Leukemia / blood cancer diseases at a glance
Most people are familiar with cancer in the form of solid tumours. Solid means they have a defined and solid structure. They are found as so-called primary tumors in various organs such as the breast, colon or prostate.
Blood cancer is completely different: it is not solid, but rather “ liquid ”. All related diseases affect the whole body, since they are derived from cells of the blood-forming system. These stem cells reside in the bone marrow and form red blood cells ( erythrocytes ), white blood cells (leukocytes) and platelets (thrombocytes).
The two blood cancers are leukemia and lymphoma .
Leukemias are characterized by the fact that the stem cells malfunction and release large numbers of non-functional white blood cells into the bloodstream.
They displace the normal blood cells, but cannot take over their functions. This leads to a lack of red blood cells for transporting oxygen, platelets for blood clotting and white blood cells for the immune system.
Therefore, the affected patients suffer from anemia (anaemia) with poor performance, constant tiredness and palpitations (tachycardia), increased bleeding tendency and increased susceptibility to infections. A rough distinction is made between acute and chronic leukemias . The former develop within a few weeks, while in the latter the course of the disease is insidious and drags on for months or years.
Lymphomas specifically affect a subset of white blood cells called lymphocytes . In addition to the bone marrow , these are usually found in the spleen and lymph nodes and in the thymus gland .
When these cells degenerate, they form large numbers of non-functional cells in these organs, which lead to a characteristic swelling, especially in the lymph nodes.
A distinction is made here between Hodgkin’s lymphomas ( Hodgkin’s disease ) , which are characterized by the presence of characteristic cells. This distinguishes them from the large and heterogeneous group of non-Hodgkin lymphomas , which vary greatly in appearance, therapy and prognosis.
The most important criteria and distinguishing features of the various leukemias and lymphomas are summarized in the following blood cancer table.
Overview of all types of blood cancer, leukemia and lymphoma
Acute Lymphocytic Leukemia (ALL) |
|
| affected age group | Kinder |
| Remarks | most common childhood cancer increasing risk in adults from the age of 50 |
| average age | 2-5 years |
| frequency | 20% of acute leukemias in children 75-80% of leukemias |
| Incidence (new cases) | on average 1.1 – 1.5/100,000 per year in children under five years 5.3/100,000 per year! |
| Gender ratio males: females | 1,4:1,0 |
| course of the disease | acute outbreak within a few weeks |
| classification | according to WHO subdivision into precursor lymphoid neoplasms of B cells or T cells Mature B-cell neoplasms – Burkitt lymphoma further subgroups according to immunological criteria and immunophenotyping (GMALL study group) Further classifications according to EGIL or FAB |
| Causes and risk factors | exact causes unclearmutagenic factors such as ionizing radiation (X-rays, radioactivity) carcinogenic chemicals chemotherapy with substances that inhibit cell proliferation (cytostatics) genetic factors viral infections (HTLV) smoking pre-existing conditions such as CML, multiple myeloma, Hodgkin’s disease |
| Increased risk with genetic diseases | Klinefelter syndrome, Down syndrome |
| degenerated cells | Progenitor cells of the lymphocytes in the bone marrow (lymphatic stem cells) form lymphoblasts, immature white blood cells (lymphocytes) that displace the normal blood formation in the bone marrow.Differentiation according to the increased leukocyte precursors in B-cell ALL (75%) and T-cell ALL (25%).
