. In other cases, the blood cancer develops slowly and insidiously. Then it's a chronic leukemia.

Acute leukemia: symptoms

The symptoms of acute leukemia develop relatively quickly. Symptoms of both acute lymphatic leukemia (ALL) and acute myeloid leukemia (AML) include:

  • decreased performance
  • persistent fever
  • night sweats
  • fatigue
  • Weight loss
  • Bone and joint pain (especially in children with ALL)

The patient's body produces large amounts of immature white blood cells (Leukocytes). These displace the healthy blood cells, i.e. mature leukocytes, red blood cells (erythrocytes) and blood platelets (thrombocytes). This causes more signs of leukemia. So the shortage of red blood cells leads to it Anemia (Anemia). For example, those affected suffer from:

The lack of blood platelets (thrombocytes) in acute leukemia often causes one increased tendency to bleed. For example, patients often have bleeding gums or nosebleeds. When injured, it takes longer than usual for a wound to stop bleeding. In addition, the patients get increased bruises (Hematoma) - another typical sign. If there is a severe shortage of blood platelets (thrombocytopenia), red bleeding occurs in the skin, so-called petechiae.

Leukemia can also weaken the immune system. As a result, patients often suffer from persistent infections like poorly healing inflammation in the oral cavity. The reason: The patient's body has too few functional white blood cells - and these normally serve to ward off infection. The immune system in leukemia is therefore weakened overall.

Other possible leukemia symptoms are:

  • painless swollen lymph nodes
  • enlarged liver and spleen
  • Rashes
  • Gum overgrowth

Chronic leukemia: symptoms

Chronic leukemia begins slowly. In the first few months or even years, many patients have no symptoms whatsoever. Some report only general symptoms such as tiredness and decreased performance. These are usually not recognized as signs of leukemia. That is why most patients do not see a doctor. Symptoms of chronic leukemia that resemble an acute course only develop at an advanced stage.

In the Chronic myeloid leukemia (CML) There are three phases in which the disease becomes increasingly aggressive. This can also be seen in the signs of leukemia:

  • Chronic phase: Here the number of white blood cells is abnormally increased (leukocytosis) and the spleen is enlarged (splenomegaly). The latter can cause a feeling of pressure in the left upper abdomen. Other symptoms of leukemia in this phase include tiredness and decreased performance.
  • Acceleration phase (transition phase): The number of leukocytes continues to rise. At the same time, the number of red blood cells and platelets decreases. Typical symptoms of CML are now skin pallor, palpitations, shortness of breath and frequent nose and gum bleeding. Night sweats and fever can also occur. The liver is increasingly enlarged.
  • Blast crisis (blast surge): In this last phase of the disease, the bone marrow releases large amounts of immature precursors of blood cells (so-called myeloblasts and promyelocytes) into the blood. This causes symptoms that are similar to those of acute leukemia. Most of the time, the patients die soon.

The Chronic lymphatic leukemia (CLL) is also slow to progress. That is why the term "leukemia" is in their name. Actually, it is not a blood cancer, but a special form of lymph gland cancer (malignant lymphoma).

Overview of the types of leukemia

The four main forms of leukemia are:

There are also other types of leukemia, but they are very rare. One example is hairy cell leukemia.

The so-called leukemias are related to myelodysplastic syndromes (MDS). These are also chronic diseases of the bone marrow in which insufficiently functional blood cells are formed. The symptoms are similar to chronic myeloid leukemia. However, they are less pronounced at the beginning. In about 25 to 30 percent of patients, the myelodysplastic syndrome sooner or later turns into fully developed leukemia, namely acute myeloid leukemia.

Myeloid Leukemia

Myeloid leukemia originates from the so-called myeloid precursor cells in the bone marrow. These progenitor cells normally develop into healthy red blood cells, platelets, and granulocytes and monocytes. The last two are subsets of white blood cells.

