Myeloid Leukemia
and Martina Feichter, medical editor and biologistMartina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
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Doctors refer to certain forms of blood cancer as myeloid leukemia. Depending on the course, a distinction is made between acute myeloid leukemia (ALL) and chronic myeloid leukemia (CML). Both occur mainly in older adults. In addition, men are affected somewhat more often than women in both cases. Read everything you need to know about myeloid leukemia!
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. C92
This is how myeloid leukemia develops
In myeloid leukemia, blood formation in the bone marrow is disturbed in certain places:
The common origin of all blood cells (red and white blood cells and platelets) are the stem cells. From them two types of progenitor cells arise, including the so-called myeloid progenitor cells. Two groups of white blood cells (monocytes and granulocytes) develop from them via several preliminary stages and - via other preliminary stages - all red blood cells and platelets (the remaining white blood cells arise from the so-called lymphatic precursor cells).
The myeloid progenitor cells also form the starting point of myeloid leukemia: the precursors of the white blood cells that arise from them can degenerate and then multiply in an uncontrolled manner. This creates large amounts of immature white blood cells that gradually displace healthy, functional white blood cells. The amount of red blood cells and platelets also decreases.
According to the course of the disease, doctors differentiate between two forms of myeloid leukemia:
- Acute myeloid leukemia (AML) develops quite suddenly and progresses rapidly.
- Chronic myeloid leukemia (CML), on the other hand, takes a slow, insidious 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 in 100,000 people develop it every year. Adults are primarily affected. The risk of illness increases with age: around half of all patients are over 70 years of age.
Note: There are several subtypes of AML. They differ, for example, in the external characteristics and genetic changes of the cancer cells.
Symptoms and Diagnosis
AML usually manifests itself through symptoms within a few weeks. These arise mainly from the fact that there are fewer and fewer healthy blood cells in the patient's body:
The lack of red blood cells triggers anemia (anemia): The patients are pale, feel tired and exhausted, are less productive and quickly get out of breath. The lack of healthy white blood cells can cause a fever. In addition, the patients are prone to infections. The lack of platelets increases the tendency to bleed. This can be seen in the fact that patients have more frequent bleeding gums or nose and bruises easily (bruises). It also takes longer for bleeding to stop (like menstrual bleeding in women or bleeding wounds).
When the cancer cells spread throughout the body, other symptoms accompany acute myeloid leukemia. These can be, for example, swollen lymph nodes, bone and joint pain, shortness of breath and skin changes. An attack on the central nervous system can manifest itself, among other things, through headaches, vomiting, visual disturbances and nerve paralysis.
Read more about the signs of acute blood cancer under Leukemia: Symptoms.
Diagnosis of AML
The symptoms mentioned can occur not only with acute myeloid leukemia, but also with many other diseases. For clarification, the doctor will first take the medical history and examine the patient physically.
The next step is blood tests and confirming the removal of a bone marrow sample (bone marrow puncture). The sample is carefully analyzed in the laboratory: Existing cancer cells are examined for their external cell characteristics and genetic changes. This will help the doctor determine the type of leukemia. If there is AML, the examination can also show which subgroup of the disease it is. The various sub-forms of AML differ in the course of the disease and the prognosis. Also, some therapies work better for some types of AML than others.
In order to check whether and how far the cancer has spread in the body, the doctor will carry out further tests. You can read more about this under Leukemia: examinations and diagnosis.
Therapy of AML
Acute myeloid leukemia is a very serious disease. She should therefore be treated at a center for cancers of the blood (haematological-oncological center).
Most patients receive chemotherapy. Which cancer drugs (cytostatics) are administered in which dosage is determined individually for each patient. The same applies to the exact therapy regimen (number of treatment cycles, total duration of chemotherapy, etc.).
Sometimes it can also make sense to replace the diseased bone marrow with healthy tissue: healthy, blood-forming stem cells are transferred to patients after their own bone marrow has been destroyed with aggressive chemotherapy. However, this stem cell transplant 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 inhibitors and monoclonal antibodies. However, these new therapeutic approaches have not yet been approved or are not yet standard in the treatment of AML. So far, they have only been used in selected cases.
For more information on the various therapies, see Leukemia: Treatment.
AML prognosis
If left untreated, acute myeloid leukemia can lead to death within a few weeks. Therefore, comprehensive therapy must be started immediately after diagnosis. Then there is the chance that the cancer will completely regress (complete remission). In individual cases, this chance of recovery depends, among other things, on age:
It is between 70 and 80 percent for patients under 50 years of age. In the 50 to 75 age group, it drops to 50 to 60 percent. In patients older than 75 years, AML can only be completely suppressed by means of therapy in 30 to 40 percent of cases. However, treatment is still important here: it can keep patients alive longer. It can also alleviate the symptoms and thus improve the patient's quality of life.
Chronic myeloid leukemia (CML)
Chronic myeloid leukemia (CML) is rare. Every year only one to two in 100,000 people develop it again. Most are 50 to 60 years old at this point. In principle, however, CML can break out at any age. As with other forms of leukemia, men are affected slightly more often than women.
Symptoms and Diagnosis
The diagnosis "chronic myeloid leukemia" is often an incidental finding by the family doctor. The reason is that the CML symptoms usually develop very slowly and are quite unspecific for a long time. These include, for example, pale skin, tiredness, general weakness and reduced performance. Some people also have a fever (with no apparent infection), lose weight, and sweat at night. Over time, other symptoms are usually added, for example a feeling of pressure in the left upper abdomen. It is caused by an enlarged spleen.
Overall, a CML usually takes place in three different phases. Read more about this under Leukemia: Symptoms.
The symptoms mentioned can have many different causes. This also includes serious diseases such as chronic myeloid leukemia. The complaints should therefore always be clarified by a doctor. This will first take the patient's medical history (anamnesis). This is followed by a physical exam.
Blood tests and an examination of the bone marrow provide clear indications of CML. 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.
This laboratory analysis also includes a precise examination of the genetic material (the chromosomes) in the cancer cells. The so-called Philadelphia chromosome can be detected in more than 90 percent of all CML patients. This is what a characteristically altered chromosome 22 is called: A certain part of this chromosome has broken off and has been replaced by a piece of chromosome 9 (the broken piece of chromosome 22 occupied the breakpoint on chromosome 9). The result is that the body produces a pathologically altered variant of the enzyme tyrosine kinase. It is responsible for the fact that the cancer cells grow 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 inhibitors (especially imatinib): They block the enzyme described above, which stimulates the growth of cancer cells in almost all patients.
If the patient's condition worsens and the tyrosine kinase inhibitors no longer work properly, an allogeneic stem cell transplant may be an option. The affected person is transferred to healthy, blood-forming stem cells from a donor (after their own bone marrow has been destroyed by intensive chemotherapy).
In the third and final phase of the disease (blast crisis), chronic myeloid leukemia resembles acute leukemia. It is then treated in a similar way, namely with chemotherapy. It has to be started as soon as possible because, without treatment, most patients die within a few weeks during this phase of the disease.
Read more about the therapy of chronic myeloid leukemia under Leukemia: Treatment.
Prognosis of the CML
Many patients with CML respond well to treatment with tyrosine kinase inhibitors such as imatinib. Of all patients treated with imatinib, 85 to 90 percent are still alive five years after diagnosis.
As effective as the drugs are, they cannot cure CML. This also applies to chemotherapy and treatment with interferons. So far, only stem cell transplantation has offered the chance to completely suppress chronic myeloid leukemia.
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