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Different Types Of Leukemia, Symptoms And Treatment

Different Types Of Leukemia

In a simple way, the types of leukemia can be classified according to 2 different criteria, which has implications for their treatment and prognosis:

Speed ​​of disease development:

Acute leukemias:

They tend to proliferate and progress rapidly without treatment.

A high proportion of altered leukocytes are detected in a younger or immature state (which are called blasts or blast cells) incapable of giving rise to mature cells capable of carrying out their usual function.

In these cases, the disease is usually detected after the appearance of symptoms.

Chronic leukemias:

They tend to proliferate slowly, presenting altered cells that are generally more mature.

Due to its slow progression even without immediate treatment, many cases are usually detected by chance in people without symptoms thanks to routine tests, without prior suspicion of the disease.

Cell of origin:

  • Lymphatic leukemia : The original alteration takes place in the lymphoid cells or lymphocytes, which originate mainly in the bone marrow.
  • Myeloid leukemia : The original alteration takes place in some of the myeloid cells that originate in the bone marrow.

Classification Of Leukemias

As previously described, in general, leukemias can be classified based on their speed of development (acute and chronic leukemias) and based on the type of cell that originates it or that proliferates uncontrollably (myeloid or lymphoid). In this way, we can distinguish acute leukemias (which are divided into 2 main groups, myeloid and lymphoid) and chronic leukemias (which are also divided into 2 main groups, myeloid and lymphoid).

What Are The Different Types Of Leukemia?

In general, we can differentiate 4 different types of leukemia :

  • Acute lymphoid/lymphoblastic leukemia (ALL)
  • Acute myeloid leukemia (AML)
  • Chronic lymphoid/lymphoblastic leukemia
  • Chronic myeloid leukemia

Acute Lymphoblastic Leukemia (ALL)

Acute lymphoblastic leukemia (ALL) is a type of cancer that starts from white blood cells in the bone marrow, the soft inner part of bones.

It is characterized by the rapid growth of abnormal lymphoblast’s, which are immature white blood cells.

These abnormal cells crowd out normal cells in the bone marrow, leading to a decrease in the production of normal blood cells.

Symptoms of acute lymphatic leukemia:

As it is an acute leukemia, the appearance of symptoms is usually very sudden , with little time passing between their debut and the diagnosis of the disease.

The symptoms of ALL are common to those of other types of leukemia, being especially characteristic:

  • Excessive fatigue and paleness resulting from anemia (lower production of red blood cells by the bone marrow).
  • Fever may appear as a result of a greater likelihood of suffering from infections.
  • Bruises caused by a decrease in the number of platelets.
  • Palpable swollen lymph nodes, liver, or spleen upon physical examination.
  • Night sweats and unintentional weight loss .

Diagnosis of acute lymphatic leukemia:

The diagnosis of acute lymphatic leukemia is made by the responsible hematologist after considering:

  • Patient’s medical history
  • Physical examinations performed (detection of swollen lymph nodes known as lymphadenopathy, palpable liver or spleen, or signs of anemia after observing mucous membranes).
  • Results from blood tests (high white blood cell counts with a reduction in the number of red blood cells or platelets in the complete blood count).
  • Results of the analyzes carried out on samples obtained directly from the bone marrow (aspirate and biopsy), and which include morphological, immunophenotypic, cytogenetic and molecular studies.

Treatment Of Acute Lymphoblastic Leukemia:

Treatment of acute lymphoblastic leukemia must be early and generally urgent, given the aggressiveness and rapid onset of the disease.

However, in older and clinically stable patients it may be better to wait a few days if the condition of the sick person allows it, in order to better understand the precise characteristics of the ALL and the weaknesses of the sick person before embarking.

In treatments that could be demanding or aggressive in order to maximize the treatment to be received based on the alterations found in the laboratory in the tumor cells.

The choice of treatment is influenced by both the initial situation of the disease (symptoms, damage outside the bone marrow, especially the central nervous system, etc.) and the state of the sick person: age, degree of conservation of the different bodily functions. (functionality), additional diseases (comorbidity), etc.

In any case, the treatment has a curative intention since it is, as generally occurs in acute leukemias, a disease that greatly shortens survival (without treatment one usually lives only a few months).

In any case, chemotherapy is today the basis of any of these treatments, both in adults and children.

Acute myeloid leukemia (AML)

Acute myeloid leukemia is the most common type of acute leukemia in adults, accounting for around 35% of all leukemias in the Western world.

According to updated data from the epidemiological registry of the Spanish Hematology Treatment Program (PETHEMA), each year around 3.5 new cases of AML are diagnosed in Spain per 100,000 inhabitants per year.

Symptoms:

The symptoms of AML often manifest due to the rapid accumulation of abnormal myeloid cells, crowding out normal cells in the bone marrow.

Common symptoms include fatigue, weakness, shortness of breath, frequent infections, easy bruising or bleeding, and pale skin.

Patients with AML may also experience bone pain or tenderness, unintentional weight loss, and swelling of the gums.