But when myeloid progenitor cells degenerate and begin to grow in an uncontrolled manner, myeloid leukemia develops. Depending on their course, doctors differentiate between them Acute myeloid leukemia (AML) and the Chronic myeloid leukemia (CML). Both forms of blood cancer are most common in adults. The AML is much more common than the CML.

You can read more about the two forms of myeloid blood cancer in the article Myeloid Leukemia.

Lymphatic leukemia

Lymphatic leukemia originates from different blood cell precursors than myeloid blood cancer: Here the so-called lymphatic precursor cells degenerate. Out of them against the lymphocytes. This subgroup of white blood cells is very important for the targeted (specific) defense against foreign substances and pathogens (specific immune defense).

  • "Don't bury your head in the sand"

    Three questions to

    Prof. Dr. med. Marcus Hentrich,
    Internal oncology
  • Why does someone get leukemia?

    Prof. Dr. Marcus Hentrich, MD

    That is certainly a question that everyone concerned asks. The answer is: we don't know. There are risk factors such as increased radioactive radiation, but these usually do not apply to normal German citizens. It is almost always random changes in the genetic material of the cells that take place there. It is completely unclear why Mr Müller gets this now and not Mr Schuster.

  • When do you need a stem cell donation with leukemia?

    Prof. Dr. Marcus Hentrich, MD

    An allogeneic stem cell transplant - for example with stem cells from family members - is a very effective, but also risky therapy. It is therefore only used in certain forms of acute leukemia. And only if an unfavorable gene constellation leads to a poor prognosis. But then it can significantly improve the chances of recovery. You have to weigh up with the patient whether the opportunities outweigh the risks.

  • How can I support my recovery?

    Prof. Dr. Marcus Hentrich, MD

    Such a diagnosis naturally kicks you out of life. But don't bury your head in the sand, try to find the best route for yourself. Don't stay in bed, move around, keep fit. A good network or self-help groups can also be helpful. It takes a lot of support, get some.

  • Prof. Dr. med. Marcus Hentrich,
    Internal oncology

    Prod. Dr. med. Marcus Hentrich is medical director and chief physician, as well as a specialist in internal medicine, hematology and oncology at the Rotkreuzklinikum Munich.

Here, too, one speaks of, depending on the course of the disease Acute lymphatic leukemia (ALL) or Chronic lymphatic leukemia (CLM). ALL is the most common type of blood cancer in children and adolescents. CLL, on the other hand, typically occurs in older adults. It is referred to as "leukemia" (blood cancer) only because of its course. CLL is actually a form of lymph gland cancer - it is one of the so-called non-Hodgkin lymphomas.

You can find out more about these two cancers in the article Lymphatic Leukemia.

Hairy cell leukemia

Hairy cell leukemia (or hairy cell leukemia) is a very rare cancer. The same applies to them as to chronic lymphatic leukemia: The part of the name "leukemia" only indicates that the disease is like blood cancer. However, it is assigned to lymph gland cancer (more precisely: non-Hodgkin lymphoma).

The part of the name "hair cells" comes from the fact that the cancer cells have hair-like extensions.

Hairy cell leukemia only occurs in adulthood. Men get it much more often than women. The chronic disease is not very aggressive. Most patients have a normal life expectancy.

You can read everything you need to know about this cancer in the article Hairy Cell Leukemia.

Childhood leukemia

Leukemia is primarily a disease of adults: it makes up around 96 percent of all patients. If leukemia develops in children, it is almost always acute lymphatic leukemia (ALL). In second place is acute myeloid leukemia (AML). Chronic leukemia is very rare in children.

If acute blood cancer is discovered and treated early in childhood, the chances of a cure are good. In comparison, acute leukemia tends to have a poor prognosis in adults.

You can find out everything you need to know about blood cancer in children in the article Leukemia in Children.

Leukemia: treatment

The leukemia treatment is individually tailored to each patient. Various factors play a role here. In addition to the age and general health of the patient, this is primarily the course of the disease (acute or chronic).

