Acute myeloid leukemia (AML) is the second most common malignant blood cancer in children and adolescents after acute lymphoblastic leukemia (ALL). Adults rarely develop acute lymphoblastic leukemia. Here you can find out more about symptoms, causes, diagnosis and therapy of acute leukemia.

Synonyms

acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL)

Definition

Leukemia definition

Acute leukemia is a malignant disease of the bone marrow. The vernacular speaks of blood cancer. In acute leukemia, the precursor cells of the white blood cells are malignantly changed. These altered cells spread increasingly uncontrollably throughout the bone marrow and displace the non-pathologically altered blood cells: the red blood cells and the platelets. These two types of blood cells are now present in the blood in far too small quantities. Above all, the lack of red blood cells gave the disease its name. Leukemia literally means “white blood”. Depending on the cells from which acute leukemia originates, myeloid and lymphatic forms are distinguished:

  • Myeloid leukaemias originate from granulocyte progenitors.
  • Lymphocytic leukaemias originate from progenitor cells of the lymphocytes.

Granulocytes and lymphocytes are both part of the body’s defense system, but perform different tasks.

Other forms of leukemia

In addition to the initial form of cell change, leukemia is divided into acute or chronic courses, so that there are four main forms of leukemia:

  • acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL)
  • chronic myeloid leukemia (CML)
  • Chronic lymphocytic leukemia (CLL) : This form of blood cancer is actually one of the sub-forms of non-Nodgkin’s lymphoma .

Frequency

The information on the frequency of leukemia is not completely uniform depending on the source, since the various forms of leukemia are sometimes assigned differently. Basically, however, leukemia is a rare disease. Depending on the form, the number of new cases per year (annual incidence) is a maximum of 4 cases per 100,000 inhabitants. According to the German Cancer Society, leukemia is ranked 11th among all types of cancer.

According to the Cancer Society, around 13,700 people develop blood cancer in Germany every year. The acute forms (acute lymphatic and acute myeolic leukemia) make up about 40 percent of new blood cancer cases. Chronic lymphatic leukemia accounts for about half . Chronic myeolic leukemia is the least common (10 percent).

The frequency peak for the onset of the disease is in all forms between the 60th and 70th year of life. Acute lymphoblastic leukemia is an exception. It occurs almost as frequently in children (approx. 500 cases / year) as in adults. Acute myeloid leukemia (AML) is the second most common malignant blood cancer in children and adolescents after acute lymphoblastic leukemia (ALL).

Symptoms

The symptoms of acute forms of leukemia are very non-specific. So there is no symptom that is characteristic. All symptoms or disorders in acute leukemia can also occur in other diseases. Nevertheless, you should pay attention to certain symptoms. The main indications are loss of appetite and unwanted / unclear weight loss, as well as fever and night sweats. Since the number of red blood cells decreases in acute leukemia, symptoms occur that are also known from anemia.

  • paleness
  • fatigue
  • fatigue
  • general feeling of sickness (similar to flu)
  • poor performance
  • Shortness of breath during physical exertion.
  • The missing platelets are also noticeable. Above all, the tendency to bleed is increased.

Typical symptoms are:

  • nosebleeds
  • Bleeding gums when brushing teeth or biting an apple
  • bloody urine
  • bloody stools (especially when pressing, similar to hemorrhoids)
  • flea-like, punctiform skin bleeding (so-called petechiae)
  • unusually easy bruising even with the smallest of events

Symptoms due to the weakened immune system

In acute leukemia, the degenerate cancer cells displace functional immune cells and thus weaken the immune system. The signs are:

  • increased susceptibility to infections, especially for bacterial diseases and fungal infections
  • poorly healing inflammation (e.g. in the oral cavity)
  • various infections in different organs, for example in the lungs or on the urinary tract
  • fever
  • swollen lymph nodes

Skin symptoms in acute leukemia

Malignant leukemia cells rarely affect the skin. The following changes can often be observed:

  • Spots on the skin
  • skin thickening
  • Nodules, which are often accompanied by itching.

