Myeloid leukemia

This is how myeloid leukemia develops

In a myeloid leukemia is in certain places the Blood formation in the bone marrow disturbed:

The common origin of all blood cells (red and white blood cells and platelets) are the stem Cells, From them initially two types of progenitor cells, including the so-called myeloid progenitor cells, From them, two groups of white blood cells (monocytes and granulocytes) develop via several precursors and – via other precursors – all red blood cells and platelets (the remaining white blood cells arise from the so-called lymphoid precursor cells).

The myeloid progenitor cells also form the starting point of a myeloid leukemia: The precursors of the white blood cells that result from them can degenerate and then reproduce in an uncontrolled manner. This results in large amounts of immature white blood cells gradually displacing the healthy, functioning white blood cells. The amount of red blood cells and platelets also decreases.

After the disease, physicians distinguish two forms of myeloid leukemia:

• The Acute myeloid leukemia (AML) develops quite suddenly and progresses quickly.
• The Chronic myeloid leukemia (CML) on the other hand takes a slow, creeping course.

Acute myeloid leukemia (AML)

Acute myeloid leukemia is the most common form of acute leukemia in Germany. Overall, however, it is rare: almost four out of every 100,000 people get it every year. Affected are primarily adults. The risk of disease increases with age: about half of all patients are over 70 years old.

Note: There are several subforms of AML. They differ, for example, in the external characteristics and the genetic changes of the cancer cells.

Symptoms and diagnosis

AML usually manifests itself in symptoms within a few weeks. These are mainly caused by the fact that in the body of patients less and less healthy blood cells are present:

So the lack of red blood cells triggers one anemia (Anemia) off: the patients are pale, feel tired and beaten off, are less powerful and advised fast out of breath, The lack of healthy white blood cells can fever cause. In addition, the patients prone to infections, The lack of platelets increases the Bleeding tendency, This is evidenced by the fact that patients have more frequent gum or nose bleeds and bruises easily (bruises). In addition, it takes longer for bleeding to come to a standstill (such as the menstruation in women or bleeding wounds).

As the cancer cells spread throughout the body, acute myeloid leukemia is accompanied by other symptoms. That can for example swollen lymph nodes, Bone and joint pain, difficulty in breathing and skin lesions be. An attack of the central nervous system can become due among other things a headache, Vomit, blurred vision and nerve palsies express.

To read more about the signs of acute blood cancer, see Leukemia: Symptoms.

Diagnosis of AML

The symptoms mentioned can not only occur in acute myeloid leukemia, but also in many other diseases. For clarification, the doctor is the first medical history raise and the patient physically examine.

In the next step follow blood tests and taking a bone marrow sample (Bone marrow) to confirm. The sample is precisely analyzed in the laboratory: Existing cancer cells are examined for their external cell characteristics and genetic changes. This helps the doctor to determine the type of leukemia. If AML is present, the examination can also show which subgroup of the disease is involved. The different subtypes of AML differ in the course of the disease and the prognosis. In addition, some therapies work better in some types of AML than others.

To see if and how far the cancer has spread in the body, the doctor will do more research. For more information, see Leukemia: Examinations and Diagnosis.

Therapy of AML

Acute myeloid leukemia is a very serious condition. It should therefore be treated at a cancer center of the blood (hematologic-oncological center).

Most patients get one chemotherapy, Which anticancer drugs (cytostatics) are administered in which dosage is determined individually for each patient. The same applies to the exact therapy scheme (number of treatment cycles, total duration of chemotherapy, etc.).

Sometimes, it may be useful to replace diseased bone marrow with healthy tissue: Patients will be transmitted healthy, blood-forming stem cells after their own bone marrow has been destroyed by aggressive chemotherapy. These stem cell but is not suitable for every patient.