Acute leukemia: treatment

As soon as possible after the diagnosis of "acute leukemia", patients with a chemotherapy start. It is considered to be the most important therapy method for acute blood cancer. The patient receives special medication, so-called cytostatics (chemotherapeutic agents). They prevent cancer cells (and other rapidly dividing cells) from growing. The damaged cells can no longer multiply. They are then recognized by the body's own control mechanisms and specifically broken down.

Most of the time they will Cytostatics as an infusion given directly into a vein (as an infusion), but occasionally too as tablets taken. They can be given individually or in combination and in different dosages. In this way, chemotherapy can be individually adapted to each patient. The treatment is also carried out in Cycles: The patient receives the cytostatics on one day or on several days in a row. Then there is a break in treatment (days to months) before a new cycle is started. Most cancer patients receive an average of four to six such chemotherapy cycles.

Acute leukemia therapy basically takes place in three phases, which together can extend over months and years:

  1. Induction therapy: The patients here receive strong chemotherapy, which is supposed to eliminate all cancer cells as far as possible and alleviate the most severe symptoms. The treatment is usually carried out as an inpatient in a hospital.
  2. Consolidation Therapy: It is designed to "solidify" the success of induction therapy. In addition, many patients receive adapted chemotherapy to eliminate any remaining cancer cells.
  3. Maintenance therapy: The aim here is to stabilize the success of the treatment and prevent a relapse (relapse). Maintenance therapy can vary greatly from patient to patient. Often, cytostatics are given in tablet form for at least a year.

Induction therapy can be so successful that practically no cancer cells can be detected in the patient's blood and bone marrow. Doctors then speak of a remission. But it does not mean that the leukemia is cured. Individual cancer cells may still have survived. Therefore further therapy steps (consolidation therapy) are necessary.

After maintenance therapy, the Aftercare on: The patient's blood and bone marrow are checked regularly. In this way, if there is a relapse, the cancer cells can be detected at an early stage. In addition, aftercare is about treating any side effects and long-term effects of previous chemotherapy.

Further therapy options

Sometimes there is oneStem cell transplant also part of the leukemia treatment. The stem cells are the "mother cells" from which all blood cells in the bone marrow arise (and for life). Prior to the transplant, high-dose chemotherapy (and possibly whole-body radiation) will destroy practically all of the patient's bone marrow and (hopefully) all of the cancer cells. Thereafter, healthy stem cells are transferred to the patient like a transfusion. The cells settle in the medullary cavities of the bones and produce new, healthy blood cells.

In leukemia, stem cells are usually transferred from a healthy donor (Allogeneic stem cell transplant). More rarely, they are stem cells from the patient himself, which were taken from him before the bone marrow was destroyed (Autologous stem cell transplant). The therapeutic method is particularly useful when other treatments (especially chemotherapy) are not working sufficiently or the patient suffers a relapse.

Many patients with acute lymphoblastic leukemia (ALL) receive chemotherapy in addition to chemotherapy radiotherapy. On the one hand, the head is irradiated as a preventive measure, since the cancer cells attack the brain more often. On the other hand, radiation can be used to specifically treat malignant lymph nodes (for example in the breast area).

Chronic leukemia: treatment

The Chronic myeloid leukemia (CML) is mostly discovered in the chronically stable phase of the disease (see above). The doctor then usually prescribes so-called Tyrosine kinase inhibitors (like imatinib). These drugs work very specifically against blood cancer cells: They inhibit growth signals in the cells. This can stop the disease for many years. The tyrosine kinase inhibitors are taken as tablets, usually for life.

At the same time, the patient's blood and bone marrow are checked regularly. If, for example, the blood values ​​or the patient's condition worsen, this indicates that the CML is moving into the next phase (acceleration phase). The doctor then changes the drug treatment: he prescribes other tyrosine kinase inhibitors. In this way, the disease can be brought back into a chronically stable phase in many patients.