As AML progresses, it can impact the normal functioning of the bone marrow and other organs, leading to a range of systemic symptoms.

Early detection and timely medical intervention are crucial for effective management of AML.

If individuals notice persistent or worsening symptoms, seeking medical attention for a thorough evaluation is essential for accurate diagnosis and appropriate treatment.

Treatment:

Treatment against acute myeloid leukemia is based in practically all cases on the use of chemotherapy, which can sometimes be accompanied by some targeted therapy.

The therapeutic objective is to achieve cure (known in these diseases as complete remission) whenever possible. When this is not achieved, the objective is to keep the leukemia under control for as long as possible.

In any case, the choice of the final treatment will depend on different factors.

Among them are the characteristics of the disease (subtype diagnosed with special attention to acute promyelocytic leukemia and the presence of genetic alterations that may determine the risk or prognosis of the disease) and the individual characteristics of the patient (age, health status or presence of additional diseases).

Chronic Lymphatic Leukemia (CLL)

Lymphatic or chronic lymphocytic leukemia (CLL) is an uncontrolled proliferation of mature B lymphocytes in the body. It is the most common cause of leukemia in the Western world and represents around 30% of adult leukemia cases.

On the contrary, its incidence is notably lower in eastern countries.

More than 70% of CLL cases are diagnosed in people over 65 years of age, and less than 10% are under 50 years of age, with an average age of onset of 70 years.

Thus, the incidence of the disease increases from less than 1 case per 100,000 inhabitants per year in people who are in the fourth decade of life, to more than 30 cases per 100,000 inhabitants per year in people over 80 years of age ( US National Cancer Institute, 2020).

The incidence of CLL is approximately twice as high in men as in women.

Symptoms of chronic lymphatic leukemia:

It is estimated that approximately 8 out of 10 patients are asymptomatic at the time of diagnosis of chronic lymphatic leukemia, remaining so for a variable period of time that can be months or years, during which they only require observation and periodic clinical control. Over time, some symptoms common to other types of leukemia appear, such as:

  • Excessive fatigue and paleness derived from anemia : The production of anemia may be due to a lower production of red blood cells due to infiltration of malignant lymphocytes in the blood factory, although sometimes CLL itself produces antibodies that break down the red blood cells. in the blood without the need for the bone marrow to be infiltrated. On this occasion, along with fatigue, yellowing of the skin and “coca-cola” colored urine may appear.
  • Increase in the size of the lymph nodes (adenopathy) and increase in the size of the liver and spleen as a consequence of the uncontrolled accumulation of these CLL lymphocytes in these organs, which can be palpable during a physical examination.
  • Hematomas and hemorrhages resulting from the reduction in the number of platelets produced by the bone marrow or even from their destruction by antibodies that can be produced by the malignant lymphocytes of CLL.
  • Recurrent infections (with a high frequency of respiratory infections that may require admission to the hospital) and reactivation of previous infections such as herpes.
  • Night sweats , loss of appetite and involuntary weight loss, although it may be mild.

Treatment of chronic lymphatic leukemia:

Not in all cases patients with chronic lymphocytic leukemia should receive treatment.

This treatment should always be started following medical criteria , in those patients with the appearance of symptoms of active disease (especially if they appear suddenly) and based on the results of the tests performed.

When the hematologist considers that treatment is necessary, he will decide the best option based on the patient’s clinical characteristics (age, functional and general health status, presence of other diseases and treatments administered simultaneously) and on the cytogenetic and molecular studies performed.

Chronic Myeloid Leukemia (CML)

Chronic myeloid leukemia accounts for between 15% and 20% of all leukemias globally. The incidence of CML in Western countries is estimated to be 1-1.5 cases per 100,000 inhabitants per year according to data from the US National Cancer Institute in 2021.

Although the disease can appear at any age, the Incidence increases significantly with age, with most cases occurring in patients over 60 years of age (average age of diagnosis 64 years) and being very rare in children.

It has also been observed that CML is 1.3 to 1.8 times more common in men than in women, although the exact reasons that may explain this are not known.

However, no geographical differences have been established in the number of new cases diagnosed.

Symptoms of chronic myeloid leukemia:

Chronic myeloid leukemia (CML) is a type of cancer that originates in the bone marrow and primarily affects myeloid cells.

Here are some common symptoms associated with chronic myeloid leukemia:

  • Fatigue and Weakness
  • Weight Loss and Loss of Appetite
  • Abdominal Discomfort
  • Bone Pain or Joint Pain
  • Easy Bruising and Bleeding
  • Night Sweats
  • Fever
  • Enlarged Spleen or Liver
  • Frequent Infections
  • Pale Skin:

Treatment Of Chronic Myeloid Leukemia:

Multiple factors are involved in the choice of treatment to be considered by the hematologist, the most important being the stage at which the diagnosis of chronic myeloid leukemia occurred , and to a lesser extent the degree of conservation of bodily functions (functionality) or the presence of associated diseases (comorbidity).

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