The department of oncology and hematology in Braunsweig clinic (Germany) is a highly specific oncologic center that offers diagnostics and treatment of oncologic diseases including leukemia using the recent scientific and medical advances and methods. Leukemia is a tumor disease of blood system that can be both acute and chronic. Today, this disease is successfully treated in numerous German clinics including ours department. We help about 10.000 patients with leukemia annually.
What is leukemia?
Leukemia (also called lymphoblastoma or blood cancer) is a group of tumor diseases that grow uncontrollably and have various etiology. Symptoms of leukemia are defined by its type and form, and can develop while normal cells are replaced with leukemic ones, which contributes to development of different complications (bleeding, anemia and so on).
Body cells in normal state usually divide, maturate, die and perform their functions according to the progam they are assigned. After cell death, they’re disrupted, and new cells maturate and grow at their place.
As for cancer, it presupposes some abnormality on cell program: they concern multiplication, life cycle and functions, which results into uncontrollable growth and division. Leukemia is a type of cancer that affects cells of bone marrow – the cells that serve as basic ones for blood cells (leukocytes and erythrocyte, white and red blood cells, and thrombolytic, or blood plates).
Blood cancer is a tumor that develops from one cell that’s directly connected with bone marrow. It presupposes its uncontrollable division within some certain time period that can last for several weeks, or several months.
Besides, this process is accompanied by displacement and suppression of other blood cells, e.g. normal cells (suppression defines their growth and development). Considering these peculiarities, the symptoms of blood cancer will be directly connected with the lack of this or that type of normal functioning cells. The tumor itself does not exist in human body in case of blood cancer, and it cannot be seen, because it’s spread over the body, and this spread is conditioned by blood flow.
Classification of leukemia types
Basically, there are two types of leucosis: acute and chronic, and they’re based on aggressiveness of the disease.
Acute leucosis presupposes having a lot of malignant immature cells that do not perform their functions. In this case, the symptoms of leucosis are manifested soon, and the disease progresses pretty quickly. It is revealed at earlier stages, and timely treatment can appear to be very helpful to prolong patient’s life expectancy.
Chronic leucosis means that cancerous cells can perform their functions, which is why the symptoms of disease are not manifested for a long time. Pretty often, chronic leucosis is revealed accidentally, for instance, when a patient goes through prophylactic examination, or his blood has to be examined for some reasons. The development of chronic leucosis is less aggressive than its acute form, however, it does not exclude the possibility of its progress, because the amount of cancer cells in blood is constantly growing.
Both of these forms have one peculiarity: despite scenarios of many other diseases, acute form of leukemia will never turn into chronic, just like chronic form cannot become acute. Therefore, to define whether leukemia is chronic or acute, the doctors should define a certain scenario of its development.
Depending on the type of leukocytes involved in pathological process, the following types of leucosis are differentiated:
Chronic lymphocytic leukemia (also called as „chronic lymphocytic leukemia“, or „chronic lymphocytic leucosis“) is a type of blood cancer that’s accompanied by abnormalities in division of lymphocytes in bone marrow, or abnormalities in their maturation.
Chronic myelocytic leukemia (also called as „chronic myeloleukemia“, „myelocytic chronic leukemia“) – is a type of blood cancer that leads to abnormalities in development or maturation of cells of bone marrow, and these cells are usually young forms of erythrocytes, thrombocytes and leukocytes.
Acute lymphoblastic leukemia (also called as „acute lymphocytic leukemia“) is development of blood cancer that’s characterized by abnormalities of maturation and division of lymphocytes in bone marrow.
Acute lymphoblastic leukemia (also called „acute myeloleukemia“, or „myeloblative acute leukosis“) – in this case, blood cancer is accompanied with abnormalities in multiplication and maturation of cells of bone marrow, and these cells play the roles of young erythrocytes, thrombocytes and leukocytes. Depending on the type of cells involved in pathological process, the following forms of cancer development are differentiated:
- leukosis without corresponding cell maturation;
- leukosis during which cells maturate, but not to a full extent;
- proelomonocytic leukosis;
- myelomonocytic leukemia;
- monoblastic leukemia;
- megakaryoblastic leukemia.