If that doesn't work, one may come Allogeneic stem cell transplant in question - i.e. the transplantation of healthy, blood-forming stem cells from a donor. So far, this is the only form of therapy that has the chance to completely cure chronic myeloid leukemia. However, it is very risky. Therefore, the benefits and possible risks of the treatment are carefully weighed beforehand for each patient.

At any stage of the disease, a patient's condition can deteriorate significantly within a short period of time. Then doctors speak of a blast crisis. As with acute leukemia, those affected usually receive an intense one chemotherapy. So one tries to suppress the signs of the disease as quickly as possible. Once the patient's condition has improved and stabilized, a stem cell transplant may be useful.

Some patients with CML will be with Interferons treated. These are messenger substances with which the cells of the immune system communicate with one another. They can inhibit the growth of cancer cells. However, like chemotherapy, interferons are usually less effective in CML than the tyrosine kinase inhibitors described above.

But this does not always apply: the tyrosine kinase inhibitors work best in patients whose cancer cells have the so-called "Philadelphia chromosome". This is what a characteristically changed chromosome 22 is called. It can be found in more than 90 percent of all CML patients. The rest of the patients do not have the changed chromosome. Treatment with tyrosine kinase inhibitors therefore often does not work so well with them. Then it may be necessary to change the therapy and use interferons, for example.

The Chronic lymphatic leukemia (CLL) does not require treatment for a long time in many patients. Only when the blood values ​​worsen or symptoms occur in an advanced stage do doctors initiate therapy - adapted to each individual patient.

For example, many sick people receive one chemotherapy plus so-called Monoclonal antibodies (Immunochemotherapy or chemoimmunotherapy): The artificially produced antibodies bind specifically to the cancer cells and thereby mark them for the immune system. Both types of therapy are occasionally used individually.

If the cancer cells show certain genetic changes, treatment with Tyrosine kinase inhibitors be useful. These drugs block a pathologically altered enzyme that promotes cancer cell growth.

If other treatments don't work, or if they relapse later, doctors sometimes run one Stem cell transplant through: After aggressive chemotherapy, healthy, blood-forming stem cells from a donor are transferred to CLL patients (allogeneic stem cell transplantation). This risky treatment is only suitable for young or very fit patients.

Accompanying measures (supportive therapy)

In addition to leukemia treatment using chemotherapy, radiation therapy, etc., supportive measures are also very important. They serve, for example, to reduce symptoms of the disease and the consequences of treatment. This can enormously improve the patient's well-being and quality of life.

For example are Nausea and vomiting common and very unpleasant side effects of chemotherapy for leukemia (and other cancers). They can be alleviated with special drugs (antiemetics).

The increased susceptibility to infection is also a serious problem in leukemia. Both the disease itself and chemotherapy weaken the immune system. It is then less able to fight pathogens. This favors infections, which can then also be very difficult. Sometimes they even become life threatening! Therefore are careful hygiene and one if possible sterile environment very important for leukemia patients. Many also receive Antibioticsto prevent or treat bacterial infections. There are also special agents against fungal infections, so-called Antifungal drugs.

Other complaints can often be treated specifically, for example anemia (anemia) using Blood transfusion and pain with appropriate Painkillers.

Read more about the therapies

Read more about therapies that can help here:

Leukemia: causes and risk factors

The causes of the various types of blood cancer have not yet been clearly clarified. However, experts have identified several risk factors that promote the development of leukemia. These include:

Genetic predisposition: The risk of leukemia is slightly higher if cancer has occurred more frequently in your own family. Certain genetic diseases also make them more susceptible to blood cancer. For example, people with trisomy 21 (Down syndrome) have a 20 times higher risk of acute myeloid leukemia (AML) than people without this genetic change.

