Lymphatic leukemia

This creates a lymphatic leukemia

As “lymphocytic leukemia” doctors refer to cancers, the so-called lymphoid progenitor cells the blood formation go out:

All blood cells (red and white blood cells as well as platelets) have a common origin – the blood stem cells in the bone marrow. Two types of progenitor cells develop from these stem cells: lymphoid and myeloid progenitor cells. The former develop in several steps lymphocytes, This subgroup of white blood cells (leukocytes) is an important part of the immune system. All other white and red blood cells and platelets are derived from myeloid progenitor cells.

In lymphatic leukemia is the Formation of lymphocytes disturbed: Large quantities of immature lymphocytes develop that multiply uncontrollably. As a result, they are increasingly pushing the mature, healthy blood cells back. That is, there is less and less of the other subgroups of white blood cells. There is also a lack of red blood cells and platelets.

Depending on the course of the disease, physicians distinguish:

• The Acute Lymphocytic Leukemia (ALL) starts quite suddenly and progresses quickly.
• The Chronic lymphocytic leukemia (CLL) develops creeping and slow.

Acute Lymphocytic Leukemia (ALL)

Acute lymphoblastic leukemia is the most common form of leukemia in children, About 80 percent of all children with leukemia have an ALL. Sprouts less than five years old are the most affected. In adults, the ALL is rather rare. The disease is more common in people over 80 years.

Overall, acute lymphoblastic leukemia is very rare: in Germany, about 1 in 100,000 people suffer from this form of blood cancer. Among others, people with trisomy 21 (Down syndrome) have an increased risk of developing the disease.

Symptoms of ALL

Acute lymphocytic leukemia manifests itself with various symptoms that usually develop within days: the increasing shortage of red blood cells causes anemia (anemia). The patients are therefore striking pale skin and mucous membranes and one fast heartbeat, Besides, they are less powerful and become quickly tired, Sometimes, too difficulty in breathing and dizziness on.

Because the cancer cells also displace the platelets, one develops Tendency to bleeding (like gum and nosebleeds). The patients also get easy bruises (Hematoma). Often one also observespunctate hemorrhages in the skin and mucous membranes, Doctors call them petechiae.

Other common symptoms of ALL are fever, lack of appetite and Tendency to infections, Many patients also have it enlarged lymph nodes and a enlarged spleen (Splenomegaly).

For example, if the cancer cells have attacked the central nervous system (brain and spinal cord) a headache, Vomit, indifference and nervous breakdowns such as paralysis come.

Diagnosis of ALL

All the above symptoms also occur in many other diseases. So they are not a clear sign of acute lymphoblastic leukemia. In any case, you should go to such a symptom as soon as possible to the doctor. This will be the first medical history by describing the symptoms accurately. For example, he also asks about pre-existing or underlying diseases as well as possible cases of cancer in the family.

Then one follows physical examination, It should provide information about the general condition of the patient.

Particularly important in suspected acute lymphoblastic leukemia (or other form of leukemia) blood tests and aBone marrow, In the latter case, the doctor takes a sample of the bone marrow and has it examined in the laboratory. This can be an ALL prove sure. In addition, it can be determined which subtype of acute lymphoblastic leukemia the patient suffers from (such as Common ALL, Pro-B ALL, Cortical T ALL, etc.). Namely, these subforms differ in terms of history and prognosis. In addition, they respond differently to different therapies.

Next to it are usually still further investigations on, for example, ECG, imaging techniques (such as X-ray, ultrasound) and an examination of the nerve water (lumbar puncture). They serve either to better assess the physical condition of the patient or to test the spread of the cancer cells in the body. For more information, see Leukemia: Diagnosis and Examinations.

Therapy of the ALL

People with acute leukemia (like ALL) need to be treated as soon as possible. With this one wants to achieve that the disease completely regresses (remission).

The exact therapy plan for each individual case depends on the age of the patient as well as the exact subform of the ALL. As a rule, patients receive an intensive chemotherapy in several cycles. It should eliminate as much as possible all cancer cells in the body. This is usually followed by further chemotherapies, which are less intensive. They serve to fight any remaining cancer cells and to avoid a relapse.

Other treatment approaches for acute lymphoblastic leukemia are one stem cell as well as one radiotherapy, In stem cell transplantation, blood stem cells are transmitted to the patient. This should result in new, healthy blood cells. Radiation therapy at ALL is mainly used to prevent or treat cancer of the brain.

In some patients, the cancer cells have a certain genetic change (Philadelphia-chromosome). Based on this chromosome, the body produces an abnormal variant of Enyzms tyrosine kinase. This type of enzyme stimulates the growth of leukemia cells. Patients therefore sometimes receive so-called tyrosine kinase inhibitor (like imatinib). They inhibit the enzyme in question.

Read more about the treatment options for blood cancer under Leukemia: Treatment.

