Acute leukaemias

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What is it about ?

Acute leukemias are a group of blood cancers (malignant blood diseases) that affect white blood cells. Acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL) begin with an overgrowth of immature cells in the bone marrow. These diseased cells then enter other parts of the body.

Often the exact cause cannot be determined. Known risk factors include certain anti-cancer drugs or chemotherapy for another cancer, radioactive radiation and exposure to chemicals such as solvents (eg benzene). The cause is sometimes a blood disease underlying.

What is its frequency?

All types combined, more than 1,600 new cases of leukemia are recorded in Belgium each year1.

The average age of the patient differs depending on the type of leukemia:

  • Acute lymphocytic leukemia is found mainly in children and young adults.
  • Acute myeloid leukemia mostly affects adults and rarely children.
  • The chronic lymphoid leukemia mainly affects older people.
  • The chronic myeloid leukemia preferably reaches middle-aged people.

Chemotherapy for the treatment of another cancer is the cause in about 10% of cases of acute leukemia.

How to recognize it?

Acute leukemia comes on suddenly and almost always causes symptoms.

Symptoms can be explained by a lack of:

  • red blood cells (anemia): pallor, fatigue, breathing problems (shortness of breath), palpitations of the heart (tachycardia);
  • normal white blood cells: infections that come back, such as tonsillitis, bronchitis and infections of the gums (gingivitis);
  • platelets: small bleeding in the skin (small dots on the skin), bleeding gums, nosebleeds, etc.

The proliferation of abnormal white blood cells is often expressed as follows:

  • enlargement of the liver, spleen and lymph nodes
  • bone pain and joint pain (this is because of the overgrowth of leukemia cells in the bone marrow). If the disease affects a child, he may start to limp from the pain.

In addition, there are general symptoms like fatigue and weight loss.

How is the diagnosis made?

The doctor will ask you what your symptoms are and do a physical exam to see if the lymph nodes, liver, or spleen are swollen. Then he will take a blood test. Depending on this, he may possibly suspect leukemia. This diagnosis must then be further studied by a doctor specializing in blood diseases (hematologist).

What can you do ?

If you are unusually tired, have been sick several times, or are bleeding for no apparent reason, do not wait to see your GP.

What can the doctor do?

If acute leukemia is suspected, the doctor will immediately refer you to a hematologist for further examinations. The hematologist will start with a bone marrow exam. Depending on the result, he can determine what form of leukemia it is and what is the best treatment.

The general practitioner will follow you in close consultation with the specialist. Most often, the treatment is chemotherapy. The treatment is tailor-made: it therefore takes into account the age, type of leukemia and other diseases. Chemotherapy aims to destroy abnormal white blood cells, help restore bone marrow, and prevent relapses.

Stem cell transplantation is a technique that destroys stem cells in the bone marrow and replaces them with stem cells from a donor. This treatment increases the chances of survival.

There are specialized centers where you can undergo cancer treatment. Less intensive treatment may be helpful if you have other illnesses or if there are factors (such as advanced age) that do not allow you to tolerate intensive chemotherapy.
In general, with acute myeloid leukemia (AML), the cancer is suppressed in 50-80% of patients, and with acute lymphocytic leukemia (ALL), even 80-90% of patients are reached. The prognosis in the elderly is poorer.

The risk of relapse is highest during the first three years. In some cases, the disease may also reappear even later. In order to follow the progress closely, the number of cells and platelets in the blood (total blood count) is checked regularly. During the first years after treatment, a bone marrow exam is also done at regular intervals. In the event of a relapse, new chemotherapy is given. Regular monitoring by the doctor is necessary for up to 10 years after treatment, and certainly in the event of a relapse or late complications of treatment.

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