Age: The development of acute myeloid leukemia (AML) is influenced by age: the risk of the disease increases with age. The same applies to chronic myeloid leukemia (CML) and chronic lymphatic leukemia (CLL). In contrast, acute lymphatic leukemia (ALL) occurs mainly in childhood.

Smoke: Researchers estimate that smoking is responsible for around ten percent of all leukemia diseases. For example, active smokers have a 40 percent higher risk of acute myeloid leukemia (AML) than people who have never smoked. In the case of former smokers, the risk of illness is still increased by 25 percent.

Ionizing rays: This is understood to mean various high-energy rays, for example radioactive rays. They damage the genetic material - especially in those body cells that divide frequently. This also includes the blood-forming cells in the bone marrow. Leukemia can develop as a result. The following applies: the higher the radiation dose that affects the body, the greater the risk of leukemia.

Such ionizing rays are also used in radiation therapy against cancer. Not only can they kill the cancer cells as desired, they can also damage the genetic material in the healthy cells. In rare cases, patients develop a second cancer caused by radiation as a result.

X-rays are also ionizing. However, experts assume that an occasional X-ray examination cannot trigger leukemia. Nevertheless, one should only take X-rays when absolutely necessary. Because the damage that the rays cause in the body can add up in the course of life.

Chemical substances: Various chemicals can increase the risk of leukemia. These include, for example, benzene and other organic solvents. Insecticides (insecticides) and pesticides (herbicides) are also suspected of promoting blood cancer.

This connection is certain for certain drugs that are actually used to treat cancer (such as cytostatics): They can promote the development of leukemia in the long term. Doctors therefore carefully weigh the benefits and risks of such drugs against each other before using them.

Viruses: Certain viruses (HTL viruses I and II) are involved in the development of a very rare form of leukemia. This so-called human T-cell leukemia mainly affects people in Japan. This blood cancer variant is extremely rare in our country.

According to the current state of knowledge, all other forms of leukemia (AML, CML, ALL, CLL etc.) arise without any involvement of viruses or other pathogens.

Leukemia: examinations and diagnosis

While chronic leukemia usually remains symptom-free for a long time, acute forms start relatively suddenly and progress quickly. Symptoms such as reduced performance, paleness, palpitations, frequent nosebleeds or persistent fever also occur in many other and sometimes harmless diseases. That is why they are not always taken seriously. With such symptoms, however, there is always a suspicion of leukemia. Therefore you should definitely go to the doctor.

The first point of contact if you suspect blood cancer is your family doctor. If necessary, he will refer the patient to a specialist, for example to a specialist in blood and cancer diseases (hematologist or oncologist).

Conversation and physical examination

The doctor will do the first Medical history raise (anamnesis). He asks how the patient is feeling in general, what symptoms he has and how long they have existed. Information on any other illnesses that currently exist or have occurred earlier can also be important. In addition, the doctor asks, for example, whether the patient is receiving any medication and whether there are any known cancers in the family.

This is followed by a thorough one physical examination. Among other things, the doctor will listen to the lungs and heart, measure the blood pressure and scan the liver, spleen and lymph nodes. The results help the doctor to better assess the general condition of the patient.

Blood test

Blood tests are important if you suspect leukemia or a related disease. There will be a small blood count and a Differential blood count created. The small blood count shows, among other things, the number of white blood cells (total number), red blood cells and platelets. For the differential blood count, the various subgroups of white blood cells are measured individually. The appearance of the blood cells can also be assessed under the microscope.

Pathological changes in blood values ​​such as an increased number of white blood cells and a lack of red blood cells can be important indicators of leukemia. However, they can also be caused by many other diseases.

In addition to the blood cells, the laboratory also other blood parameters assesses, for example, the kidney values ​​and liver values. These values ​​indicate how well these two organs are working. If leukemia is confirmed in the further course and the kidney and / or liver values ​​of the patient are poor, this must be taken into account when planning therapy.