Causes of leukemia
Today, scientists don’t know for sure what causes leukemia. However, some perspectives are directly connected with the diseases and are believed to trigger its development. These factors include:
- Exposure to radioactive elements: people who were exposed to considerable amounts of radiation have a higher risk of acquiring acute myelomonocytic leukemia, acute lymphoblastic leukemia, or chronic myelocytic leukemia.
- Long-term contact with benzenes widely used in chemical production contributes to a higher risk of developing leukemia of different kids. By the way, benzenes are also contained in gas and cigarette fume. The more a patient smokes, the more he is exposed to dangerous chemicals that gather inside body and provoke the condition.
- Down’s syndrome, and many other diseases and conditions with chromosome disorders are likely to provoke development of acute leukemia.
- Chemotherapy of this or that type of cancer can be the reason of leukemia development in the future. Some certain chemical medications also have accumulative effect and start affecting body when the concentration gets too high.
Surprisingly, inheritance doesn’t play much role in development of leukemia. In rare cases, doctors face the situations when several family members develop leukemia with inheritance as one of factors that might have causes it. If this variant happens, most likely it is chronic lymphocytic leukemia.
It should also be noted that if you have one or several of the above mentioned factors contributing to leukemia development, it doesn’t necessarily mean you will acquire this disease. Many people who are exposed even to several factors do not face the disease even in the farthest future.
Symptoms of leukemia
As it has already been mentioned, the symptoms typical of the disease depend on peculiarities of condition, the extent to which malignant cells have spread, and their overall quantity. For example, chronic leukemia at early stages is characterized by a small amount of cancerous cells, which means that the symptoms of condition can be absent for a really long time. As for acute leukemia, the symptoms tend to appear much earlier.
Let’s highlight the main symptoms typical of leukemia development (in both chronic and acute forms):
- growth and increased size of the lymph nodes (mostly the nodes that are situated in armpits and neck), painful sensations in the lymph nodes are usually absent during leukemia;
- fast fatigue and weakness;
- vulnerability to infectious diseases (herpes, pneumonia, bronchitis, and so on);
- high temperature (without factors that might have caused it), increased perspiration during nighttime;
- pain in joints;
- increased size of liver and spleen, which, in its turn, can contribute to sensation of heaviness in the zone of right or left hypochondria;
- disorders of blood coagulability: appearance of bruises, bleeding from nose, red dots appearing under skin, bleeding of gums.
When cancerous cells start gathering in some certain body parts, the following symptoms can be exhibited:
- clouding of consciousness;
- problems breathing;
- nausea and vomiting;
- disorders in coordination and movements;
- blurred vision;
- convulsions in different body parts;
- painful swelling in the zone of groin or upper limbs;
- pain in scrotum and swelling (in men).
Diagnostics of leukemia
Leukemia can be diagnosed based on the results of blood analyses only. These analyses include general blood analysis that can truly show the peculiarities of disease.
In order to get reliable results concerning leukemia, doctors use the information gathered after performing puncture. Puncture of bone marrow presupposes piercing the hipbone and chest with the help of a special thick needle. During this process, a minor amount of bone marrow is taken, and the sample is examined under a microscope. Cytologist (specialist who examines samples of bone marrow in laboratory) will define the type of the tumor, degree of its aggressiveness, and the extent to which patient’s body is affected by the condition.
In more complicated cases, biochemical diagnostics is used: it’s called „immunohistochemistry“ and it helps to define the nature of tumor based on the type of proteins contained in it with almost 100% precision. Why is it so important to define the type of tumor? Let’s clear this out. Our body has many different cells that constantly grow and develop, which means there might be various types of leukemia. However, it’s not pretty right: the most widespread types of leukemia are well researched, and there are perfect ways for diagnostics. But the better diagnostics methods become, the more types of leukemia are revealed. This is why the nature of tumor matters: based on the type of cells and proteins, an appropriate way of treatment can be figured out.
Methods of leukemia treatment in Germany
Leukemia treatment in Germany is conducted in several steps:
- Preparatory treatment in Germany. A person goes through chemotherapy, radiation therapy (X-ray and beam therapy), or both of them. This stage of treatment is aimed at killing as many cancer cells as possible. Together with it patient’s immune system is weakened so that his body wouldn’t develop allergy and reject the implanted bone marrow.