Accumulation of the degenerated cells in the bone marrow, lymph nodes, spleen, central nervous system. |
| Speed of changes in the blood picture | fast |
| localization | distributed throughout the body |
| leukocytes increased | 50% of the cases |
| anemia | at over 90% |
| decreased platelet count (thrombocytopenia) | 90% of the cases |
| Changes in other blood values | Hemoglobin (Hb) partially increased or decreased |
| Enlargement of the lymph nodes | middle |
| enlargement of the spleen | very often |
| blood count | small and large blood count (differential blood count) |
| other methods of diagnosis | Bone marrow puncture Lumbar puncture to clarify an infestation of the central nervous system |
| further microscopic examinations | Examination of a bone marrow smear Liquor examination of the lumbar puncture |
| cytogenetic markers | in adults and children different genetic changes with complex aberrations of the chromosomes (Philadelphia chromosome, etc.) |
| Imaging procedures | Sonography, computed tomography (CT), magnetic resonance imaging (MRI), X-ray |
| symptoms | Inadequate function of the bone marrow due to suppression of normal blood formation by the proliferating lymphoblastsSigns of anemia with weakness, pallor
Blood clotting disorders due to a lack of blood platelets with nose and gum bleeding, bruises (hematomas) and skin bleeding (petechiae). Slowed wound closure Immune deficiency with infections and feverish inflammations due to the lack of functional leukocytes Bone and joint pain, especially in children Swelling of the lymph nodes, enlarged spleen, liver and thymus gland Symptoms of paralysis and neurological deficits due to the involvement of the brain and meninges Loss of appetite and weight loss |
| Classification of the risk group according to | Age Health status Subgroup of ALL Number of leukocytes Concomitant diseases |
| therapy | Chemotherapy with corticosteroids, anthracyclines, cytarabine, vincristine, cyclophosphamideRadiation therapy to prevent involvement of the brain, sometimes including the mediastinum
stem cell transplant |
| success rate of therapy | if left untreated, fatally curable within days to weeks with chemotherapy in 35-50% of adults and up to 80% of all children Prognosis varies greatly from case to case, since the clinical picture is inconsistent |
Acute myeloid leukemia (AML) |
|
| affected age group | Adult |
| Remarks | most common neonatal leukemia in children rare half of patients over 70 years |
| average age | 63 years |
| frequency | 80% of acute leukemias in children 20% of leukemias |
| Incidence (new cases) | 3/100,000 per year |
| Gender ratio males: females | 1,4:1,0 |
| course of the disease | acute outbreak within a few weeks |
| classification | according to WHO in AML with recurrent genetic changes AML with myeolodysplasia-associated changes Therapy-associated myeloid neoplasms AML not otherwise classified Further classification according to FAB |
| Causes and risk factors | mutagenic factors such as ionizing radiation (X-rays, radioactivity) carcinogenic chemicals chemotherapy with substances that inhibit cell proliferation (cytostatics) genetic factors pre-existing conditions such as CML, aplastic anemia smoking |
| Increased risk with genetic diseases | Klinefelter syndrome, Down syndrome, Patau syndrome; Kostmann syndrome, Bloom syndrome, Fanconi anemia |
| degenerated cells | Myeloid stem cells (progenitor cells of the red blood cells ( erythrocytes ), blood platelets (thrombocytes) and part of the white blood cells (leukocytes: granulocytes , monocytes ) remain at an early stage of development: myeloblasts.Massive increase in bone marrow and blood. |
| Speed of changes in the blood picture | fast |
| localization | distributed throughout the body |
| leukocytes increased | 50% of the cases |
| anemia | at over 90% |
| decreased platelet count (thrombocytopenia) | 80% of the cases |
| Changes in other blood values | Lactate dehydrogenase (LDH) increased ESR increased Uric acid increased |
| Enlargement of the lymph nodes | light to medium |
| enlargement of the spleen | oft |
| blood count | small and large blood count (differential blood count) |
| other methods of diagnosis | Bone marrow puncture Lumbar puncture to clarify an infestation of the central nervous system |
| further microscopic examinations | Examination of a bone marrow smear Liquor examination of the lumbar puncture |
| cytogenetic markers | Relocation of chromosome sections (translocations), e.g. Philadelphia chromosome or translocation t(15;17) in acute promyelocytic leukemia (APL) |
| Imaging procedures | Sonography, computed tomography (CT), magnetic resonance imaging (MRI), X-ray |
| symptoms | Inadequate function of the bone marrow due to the suppression of normal blood formation by the proliferating myeloblastsSigns of anemia with weakness, pallor