Causes

Acute leukemia is caused by a disorder in the formation of white blood cells. Normally, white blood cells form from the stem cells of the bone marrow and mature through various intermediate cell stages. With leukemia, this process is faulty. Scientists have not yet found out why this defect occurs. Various factors must presumably come together before acute leukemia develops. However, most of those affected do not know why acute leukemia occurred.

Genetic predisposition may also play a role in the development of acute leukemia. The risk of developing blood cancer is e.g. B. is greater if other malignant diseases have already occurred in the family. Certain chromosomal disorders are also associated with an increased risk of illness. For example, people with Down syndrome (Trisomy 21) are particularly often affected by acute myeloid leukemia.

Risk factors for acute leukemia

Certain risk factors increase the risk of acute leukemia. These include:

  • radioactive beams
  • X-rays
  • chemical substances such as benzene
  • certain insect or plant protection products
  • chemotherapeutic agents against other types of cancer (cytostatics)
  • Smoke

Examination

Unlike many other types of cancer, such as breast, colon, or skin cancer, there are no screening tests for acute leukemia. Most people are diagnosed accidentally. If there is any suspicion, the doctor first scans the lymph nodes, liver and spleen. They are almost always enlarged in acute leukemia. If this is the case, a blood test follows.

Blood count in acute leukemia

In acute leukemia, a blood test provides the crucial information for the diagnosis. In the so-called blood count, the doctor recognizes, for example, anemia (anemia) and a lack of platelets. In addition, the total number of white blood cells is increased or decreased. Furthermore, the rate of blood cell lowering (BSG or BKS) is significantly accelerated in the vast majority of cases, but blood clotting is reduced. In order to confirm the diagnosis of acute leukemia, the blood is also smeared. The typical leukemia cells or leukemic cell precursors can be seen under the microscope. Acute myeloid leukemia is also characterized by reddish-purple inclusions in the cells (so-called Auer sticks). To confirm the suspicion of diagnosis,

Bone marrow examination (bone marrow biopsy)

During a bone marrow examination, the doctor takes a sample from the patient’s bone marrow, usually from the iliac crest. This is also known as a bone marrow biopsy. Don’t worry: this is usually done with local anesthesia. Smaller children and very anxious patients may also be given a short anesthetic. The removed cell material is examined microscopically. In acute leukemia, a significant number of degenerate cell precursors will be recognized. Mature and healthy white blood cells are almost no longer to be found in acute leukemia.

Imaging procedures

After diagnosing acute leukemia, your doctor will check whether the cancer cells have affected other organs besides the bone marrow. Corresponding imaging methods are e.g. B. ultrasound examinations (sonography), X-ray and possibly sectional image examinations such as computer tomography (CT) or magnetic resonance imaging (MRI).

Cerebrospinal fluid

If it is suspected that the meninges are affected by leukemia cells, the nerve water (the so-called cerebrospinal fluid) is examined. To do this, a small hollow needle is usually inserted into the spinal canal at the level of the lumbar spine (lumbar puncture). A few drops of the draining nerve water flow into a sterile tube via the needle. The cerebrospinal fluid is then examined for cancer cells in the laboratory.

Treatment

In the treatment of acute leukemia, the primary goal is to completely cure blood cancer. Treatment should start as soon as possible, i.e. a few days after the diagnosis.

Goals of leukemia therapy

  • Cure blood cancer
  • Restoration of healthy blood cell formation
  • Alleviate the discomfort
  • Protection against infectious diseases

Chemotherapy for acute leukemia

Chemotherapy is at the forefront of any leukemia treatment. Chemotherapy is given in the form of infusions, sometimes it is given as a tablet. The aim of chemotherapy is to destroy all malignant cells in the body. Leukemia cells often affect the brain, especially in acute lymphoblastic leukemia (ALL). Preventive chemotherapy is therefore also carried out in the central nervous system (CNS). For this, small doses of the chemotherapeutic agent are injected directly into the spinal fluid (so-called intrathecal chemotherapy).

