Leukemia Treatment in Germany

The symptoms of leukemia vary widely and, as a rule, appear in the acute form of the disease. Chronic leukemia may remain asymptomatic for a long time, even for many years, and may be diagnosed only on the basis of a routine blood test (this is particularly true of chronic lymphoblastic leukemia). In acute leukemia the symptoms most often arise from a shortage of blood cells (anemia, infections and bleeding), from the increased viscosity caused by leukemic cells, or from organ dysfunction caused by leukemic cells.

The chronic forms of leukemia may be accompanied by similar symptoms, although these are more diffuse and develop over a long period. In addition, a raised body temperature in the absence of infection, weight loss and heavy night sweats may be observed. In some cases the symptoms may be caused by enlargement of the lymph nodes or of the spleen.

In patients with the symptoms described above, the most common findings are anemia (a shortage of red blood cells), in which the hemoglobin level falls below normal; a low white blood cell count in the acute forms of leukemia and a high white blood cell count in the chronic forms; and a reduced platelet count in the blood. Anemia manifests itself as fatigue, pallor, a rapid heartbeat, ringing in the ears and general malaise. A low platelet count causes a tendency to bleed, which shows itself, for example, as spontaneous bruising, nosebleeds, bleeding gums and wounds that bleed for a long time. A fall in the white blood cell count leads to increased susceptibility to infection. Although the white blood cell count in the blood rises in the chronic forms of leukemia, the level of healthy white blood cells in the bone marrow and in the blood falls, which may lead to increased susceptibility to infection.

Leukemia is treated under the supervision of a hematologist. In Finland, patients with acute forms of leukemia are usually referred for treatment to the hematology department of a university hospital. Therapy for the chronic forms may also be carried out in the hematology departments of other medical institutions: as a rule, treatment is given on an outpatient basis and an inpatient stay is not required. Standard treatment of leukemia includes therapy with various chemotherapy drugs, in some cases combined with antibodies that recognize cancer cells. Supportive therapy is given alongside this, for example blood products, antibiotics, anti-nausea medication and drugs that protect the lining of the gastrointestinal tract and the kidneys.

In the acute forms of leukemia the patient first receives a high dose of chemotherapy (induction therapy) in order to clear the leukemic cells from the blood and the bone marrow (to achieve what is known as morphological remission). If this stage of treatment is successful, various types of therapy are given to improve the body's response to treatment; in medical language these are called consolidation therapy. If these methods fail to cure the leukemia, or if it relapses, transplantation of donor stem cells (allogeneic transplantation) may be considered. Finding a suitable donor is a fairly difficult task, since the donor and the patient must have an identical tissue type. The patient's own brothers or sisters are most often suitable as donors, but a suitable donor may also be found in an appropriate register of volunteers. The search is carried out through the European, American and Canadian stem cell donor registers. The registers hold a total of some 22 million potential donors.

A stem cell transplant is a very complex procedure and it cannot be performed in some patients. In some cases the procedure may lead to death. Death may result from the toxicity of the procedure, from possible rejection of the foreign cells and from relapse of the disease.

Recurrent leukemia is common in adult patients. Most children who have had leukemia recover. Thanks to modern treatment, the most common form of leukemia in children, acute lymphoblastic leukemia, can be cured in more than 80% of cases.

The company msp group germany recommends that its patients suffering from malignant diseases of the blood and bone marrow undergo treatment at the largest stem cell transplant centers in Germany and Europe, whose quality of work is confirmed by ongoing certification procedures (the EQ-Zert certificate of the European Institute for the Certification of Management Systems and Personnel; the certificate of the European Society for Medical Oncology (ESMO); the quality management system certificate in accordance with the DIN ISO 9001:2008 standard).

These hospitals are world leaders in stem cell transplantation for myelofibrosis, including in patients over the age of 70. They are also centers of scientific and clinical research in the programming and reprogramming of T cells, translational hematology and oncology, molecular dynamics modeling and methods of telomere lengthening; they maintain a register of telomeropathies and aplastic syndromes and a hematological biobank.

All of the recommended hospitals and departments have

• sterile units for allogeneic stem cell transplantation with a special air purification system (filtration by means of a high-efficiency air filter; all of the rooms in the unit are isolated from the rest of the hospital);
• outpatient examination rooms;
• treatment rooms for infusion and transfusion therapy;
• hematological diagnostic laboratories;
• a laboratory for stem cell processing and cryopreservation;
• an interdisciplinary oncology outpatient clinic.