Blood clotting disorders due to a lack of blood platelets with nose and gum bleeding, bruises (hematomas) and skin bleeding (petechiae). Slowed wound closure Immune deficiency with infections and feverish inflammations due to the lack of functioning granulocytes and monocytes/ macrophages bone and joint pain Swelling of the lymph nodes, enlarged spleen Stomach pain, loss of appetite, weight loss Rarely affects the central nervous system, skin changes and shortness of breath |
| Classification of the risk group according to | Age Health status Subgroup of AML Number of leukocytes Concomitant diseases |
| therapy | Chemotherapie (Cytarabin (AraC), Daunorubicin, Thioguanin, Azacitidin, Decitabin)stem cell transplant
If myeloblasts are stored in the skin, periosteum and bone marrow (chloromas), additional radiation |
| success rate of therapy | complete remission in 70% of cases |
chronic lymphocytic leukemia
|
|
| affected age group | middle-aged and older adults |
| Remarks | most common leukemia in adults “senile leukemia” |
| average age | 70 – 75 years |
| frequency | in children less than 1% of all leukemias |
| Incidence (new cases) | 4/100,000 per year |
| Gender ratio males: females | 1,7:1,0 |
| course of the disease | very heterogeneous, with aggressive or very slow progressions |
| classification | Classification according to Binet with stages A, B, C according to hemoglobin concentration, platelet count and number of affected regions (lymph nodes, liver, spleen) Classification according to Rai according to lymphadenopathy, hepatomegaly/splenomegaly, hemoglobin and platelets |
| Causes and risk factors | Risk factors are mutagenic factors such as ionizing radiation (X-rays, radioactivity) carcinogenic chemicals chemotherapy with substances that inhibit cell proliferation (cytostatics) |
| Increased risk with genetic diseases | |
| degenerated cells | Precursor cells of the lymphocytes, especially B-cells, rarely B-cells, form defective, non-functional lymphocytes in the blood, bone marrow, spleen and liver |
| Speed of changes in the blood picture | over months or years |
| localization | distributed throughout the body |
| leukocytes increased | always |
| anemia | 50% of cases, minor |
| decreased platelet count (thrombocytopenia) |
40% of cases |
| Changes in other blood values | |
| Enlargement of the lymph nodes | very pronounced |
| enlargement of the spleen | frequent but moderate |
| blood count | small and large blood count (differential blood count) |
| other methods of diagnosis | bone marrow puncture |
| further microscopic examinations | Examination of a bone marrow smear Immunocytochemical examination of the leukemia cells with antibodies against specific surface markers (CD19, CD23, CD5) |
| cytogenetic markers | especially changes in the chromosomes with the omission (deletion) of sections or shifts (translocations), trisomy 12 |
| Imaging procedures | Sonography, computed tomography (CT), magnetic resonance imaging (MRI), X-ray |
| symptoms | Paralysis of the immune system due to a lack of antibodies, resulting in immune deficiency and susceptibility to infection , swelling of the lymph nodes, enlargement of the liver and spleen, involvement of the skin (itching, eczema, fungal diseases, bleeding (petechiae), infiltrates) |
| Classification of the risk group according to | Age Health status Subgroup of CLL Number of leukocytes Concomitant diseases |
| therapy | Chemotherapy (cyclophosphamide, fludarabine) Stem cell transplantation Antibody therapy (rituximab) |
| success rate of therapy | Depending on the genetic background, complete healing through chemotherapy and antibody therapy is not possible . In principle, complete remission through stem cell transplantation is possible, but mortality rates are high |
chronic myeloid leukemia (CML) |
|
| affected age group | Adult |
| Remarks | risk increases with age |
| average age | 35 – 60 years |
| frequency | 2% of leukemias in children |
| Incidence (new cases) | 1.6/100,000 per year |
| Gender ratio males: females | 1,4:1,0 |
| course of the disease | slow development with untreated typical course of chronic phase, acceleration phase and blast crisis |
| classification | according to European Leukemia Net (ELN) in chronic phase, accelerated phase and blast crisis- like criteria according to the classification of the WHO |
| Causes and risk factors | genetic factors, mutagenic factors such as ionizing radiation, carcinogenic chemicals, chemotherapy |
| Increased risk with genetic diseases | |
| degenerated cells | Progenitor cells of the granulocytes form immature granulocytes, settling in the spleen and liver further precursors from the myeloid series |
| Speed of changes in the blood picture | gradually over months or years, then very quickly |
| localization | distributed throughout the body |
| leukocytes increased | always |
| anemia | very often, slightly pronounced |
| decreased platelet count (thrombocytopenia) | oft |
