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 decrease in the patient’s general condition that has lasted a few days or weeks, bone pain, fatigue, infection, fever, and an acute tendency to bleed.  

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 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 count. 

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

If an abnormal examination result or finding is made, you will be referred to HUS.

More detailed examinations and treatment of acute leukemia are mainly centralized in our 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 your disease appears to have developed slowly, the changes detected in your blood profile are minor and your condition is stable, the referring physician will make an urgent referral based on your condition and place of residence either to an internal medicine outpatient clinic at the Jorvi, Peijas, Helsinki Laakso ,or Malmi Hospital, or to a 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, at our discretion, 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 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.

We take the bone marrow samples from the rear part of the pelvic 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 enclosed with your appointment letter.

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, the preliminary diagnosis of acute leukemia is often confirmed during the day of sampling or the following day. In this case, the main type of leukemia is confirmed: acute myeloid (AML) or acute lymphoblastic (ALL) leukemia.

As initial treatment for leukemia, i.e. induction therapy, we administer strong combination chemotherapy, which lasts from a few days to a month. 

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 of patients in remission continues on an outpatient basis for ten years due to possible recurrence of leukemia and late complications of treatment.

Good palliative care and psychosocial support are an integral part of cancer treatment. The Palliative Care Center provides help in the stressful life situation caused by the illness or cancer treatments. We help treat difficult symptoms and offer conversational support. 

A decision on palliative, i.e. symptomatic, treatment is made when the focus of your treatment shifts from slowing down the progression of cancer to managing the symptoms. In this case, treatment aims to alleviate symptoms and, as far as possible, to ensure a good and active life with the illness until death. Typically, at this stage, your care responsibility is transferred to the palliative care unit or to the palliative outpatient clinic or hospital-at-.home unit in your area.

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 you transfer to palliative care, we will make a referral to a palliative outpatient clinic and/or hospital-at-home unit.