Care pathway for acute leukemia

Acute leukemia is a cancer in which a blood cell precursor that has become malignant begins to divide and leukemia cells accumulate in the bone marrow.  

The most common symptoms of acute leukemia are

• a decline in overall health that has lasted for a few days or weeks
• bone pain
• tiredness
• infection
• fever, and
• an acute bleeding tendency.

Because of the symptoms, the physician will examine the patient’s blood count, which usually shows anemia, i.e. low hemoglobin in the blood and low platelet counts. White blood cell counts may also be abnormally high or low.

The symptoms and abnormal blood counts require differential counting of white blood cells. In some patients, leukemia cells, i.e. blasts, circulating in the blood are detected in the white blood cell counts. 

The initial examinations for acute leukemia may be performed at a health center, in occupational health care, or at a private medical clinic.

If an abnormal examination result or finding is made, the physician will make a referral to us at HUS.

More detailed examinations and treatment of acute leukemia are mainly centralized in the hematology unit. Sometimes examinations can also be performed at your local hospital.  

In an urgent situation where the changes found in your blood profile are significant and/or your condition is unstable, the physician at the referring unit will discuss arranging examinations by telephone with our hematologist. In this case, you will be transferred either from the emergency department or the referring unit directly to our hematology ward for further examinations.  

If the disease has progressed slowly, the changes observed in your blood counts are minor, and your condition is stable, the referring physician will issue an urgent referral based on your status and place of residence

• to the internal medicine outpatient clinic at Jorvi, Peijas, Lohja, Raseborg, or Malmi Hospital, or
• to the hematology outpatient clinic at the Comprehensive Cancer Center, Hyvinkää Hospital, or Porvoo Hospital. 

For the diagnosis of acute leukemia, we will take bone marrow and blood samples and, if required, also a skin or cerebrospinal fluid sample. The leukemia diagnosis is based on accurate test results carried out in a specialized laboratory.

Samples in the diagnostic phase are taken urgently on the hematology ward or in the procedure room at the outpatient clinic.

We take bone marrow samples from the back of the hip bone under local anesthesia. The procedure takes about 20–30 minutes. You will receive more detailed instructions about the procedure from the ward nurse and physician or appended to your appointment letter. Learn more about bone marrow sampling.

We will ask for your consent for taking biobank samples and aim to determine your suitability for ongoing clinical trials regarding acute leukemia as early on as possible.

At the appointment, the physician will discuss the examination results and your treatment plan with you once the preliminary test results have been completed.

If you are being treated on an inpatient ward, a preliminary diagnosis of acute leukemia is often confirmed during the day of sampling or in the following day. This will determine the main type of leukemia:

• acute myeloid leukemia (AML) or
• acute lymphoblastic leukemia (ALL).

Examinations specifying the diagnosis of acute leukemia take about a week to a month to complete.

In addition to traditional chemotherapy, the initial treatments for acute leukemia may include combinations of antibodies and chemotherapy or other drugs targeted at the specific characteristics of the disease.

A multidisciplinary care team is responsible for the treatment of acute leukemia. You can reach your treatment team on the Maisa portal and by phone. You will find the contact information for the unit treating you on the invitation letter.  

• The Comprehensive Cancer Center helpline at 09 471 74900 is open Monday through Friday from 7:30 a.m. to 4:00 p.m.
• If your condition deteriorates suddenly or your fever rises above 38 degrees Celsius, contact the 24-hour emergency Medical Helpline at 116 117 (toll-free) or the nearest hospital with on-call services.
• In an emergency, always call 112. 

The risk of recurrence of leukemia is highest during the first three years. In case of recurrence, regular follow-up continues with blood and bone marrow samples for 2–5 years after diagnosis. Sensitive genetic tests can detect up to one leukemia cell out of a million cells and thus guide the planning of follow-up and treatment.

Further follow-up in case your disease is in remission will continue on an outpatient basis for ten years due to possible recurrence of leukemia and late complications of treatment.

The symptoms of acute leukemia are often associated with low blood cell counts, specifically anemia, a low platelet count, and an increased susceptibility to infection due to a low white blood cell count.

Long hospital stays, bed rest, and especially infections contracted during treatment can impair the patient’s overall condition and functional capacity. Staying active and maintaining muscle strength within the limits of one’s health is still important, and we strive to make this possible, for example, through home care for leukemia patients.

Chemotherapy can also cause nausea, which can be treated with medication. Please make sure you eat a healthy and varied diet.

Your follow-up at HUS usually ends after five years if we have not detected a recurrence of the disease. In between follow-up visits, you can contact the unit that treated you if you have any questions.

If we decide to provide you with symptomatic treatment, the physician will refer you to a palliative care clinic and/or home health care.