- Implantation of bone marrow is the mainstay of treatment in Germany. There are three types of bone marrow transplantation:
- Autologous. This method implies transplanting patient’s own healthy stem cells or bone marrow. Before executing this stage of treatment, patient’s blasts are sampled and frozen before the moment of transplantation. After successful treatment, these cells are refrozen and implanted in patient’s body by intravenous injections.
- Allogenic. This approach means that the patient has his brother's or sister's bone marrow cells transplanted. Histocompatibility plays crucial role in this case. If relative’s cells are likely to be rejected by patient’s body, some other unrelated donor can be found, if he complies with the criteria.
- Syngenetic. This kind of transplantation implies using cells of the identical twin.
Behavior of immune system and its response to transplantation is impossible to foresee. During the first days after the operation, the immune system is controlled with the help of immunosuppressant drugs, a bit later its reaction gets less dangerous. Within six months, the course of immunosuppressant drug can be ceased, because immune system fully adapts during this time.
Leukemia therapy in Germany with bone marrow transplantation weakens patient’s body considerably. To protect the person from bacteria and viruses in environment, he or she has to be isolated, air and water should be filtered, and meals should be cooked in certain conditions. A lot of safety measures should be undertaken.
As far as patient’s primary immunity and bone marrow are destroyed by chemotherapy and radiotherapy obligatory for leukemia treatment in Germany, and the new blood hasn’t been produced yet, the risk of catching bacteria and fungus are high. Therefore, patients should be closely examined after bone marrow transplantation. If any virus or bacteria is caught, it should be destroyed immediately.
Leukemia treatment in Germany means that the patient has to reside in the clinic until the functions of bone marrow fully restore, e.g. until the amount of white cells in blood reaches an optimal level to defend against infections. Even after leaving the clinic, patient won’t have the immune system fully restored. It means that the danger of catching infection would still exist.
After treatment, a patient will have to visit the oncologic center to go through regular examinations. With the time being, periods between visits will get longer. As a rule, full recovery period takes about a year.
New ways of blood cancer treatment imply switching curative effects from the stage of chemotherapy/radiation therapy to the stage of bone marrow transplantation. The intensity of initial stages is lowered, which allows transplanting bone marrow to the elderly patients by minitransplantation method.
Prognosis for different types of leukemia
Every type of blood cancer has different susceptibility to treatment (efficiently, or not very efficiently), this is why the prognosis for every cancer type is defined according to the complex of its symptoms, the way it develops and many other corresponding factors.
For example, acute lymphoblastic leukemia and its prognosis are defined based on the level of leucocytes in blood. The prognosis for it depends on how correct and timely the therapy was, as well as patient’s age. Children from 2 to 10 often reach full remission, and even if the disease doesn’t disappear entirely, at least most of its symptoms subside. It should also be noted that the more leukocytes are found in blood for diagnostics of disease, the lower is the possibility of full recovery.
As for acute myeloleukemia, its prognosis is defined according to the type of cells that are involved in pathological development of disease, patient’s age and correctness of therapy assigned. Standard modern treatment therapies guarantee 35% of survival rate during the next five years (and more) in adult patients (up to 60 years old). In this case, there’s a tendency: the older patient is, the worse is recovery prognosis. The patients older than 60 have only 10% chance to survive within 5 years starting from the moment the disease was revealed.
During chronic myeloleukemia, the prognosis is defined by the stage of its development, because the disease progresses slower than acute myeloleukemia . About 85% of patients with this form of disease have their condition considerably degraded after 3-5 years since the moment it was revealed. It is defined as so-called „blast crisis phase“, e.g. the last stage of disease that’s accompanied by appearance of some immature cells in bone marrow and blood. Timely and appropriate treatment allows patient to survive within 5-6 years since the moment it was diagnosed. Advanced therapy methods can give even higher chances for survival that can reach 10 years and sometimes even more.
As for chronic lympholeukosis, prognosis and survival rate slightly vary. Some people die within 2-3 years since the moment the disease was revealed (it happens because some complications take place). However, sometimes survival rate can even reach 5-10 years since the moment the disease was revealed, besides, these chances can be even higher until the disease reached final stage of development. Appropriate treatment greatly increases the chances for success.