Originally the terms "acute" and "chronic" leukemia referred to the life expectancy of the patient, but today leukemias are classified according to the degree of cell maturity.

Acute leukemias

Acute leukemias (acute leukemia) consist predominantly of immature, poorly differentiated cells (usually blast forms). Acute leukemias are divided into lymphoid (ALL— acute lymphocytic leukemia (ALL): acute myeloblastic leukemia (acute myeloblastic leukemia, acute myeloid leukemia, acute myeloblastosis) and acute lymphoblastic leukemia) and myeloid (AML— acute myeloid leukemia (AML)) forms, which in turn are divided into subtypes.

Chronic leukemias

Chronic leukemias consist of more mature cells. They usually present with an abnormal leukocytosis, with or without cytopenia, in patients without other symptoms. The clinical picture and the treatment of chronic lymphocytic leukemia (CLL— chronic lymphocytic leukemia (CLL)) and chronic myeloid leukemia (CML— chronic myeloid leukemia (CML)) differ considerably.

When speaking of chronic leukemia, two of the most common forms should be mentioned: chronic lymphoblastic leukemia (the most common type of leukemia) and chronic myeloblastic leukemia. The rarer chronic forms of leukemia include T-cell prolymphocytic leukemia, hairy cell leukemia and large granular lymphocytic leukemia.

Myelodysplastic syndromes

The myelodysplastic syndromes (myelodysplastic syndrome) involve progressive bone marrow failure with a smaller number of blast cells (< 30%) than in AML; in 40–60% of cases they transform into AML.

Leukemoid reaction

A leukemoid reaction is a granulocytic leukocytosis (that is, a white blood cell count > 30,000/mcL) produced by normal bone marrow in response to a systemic infection or to cancer. Although it is not a neoplasm, a leukemoid reaction with a very high white blood cell count may require differential diagnosis from CML (chronic myeloid leukemia (CML)).

Advanced methods of treating leukemia are available today and effective forms of therapy have been found for the various types of this disease. Chronic myeloblastic leukemia was the first type of blood cancer for which a set of targeted treatments was developed, thanks to which in most cases the course of the leukemia can be controlled and remission achieved. The prognosis for recovery in patients with this type of leukemia has improved considerably. In the treatment of other types of leukemia, chemotherapy combined with antibodies achieves good results, and the transplantation of stem cells taken from healthy people (allogeneic stem cell transplantation, bone marrow transplantation) is increasingly producing good outcomes.

As a rule, the cause of leukemia cannot be established. It is known, however, that if a patient has previously been diagnosed with another type of cancer, this may in some cases trigger leukemia (secondary leukemia). Various genetic disorders may be another cause of leukemia. In chronic myeloblastic leukemia (chronic myeloid leukemia), an exchange of segments of chromosomes 9 and 22 in the earliest precursor of the blood cells, the stem cell, produces a mutant (Philadelphia) chromosome that causes blood cancer. The causes of the other types of leukemia are as yet insufficiently understood. Certain factors, for example ionizing radiation, contact with solvents (especially benzene) and other chemicals, certain types of chemotherapy, some viruses and rare hereditary and congenital diseases increase the risk of leukemia.

• treatment of oncological diseases in Germany at specialized hospitals and departments and at comprehensive cancer centers;
• the highest five-year survival rates in the world;
• appropriate (and, where possible, gentle) therapy that takes the patient's age and psychological profile into account and matches the extent and the aggressiveness of the disease;
• interdisciplinary cooperation between hematologist-oncologists, surgeons, radiologists, chemotherapists, specialists in nuclear medicine and radiotherapy, and psycho-oncologists;
• multimodal therapy;
• successful autologous and allogeneic (donor) transplantation of hematopoietic stem cells;
• allogeneic transplantation of stem cells from peripheral blood or bone marrow from a related or unrelated donor in the treatment of leukemias, multiple myeloma, lymphomas, myelodysplasias and myelofibrosis;
• strict adherence to the international protocols for allogeneic transplantation of blood and bone marrow stem cells;
• unique programs for the prevention of severe graft-versus-host reactions using antisera and gene therapy protocols;
• low-dose conditioning protocols (so-called mini-transplants) for patients suffering from multiple myeloma, lymphoma, leukemia,
• myelodysplasia or myelofibrosis;
• donor lymphocyte protocols (adoptive immunotherapy) for the prevention and treatment of relapses;
• post-transplant vaccination strategies for the treatment of minimal residual disease;
• autologous blood stem cell transplantation for the treatment of all hematological neoplasms and solid tumors.