Leukemia develops by chance

Acute leukemia (blood cancer, ALLES, AML)

The term leukemia describes a group of diseases of the blood-forming system in which there is an uncontrolled increase in immature white blood cells. In contrast to chronic leukemia - which has a slow and insidious course - acute leukemia occurs suddenly and, if left untreated, leads to death within a few weeks.

Blood cells

The blood consists of liquid (blood plasma) and solid components (blood cells). These include white (leukocytes) and red blood cells (erythrocytes) and platelets (thrombocytes).

The white blood cells can be further divided into lymphocytes, granulocytes and monocytes. Their task is to fend off pathogens and foreign structures and to form defense cells (antibodies).

If there is an uncontrolled increase in white blood cells, doctors speak of leukemia.

How does leukemia develop?

All blood cells are made in the bone marrow: They are created through gradual division and maturation from a common stem cell. The blueprint for this lies in the DNA (genetic information) of each individual cell. If a mutation (genetic change) occurs at an early stage in the formation of white blood cells (leukocytes), the normal maturation process is interrupted: the cell begins to divide and multiply in an uncontrolled manner, and tumor cells (leukemic blasts) develop. The blasts accumulate in the bone marrow and displace more and more healthy blood cells. The tumor cells are finally washed into other organs via the blood and lymphatic systems, where they lead to severe functional disorders.

How and why the mutations occur in the immature blood cells is not fully understood. In any case, it is certain that acute leukemia is seldom congenital and not contagious, but usually arises “by chance”. It is assumed that only the interaction of several factors triggers the disease. The currently known risk factors include chemical substances, ionizing radiation (X-ray examination, radiation therapy) or certain drugs (previous chemotherapy). In most cases, however, the trigger remains unclear. The disease is more common in old age.

In contrast to chronic leukemia, which has a slow and rather insidious course, acute leukemia develops quickly and manifests itself in symptoms that suddenly set in.

Forms of acute leukemia

White blood cells can be divided into three groups: granulocytes, lymphocytes, and monocytes. These not only differ in their appearance, but also perform different tasks.

Depending on the cell type in which the leukemia begins, acute leukemia is divided into two forms:

1. Acute lymphocytic leukemia (ALL):

ALL develops from immature lymphocyte precursors. It is the most common form of childhood leukemia, mostly affecting children under 5 years of age. It occurs rarely in adults, typically after the age of 50. Overall, the male sex is affected somewhat more frequently than girls and women.

Depending on which lymphocytes are affected, acute lymphocytic leukemia can be further subdivided into:

  • B-cell ALL (based on B-lymphocytes)
  • T-cell ALL (based on T-lymphocytes

2. Acute myeloid leukemia (AML):

The AML develops from immature precursors of granulocytes, monocytes, but also from immature precursors of red blood cells and platelets. It is the most common form of acute leukemia in adults and characteristically only occurs in old age (from the age of 70).

  • Primary AML: develops independently and without previous bone marrow or cancer disease
  • Secondary AML: develops from another bone marrow disease (e.g. from a myelodysplastic syndrome) or after previous chemotherapy or radiation therapy

What are the symptoms of acute leukemia?

The symptoms of acute leukemia develop within a few weeks. They are due to the displacement of normal blood cells and the infestation of organs with tumor cells.

  • Pallor, tiredness, fatigue

Cause: anemia (anemia, reduction in red blood cells)

  • Small, punctiform bleeding in the skin (petechiae), bruises, nosebleeds, prolonged bleeding (after visiting the dentist, injuries), prolonged menstrual period in women

Cause: Reduction in blood cells (thrombopenia)

  • Increased susceptibility to infection

Cause: Reduction in (healthy) white blood cells (leukopenia)

  • Joint and bone pain

Cause: spread of the tumor cells into the bones (in about a third of patients, mainly in children)

  • Lymph node swelling, enlargement of the spleen with a feeling of pressure in the left upper abdomen, enlargement of the liver with a feeling of pressure in the right upper abdomen, enlargement of the thymus gland or the lymph nodes in the chest, swelling of the veins in the neck area

Cause: Infestation of the internal organs

  • Loss of appetite, severe weight loss
  • Fever (in about 50% of patients)
  • Rare: neurological changes

Cause: Involvement of the brain, the spinal cord or the meninges

  • Rarely with the first illness, more likely with relapse: Invasion of other organs such as skin, mucous membrane, testicles or breast

Diagnosis: leukemia

There are several subspecies of leukemia; Here you get an overview of the diagnostic method and the individual therapy options.

How is acute leukemia diagnosed?

If acute leukemia is suspected, a quick investigation is necessary. In addition to a detailed anamnesis (= taking the medical history) and a clinical examination, extensive further examinations are required - usually as part of an inpatient hospital stay:

The focus is on immature cells in the blood, anemia or thrombopenia.

For this purpose, bone marrow is taken from the hip bone or sternum with a syringe under local anesthesia. The leukemia cells are precisely typed under the microscope and using special examination methods (immunophenotyping). Through this analysis, the disease can be assigned to the respective sub-form. This is critical to developing an appropriate plan for treatment.

  • Further investigations

If the suspicion of ALL is confirmed, additional examinations can follow in order to rule out the involvement of other organs: X-ray examination of the chest, CT and ultrasound examination of the heart and other internal organs. An analysis of the spinal cord fluid can determine whether the brain is affected.

++ More on the topic: Treatment of acute leukemia ++

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Authors:
Astrid Leitner
Medical review:
Univ.Prof. Dr. Ulrich Jäger
Editorial editing:
Mag. Julia Wild

Status of medical information:

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ICD-10: C92.0, C91.0