Stem cell therapy and radiation

If tumor cells can no longer be detected, especially in young patients, after chemotherapy, healthy donor cells are transplanted into the bone marrow (so-called stem cell transplantation). This is useful in order to return to normal blood cell formation. The healthy stem cells are transferred via an infusion. For a stem cell transplant to be successful, however, the body must be as free as possible from tumor cells. Therefore, radiation therapy is first used to destroy cancer cells that are still present. Stem cell therapy (i.e. blood stem cell transplantation) can also be used if acute leukemia relapses.

Severe side effects of treating acute leukemia

The therapy of acute leukemia is very stressful for the body. For example, there is an increased risk of infection and bleeding throughout the treatment. After a stem cell transplant, the main fear is rejection of the transplanted cells. With chemotherapy, most people are afraid of hair loss, nausea and vomiting, as well as physical fatigue. The concerns are not entirely unfounded. However, your doctor will try to keep these side effects as low as possible. However, hair loss cannot be avoided. But there is good news: In almost all patients, the hair grows back after chemotherapy – often fuller and more beautiful than before.

Reduce the side effects of blood cancer therapy

There are various methods available to the doctor to reduce the side effects of blood cancer therapy, for example:

  • preventive administration of nausea-relieving medication
  • Transfusions of red blood cells (erythrocyte concentrates)
  • Platelet transfusions (platelet concentrates)
  • Administration of antibiotics and anti-fungal agents
  • Administration of growth factors that stimulate the formation of white blood cells after intensive chemotherapy

Medical cannabis for side effects of chemotherapy

Medical cannabis for seriously ill people has been available on prescription since March 2017. According to current knowledge, main cannabis ingredients such as tetrahydrocannabinol (THC) and cannabidiol can help to reduce nausea, vomiting and loss of appetite during chemotherapy (Cridge & Rosengren, 2013; Velasco et al., 2012). Despite the release of medical cannabis by the legislator and the associated reimbursement, the statutory health insurance companies are not yet ready to actually cover the costs of several hundred euros per month.

The ingredients of the cannabis plant may not only alleviate the side effects of chemotherapy. British doctors published a study back in 2013, according to which various ingredients (cannabinoids) in laboratory tests could clearly slow down the growth of leukemia cells.

Mistletoe

In addition to standard therapy, some doctors and alternative practitioners recommend supplementary treatment with mistletoe preparations. This alternative therapy is intended to reduce the side effects of chemotherapy, improve the quality of life of the patient and normalize or activate the functions of the body’s defense system. With this form of therapy, extracts from mistletoe from various host trees (such as apple trees, oaks) are injected into or under the skin. Infusions of mistletoe extracts into a vein or direct injection into the cancerous area itself are also possible. Mistletoe preparations are less often used.

Mistletoe therapy is one of the alternative healing methods. Among cancer researchers and doctors there are both supporters and opponents of mistletoe. According to current scientific knowledge, the benefits of mistletoe therapy have not been proven. Mistletoe preparations are therefore not recommended in the German guidelines for scientifically based cancer treatment.

Disease

The chance of recovery (prognosis) in acute leukemia depends heavily on various factors. For example, it depends on the age of the patient, the concomitant diseases and the type of leukemia cells. Basically, the chances of a cure for acute leukemia are not too bad. So healthy adult patients with acute myeloid leukemia (AML) in about 60 to 70 percent of cases. Children have a much better prognosis.

In acute lymphoblastic leukemia (ALL), the chances of recovery are around 45 percent in adults and 80 percent in children. The remaining 55 and 20 percent of patients relapse over the course of their lives, i.e. recurrent acute leukemia.

Prevention

There is no real prevention of acute leukemia. It makes sense to carry an X-ray passport with you. This helps to prevent unnecessary or double X-ray examinations and thus keep the radiation exposure as low as possible. The following also applies:

  • Avoid contact with substances containing benzene.
  • Do not smoke or quit smoking.
  • Unclear complaints such as tiredness, fever, loss of appetite and unwanted / unclear weight loss should quickly lead you to the doctor.
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