The laboratory also tests whether there are any signs of bacterial, viral, or fungal infection in the blood. These germs could also be responsible for some complaints, for example an increased number of white blood cells, fever and fatigue.

Bone marrow puncture

Whenever leukemia is suspected, it is necessary to carefully examine the patient's bone marrow. To do this, the doctor takes a bone marrow sample with a special needle under local anesthesia, usually from the pelvic bone (bone marrow puncture). The number and appearance of the bone marrow cells are examined in the laboratory. With typical changes, one can clearly identify leukemia. Sometimes the form of the disease can even be determined. In addition, the cells can be examined for changes in their genetic make-up (for example the "Philadelphia chromosome" in chronic myeloid leukemia).

Adults and older children are usually given a local anesthetic before the bone marrow is removed. A brief anesthetic can be useful for smaller children. The whole puncture usually only takes about 15 minutes and can be performed on an outpatient basis.

Further investigations

Once the diagnosis of leukemia is confirmed, further examinations are often necessary. They should show whether other parts of the body and organs are also affected by the cancer cells. The general condition of the patient can also be better assessed with such examinations. This is important for therapy planning.

For example, you can use internal organs (spleen, liver, etc.) Ultrasonic examine. There may also be a Computed tomography (CT) made. This imaging procedure can also be used to assess the bones. This is important if the doctor suspects that the cancer cells have spread not only in the bone marrow but also in the bone itself. Sometimes there will be a Magnetic resonance imaging (MRI) or one Scintigraphy carried out.

In acute lymphoblastic leukemia (ALL) and some subtypes of acute myeloid leukemia (AML), the cancer cells sometimes affect the brain or meninges. Possible signs of this are headaches and nerve failures such as visual disturbances and paralysis. Then one can Spinal fluid sample taken (lumbar puncture) and analyzed in the laboratory. An MRI can also be helpful to detect cancer of the brain.

Read more about the examinations

Find out here which examinations can be useful for this disease:

Leukemia: disease course and prognosis

For many people with leukemia, the chances of survival are significantly better today than they were several years or decades ago. Modern therapies can often improve the chances of recovery. If the cancer is too advanced, treatment can at least relieve the symptoms of many patients and extend their survival time.

In individual cases, the prognosis for leukemia depends on various factors. The first is the type of cancer and the stage of the disease at the time of diagnosis. How well the patient responds to the therapy also has an influence on the prognosis. Other factors that influence life expectancy and the chances of recovery in leukemia are the age and general condition of the patient as well as possible concomitant diseases.

Leukemia: Chances of a Cure

"Is Leukemia Curable?" Many patients and their families ask themselves this question. In principle, with acute leukemia Healing is possible. The earlier the disease is discovered and treated, the greater the chances of recovery. This is especially true for younger patients:

Without treatment, most patients only survive a diagnosis of acute leukemia for about three months. With acute lymphatic leukemia (ALL) treatment, 95 percent of children and 70 percent of adults are still alive five years after diagnosis. For acute myeloid leukemia (AML), the 5-year survival rate is 40 to 50 percent in patients under 60 years of age and 20 percent in the 60+ age group.

Even if the cancer can be suppressed, a relapse (relapse) can occur later, even after months and years. The chances of recovery decrease, especially with an early relapse. Leukemia patients then have to be treated again. Sometimes doctors choose more aggressive therapy or other treatments.

At achronic leukemia The cancer cells multiply more slowly than in acute forms of cancer (exception: blast crisis in CML) - and usually for years. Therefore, the treatment is usually less intensive, but must be continued over the long term. In general, chronic leukemia cannot be cured (this chance only exists with risky stem cell transplants). In many patients, however, the therapy can alleviate the symptoms and the progression of the chronic ones leukemia brake.

Additional information

Book recommendations

Chronic leukemia: advice and help for those affected and their relatives (advice & help) (Hermann Delbrück, Kohlhammer, 2008)

Guidelines