Forecast of the ALL

In recent decades, the number of patients with ALL who could be cured, has increased. Especially in children, the chances of recovery are usually good. Five years after diagnosis, about 70 percent of adult patients and 95 percent of affected children still live with proper treatment. After ten years, the survival rates are about 33 percent in adults and 70 percent in children.

In individual cases, however, the prognosis of acute lymphoblastic leukemia depends on many different factors. These include the exact form of ALL, the stage of the disease at the time of diagnosis, and the patient’s age and general condition.

Chronic lymphocytic leukemia (CLL)

Chronic lymphocytic leukemia is a slow-acting leukemia disorder; It usually develops over many years and can persist for a long time without causing noticeable symptoms.

Note: Despite its name, the chronic lymphocytic leukemia is no longer counted as leukemia (“blood cancer”), but is considered a form of lymph node cancer (more precisely, non-Hodgkin’s lymphoma).

Chronic lymphocytic leukemia is the most common form of leukemia in western industrialized countries. In Germany, about 3,000 men and 2,000 women suffer from it each year. These are mostly older patients: the mean age of onset is between 70 and 75 years. Chronic leukemias like CLL are very rare in children.

Symptoms and diagnosis

Chronic lymphocytic leukemia usually causes no symptoms for a long time. Sometimes unspecific complaints occur like reduced efficiency, fatigue and anorexia on. In the further course develop painless swollen lymph nodes as well as one enlarged liver and spleen, Some patients get fever, sweat at night and are prone to infections andbruises (Hematoma). Also signs of a anemia (Anemia) (paleness of the skin and mucous membranes, rapid fatigue, dizziness, etc.).

For more on the signs and course of chronic leukemia, see Leukemia: Symptoms.

Frequently, the doctor discovers chronic lymphocytic leukemia by chance, perhaps because the number of white blood cells is strikingly high. In addition to accurate blood tests are the Survey of the medical history (Anamnesis) and one physical examination the essential diagnostic steps in case of suspected CLL.

In some cases it is necessary to have one Tissue sample (biopsy) of the lymph nodes and to analyze in the laboratory. This will determine if and how far the disease has spread. For the same reason, for example, a Ultrasound examination of the abdominal cavity be performed. In some cases, one is also Bone marrow examination meaningful.

You can read more about the different examinations under Leukemia: Examinations and Diagnosis.

Therapy of CLL

Many patients with CLL do not feel ill and have no symptoms for years because the disease progresses very slowly. Then usually no therapy is necessary: ​​Instead, the doctors wait and perform only regular checkups (watch and wait).

If the blood levels deteriorate or the cancer causes discomfort, therapy is initiated. The way it looks depends on the patient’s general condition, kidney function and possible pre-existing conditions.

Often then becomes a so-called chemoimmunotherapy (or immunochemotherapy). That is, the patients receive chemotherapy in combination with an immunotherapy:

The anticancer drugs (cytostatics) of chemotherapy are given as a tablet or infusion. In addition, patients receive so-called immunotherapy Monoclonal antibodies, These are special, artificially produced antibodies that specifically recognize the cancer cells of the patient and can bind to them. Then the immune system can specifically target the malignant cells.

In some patients, the chronic lymphocytic leukemia with only one Chemotherapy or immunotherapy alone treated. Rarer is an additional one radiotherapy or surgery necessary. This may be the case, for example, when lymph nodes are affected by cancer cells and cause complications.

In some CLL patients, cancer cells develop certain genetic changes over time (see above: Therapy of ALL). Those affected no longer respond well to standard chemotherapy and immunotherapy treatments. Then a treatment with so-called TKI (like ibrutinib) to be more effective.

In some cases, if the first cancer treatment fails or the cancer goes down stem cell in question. First, high-dose chemotherapy kills all bone marrow and (hopefully) all cancer cells. Thereafter, the patient is given blood stem cells from a donor, from which new, healthy blood cells emerge. Stem cell transplantation is a very stressful and risky treatment. It is therefore only suitable for young or fit patients. And even with them, the benefits and risks of treatment must be weighed carefully in advance.

Forecast of the CLL

Chronic lymphocytic leukemia (CLL) is the “most benign” form of leukemia. The disease usually progresses only slowly and often causes no or no complaints for years. If treatment is needed, it can usually repress the CLL and slow its progression. According to the current state of knowledge, however, only a risky stem cell transplantation offers a chance of recovery.

How long patients with chronic lymphocytic leukemia survive depends strongly on the stage of the disease and the genetic make-up of the cancer cells (shape and structure of the chromosomes, possible genetic changes, etc.). Possible pre- and concomitant diseases as well as the general condition of the patients influence the prognosis.

Especially dangerous for the patients is that they are prone to infections due to their weakened immune system. Uncontrollable infections are therefore the most common cause of death in people who have a chronic lymphocytic leukemia (or another form of leukemia).