| Changes in other blood values | Lactate dehydrogenase (LDH) increases Uric acid increases |
| Enlargement of the lymph nodes | slightly |
| enlargement of the spleen | often but moderately |
| blood count | small and large blood count (differential blood count) |
| other methods of diagnosis | Bone marrow aspiration cytogenetic study |
| further microscopic examinations | Examination of a bone marrow smear |
| cytogenetic markers | 95% of cases with Philadelphia chromosome 22, remaining 5% with complex chromosomal abnormalities |
| Imaging procedures | Sonography, computed tomography (CT), magnetic resonance imaging (MRI), X-ray |
| symptoms | Chronic phase with a slow increase in white blood cells ( leukocytosis ) and enlargement of the liver and spleen Acceleration phase with increasing leukocytosis , anemia and reduced blood platelet count (thrombocytopenia) due to suppression of blood formation Blast crisis similar to acute leukemia with acute leukocytosis and accumulation of blasts in the blood and outside of the lymphatic organs (chloromas) |
| Classification of the risk group according to | Age Health status Subgroup of CML Number of leukocytes Concomitant diseases |
| therapy | Stem cell transplantation Tyrosine kinase inhibitors (TKI) such as imatinib, dasatinib, bosutinib |
| success rate of therapy | Complete remission is still under discussion, as TKI has not been in use long enough In any case, significantly better survival rates since the introduction of TKI (five-year survival rate with imatinib over 90%) |
Hodgkin-Lymphome (HL) |
|
| affected age group | Adult |
| Remarks | especially middle-aged adults |
| average age | three age peaks: 12 – 44 – 70 years mean age peak at 32 years |
| frequency | 0.4% of all new cancer cases |
| Incidence (new cases) | 2-4/100,000 per year Children: 0.7/100,000 per year |
| Gender ratio males: females | 1,5:1,0 |
| course of the disease | slow development |
| classification | WHO classification with nodular lymphocyte-predominant HL (NLPHL) Classical Hodgkin lymphoma (cHL) |
| Causes and risk factors | exact causes not yet clarified Connection with infection with Epstein-Barr virus (EBV: glandular fever, mononucleosis infectiosa): virus leads to rearrangement of the genes for the immunoglobulins in the B cells (Hodgkin cells, Reed-Sternberg cells) disorders of the immune system by HIV or immunosuppressants after bone marrow and organ transplants increase the risk significantly |
| Increased risk with genetic diseases | |
| degenerated cells | especially B lymphocytes in the lymph nodes, plus other lymphocytes, macrophages, eosinophilic granulocytes , plasma cells |
| Speed of changes in the blood picture | over months |
| localization | most common in the neck (cervical; 80%) In the chest (mediastinal) or groin (inguinal) |
| leukocytes increased | usually significantly lowered! If leukocytosis occurs, then only from proliferating lymphocytes (lymphocytosis) |
| anemia | frequently |
| decreased platelet count (thrombocytopenia) | oft |
| Changes in other blood values | C-reactive protein (CRP) increased ESR increased Lactate dehydrogenase (LDH) increased |
| Enlargement of the lymph nodes | significant but painless |
| enlargement of the spleen | often significantly |
| blood count | small and large blood count (differential blood count) no specific laboratory parameters! |
| other methods of diagnosis | Confirmation of the diagnosis through biopsies and removal of affected lymph nodes for subsequent histological examinations |
| further microscopic examinations | Detection of typical Hodgkin cells and Reed-Sternberg cells |
| cytogenetic markers | no clear cytogenetic markers |
| Imaging procedures | Sonography, computed tomography (CT), magnetic resonance imaging (MRI), X-ray |
| symptoms | Painless swelling of the lymph nodes in the neck, armpit and groin Fever , night sweats, loss of performance, tiredness, inexplicable weight loss Rare but absolutely typical painful lymph nodes after drinking alcohol Enlargement of the spleen and liver rarely occurs in advanced stages, susceptibility to infection, nerve damage (neuralgia), brain inflammation (encephalitis), autoimmune phenomena |
| Classification of the risk group according to | Age Health status Presence of the B cell antigens CD20 and CD79a Number of lymphocytes Number of affected lymph node regions Side of the diaphragm with lymph node involvement Tumor in the intermediate membrane space (mediastinum) Involvement of organs outside the lymphatic system |
| therapy | Depending on the type of chemotherapy (vincristine, etoposide, adriamycin, cyclophosphamide) and/or radiation therapy Caution: Radiation can cause other tumors (secondary malignancies)! antibody therapy |
| success rate of therapy | complete remission possible in many cases, especially in the early stages healing rate in advanced stages around 60% 5-year survival rate depending on the stage over 90%, in case of recurrence (recurrence) significantly lower in case of recurrences prognosis the worse, the earlier this occurs especially very good prognosis in children and adolescents |