In certain cases of acute myeloid leukemia, other therapies may be considered. These include, for example, so-called tyrosine kinase inhibitor such as Monoclonal antibodies, These new therapeutic approaches are not yet approved or yet standard in the treatment of AML. So far, they are only used in selected cases.

For more information about the different therapies, see Leukemia: Treatment.

Prognosis of AML

If an acute myeloid leukemia is not treated, it can lead to death within a few weeks. Therefore, the comprehensive therapy must be started immediately after the diagnosis. Then there is a chance that the cancer completely regresses (complete remission). In individual cases, this chance of recovery depends, among other things, on age:

It is between 70 and 80 percent in patients under the age of 50 years. In the age group of 50- to 75-year-olds, it drops to 50 to 60 percent. In patients over the age of 75, therapy with AML can only be completely repressed in 30 to 40 percent of cases. Nevertheless, the treatment is important here: it can keep patients alive longer. In addition, it can alleviate the symptoms and thus improve the quality of life of patients.

Chronic Myeloid Leukemia (CML)

Chronic myeloid leukemia (CML) is rare. Each year, only one or two out of every 100,000 people become ill. Most are 50 to 60 years old at this time. In principle, however, CML can break out at any age. As with other forms of leukemia, men are more likely to be affected than women.

Symptoms and diagnosis

The diagnosis “Chronic myeloid leukemia” is often a coincidence with the family doctor. The reason is that the CML symptoms usually develop very slowly and are quite unspecific for a long time. For example, it counts pallor, fatigue, general weakness and reduced efficiency, Some patients have too fever (without detectable infection), lose weight and sweat at night, Over time, more symptoms usually accompany this, for example one Pressure in the left upper abdomen, It is from a enlarged spleen caused.

Overall, a CML usually runs in three different phases. Read more about Leukemia: Symptoms.

The symptoms mentioned can have many different causes. This includes serious diseases such as chronic myeloid leukemia. The complaints should therefore always be clarified by a doctor. This will be the first Medical history of the patient to raise (anamnesis). Then one follows physical examination.

Provide clear evidence of a CML blood tests and a Examination of the bone marrow, A sample of the bone marrow is taken using a special needle under local anesthesia (bone marrow puncture). The tissue is then analyzed in the laboratory.

Part of this laboratory analysis is to study the genome (s) in cancer cells. In more than 90 percent of all CML patients, the so-called Philadelphia chromosome prove. This is called a characteristically altered chromosome 22: A certain part of this chromosome has been broken off and replaced by a piece of chromosome 9 (the broken piece of chromosome 22 has occupied the fracture site on chromosome 9). The result is that the body produces a pathologically altered variant of the enzyme tyrosine kinase. It is responsible for the cancer cells growing uncontrollably.

Therapy of CML

The treatment of chronic myeloid leukemia depends, among other things, on the phase in which the disease is discovered. Most patients receive so-called tyrosine kinase inhibitor (especially imatinib): they block the enzyme described above, which stimulates the growth of cancer cells in almost all patients.

If the condition of the patient worsens and the tyrosine kinase inhibitors are no longer effective, one may come allogeneic stem cell transplantation in question. Those affected will receive healthy, blood-forming stem cells from a donor (after their own bone marrow has been destroyed by intensive chemotherapy).

In the third and final disease phase (blast crisis), chronic myeloid leukemia is similar to acute leukemia. It is then treated similarly, namely with a chemotherapy, It must be initiated as soon as possible, because without treatment, most patients die within a few weeks in this disease phase.

For more information on the treatment of Chronic Myeloid Leukemia, see Leukemia: Treatment.

Prognosis of CML

Many CML patients respond well to treatment with tyrosine kinase inhibitors such as imatinib. Of all patients treated with imatinib, five to five years after diagnosis, 85 to 90 percent still live.

As effective as the drugs are, it will not work to cure CML. This also applies to chemotherapy and treatment with interferons. So far, only the stem cell transplantation offers the chance, the chronic myeloid leukemia completely push back.