Non-Hodgkin-Lymphome (NHL) |
|
| affected age group | all ages |
| Remarks | risk increases with age |
| average age | increasing with age |
| frequency | 5% of all new cancer cases |
| Incidence (new cases) | 5-10/100,000 per year in AIDS patients 1,000-fold increased risk |
| Gender ratio males: females | 1,5:1,0 |
| course of the disease | very heterogeneous, course dependent on the genetic subtype |
| classification | WHO classification according to progenitor cells, surface characteristics, shape of the cells and rate of division: Prolymphocytic leukemia Small-cell B-cell lymphoma Large-cell B-cell lymphoma Burkitt’s lymphoma Multiple myeloma (plasmocytoma) |
| Causes and risk factors | exact causes not yet fully understood, especially genetic changes in the chromosomes mutagenic factors such as ionizing radiation, carcinogenic chemicals, chemotherapy, pesticides (malathion, glyphosate) viral infections (HIV, EBV, HTLV-1) autoimmune diseases (Sjögren’s syndrome) bacterial infections with Helicobacter pylori , the main cause of gastric ulcers (MALT lymphoma of the gastric mucosa) |
| Increased risk with genetic diseases | hereditary in Wiskott-Aldrich syndrome |
| degenerated cells | B or T cells of the lymphatic organs (lymph nodes, spleen), therefore differentiation between a B (80%) and a T line (20%) of the NHL killer cells are very rarely affected |
| Speed of changes in the blood picture | over months |
| localization | very different depending on the classification: distributed throughout the body or in various internal organs (extranodal), in lymph nodes (nodal), preferably in the skin (cutaneous) |
| leukocytes increased | usually significantly lowered! If leukocytosis occurs, then only from proliferating lymphocytes (lymphocytosis) |
| anemia | common, often due to breakdown of red blood cells (haemolytic anemia) |
| decreased platelet count (thrombocytopenia) | oft |
| Changes in other blood values | Blood sedimentation rate (ESR) increased Blood value for iron decreased Blood value for ferritin increased Fibrinogen increased Globulin values increased – especially the immunoglobulins of the degenerated B cells (monoclonal gammopathy) |
| Enlargement of the lymph nodes | significant but painless |
| enlargement of the spleen | often significantly |
| blood count | small and large blood count (differential blood count) laboratory parameters very different |
| other methods of diagnosis | Confirmation of the diagnosis through biopsies and removal of affected lymph nodes for subsequent histological examinations, cytogenetic and molecular-biological examinations of the underlying chromosomal changes in the tissue material |
| further microscopic examinations | Evidence of the absence of Hodgkin cells and Reed-Sternberg cells typical of HL |
| cytogenetic markers | classic marker: displacement of a chromosomal fragment (Burkitt translocation t(8;14)(q24;q32)), which activates the protooncogene c-MYC further chromosomal changes in the various subgroups (trisomy 3, trisomy 12 and others) |
| Imaging procedures | Sonography, computed tomography (CT), magnetic resonance imaging (MRI), X-ray |
| symptoms | Painless swelling of the lymph nodes in the neck, armpit and groin Fever, night sweats, loss of performance, tiredness, inexplicable weight loss Enlargement of the spleen and liver less frequently in advanced stages Susceptibility to infection, due to the suppression of blood formation in the blood count either hardly any leukocytes can be found ( leukopenia ) or only Lymphocytes (leukocytosis, more precisely lymphocytosis) |
| Classification of the risk group according to | Age Health status ESR Number of affected lymph nodes Side of the diaphragm affected by lymph nodes Involvement of organs outside the lymphatic system Malignancy (malignancy) |
| therapy | depending on stage and subtype chemotherapy (cyclophosphamide, vincristine, doxorubicin plus prednisolone = CHOP) and/or radiotherapy |
| success rate of therapy | Very heterogeneous group, therefore the prognosis varies greatly depending on the subtype of NHL, stage and age of the patient Complete remission in some cases possible Fatal course in some cases Long convalescence times |
Further information and help:
- Competence network Magline Lymphoma . links>> .
- Leukemia Competence Network: Leukemias . links>> .
- German Society for Hematology and Oncology :
- German Cancer Aid – The Blue Guides:
- Janssen-Cilag cancer guide :
- From blood cancer and swollen lymph nodes. links>> .
- leukemias and lymphomas. links>> .
- German Cancer Research Center (DKFZ):
- German Leukemia and Lymphoma Aid (DLH):
- Brochures for patients. links>> .
- DLH info sheets. links>> .
- Children’s Cancer Info:
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