Leukemia: A Complete Guide to Symptoms, Causes, Treatments, and Outlook
This article covers the common types of leukemia, including their symptoms, causes, treatments, and more.
Leukemia is a general term for many malignant blood and bone marrow diseases. It mainly affects white blood cells and how they grow and develop. White blood cells are blood cells that help fight infection.
If you have leukemia, your bone marrow produces atypical white blood cells. These leukemia cells grow rapidly, spread out into the bloodstream, and crowd out healthy white blood cells, red blood cells, and platelets.
Doctors classify the four main types of leukemia by how quickly the disease progresses and the type of white blood cell it affects.
Acute leukemia progresses rapidly. The disease affects immature blood cells that multiply at a high rate, so symptoms worsen quickly. People with acute leukemia should receive prompt, aggressive treatment.
Chronic leukemia affects mature blood cells, which multiply more slowly. These cells can also maintain their typical function for a longer time, slowing the progression of the disease. Some people have no symptoms for years and, once they receive a diagnosis, may undergo “watchful waiting” before starting treatment.
The types of cells that leukemia can affect are:
- Lymphocytes: These are a type of white blood cell.
- Myeloid cells: These are blood forming cells that generate red blood cells, white blood cells, and platelets.
Rapidly progressing types of leukemia
- Acute lymphoblastic leukemia (ALL): ALL is the most common type of leukemia in children and teenagers, but adults can also get ALL. Although treatment can often cure the condition in children, the outlook for adults is improving.
- Acute myeloid leukemia (AML): AML is more common in adults than children. Although it can be difficult to treat, AML is curable in some cases.
Slowly progressing types of leukemia
- Chronic lymphocytic leukemia (CLL): CLL is the most common type of leukemia in adults. It usually grows slowly, but it can grow quickly as well. The slow growing form is less severe than the fast growing type. CLL may not require treatment for several years when it grows slowly, and doctors may recommend watchful waiting instead.
- Chronic myeloid leukemia (CML): CML occurs due to the formation of an atypical gene called the BCR-ABL1 fusion gene. The fusion gene makes a protein that leads to the replication of CML cells. CML progresses slowly, and oral treatment is very effective for most people.
There are also less common forms of leukemia, including:
- B-cell prolymphocytic leukemia
- blastic plasmacytoid dendritic cell neoplasm
- chronic myelomonocytic leukemia
- hairy cell leukemia
- juvenile myelomonocytic leukemia
- large granular lymphocytic leukemia
- T-cell prolymphocytic leukemia
The disease itself develops when blood cells do not behave normally. Typically, blood cells grow at a specific rate and die within a specific timeframe. This turnover allows the blood to maintain steady levels of cells. With leukemia, the atypical blood cells grow and multiply, which crowds out healthy blood cells.
Symptoms of leukemia can vary from person to person. They can also differ depending on the specific type of leukemia a person has. For example, some types of leukemia — such as chronic lymphocytic leukemia and chronic myeloid leukemia — might be asymptomatic.
Leukemia symptoms result from the high numbers of atypical white blood cells crowding out the healthy cells. The reduced number of red blood cells leads to anemia. The lower number of platelets leads to poor blood clotting.
Leukemia cells cannot fight infections as effectively as normal white blood cells, which increases the risk of infections. Leukemia cells can also accumulate in the body’s organs, such as the spleen, liver, lymph nodes, testes, and brain. These organs may not function normally as a result.
Possible symptoms of leukemia include:
- achiness in the joints and bones
- easy bleeding or bruising
- enlarged liver, spleen, and lymph nodes
- frequent infections or low-grade fever
- a loss of appetite
- night sweats
- pale skin or pallor
- shortness of breath
- slow healing of wounds
- tiny red spots on the skin, or petechiae
- weight loss
When diagnosing leukemia, a doctor performs a complete medical history, a physical examination, blood tests, and X-rays. Other diagnostic procedures may include:
- Bone marrow aspiration or biopsy: This procedure involves extracting bone marrow fluid (aspiration) or solid bone marrow tissue (biopsy), usually from the hip bones.
- Complete blood count: This blood test measures the size, number, and maturity of different blood cells.
- CT scan: This imaging exam uses a combination of X-rays and computer technology to produce cross-sectional images of the body.
- Chromosome testing: This process looks for specific molecular and genetic changes.
- Lymph node biopsy: This procedure removes lymph node tissue or cells from the body for examination under a microscope.
- MRI scan: This imaging exam uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.
- Ultrasound (sonography): This imaging technique uses sound waves and a computer to view internal organs and assess blood flow.
- Spinal tap (lumbar puncture): This procedure removes cerebrospinal fluid to see if leukemia is affecting the central nervous system and exclude the possibility of an infection or another problem.
Leukemia treatment aims to bring about a complete remission of the disease. Remission means that there is no longer any sign of the disease in the body. However, even with remission, leukemia can come back.
Plans for treating leukemia depend on the type of leukemia and its stage. Doctors will also consider your age, medical history, and other diseases or conditions you have.
Treatment may include a combination of:
- Chemotherapy: This is the main treatment option for most types of leukemia.
- Immunotherapy: This treatment uses antibodies or other aspects of the immune system to fight leukemia.
- Radiation therapy: This treatment involves using radiation to kill cancer cells.
- Stem cell transplant: This provides new stem cells that divide to make healthy new blood cells.
- Surgery: This is uncommon because of the way leukemia spreads through the blood and bone marrow.
- Targeted therapies: These are drugs that can recognize and attack the unique characteristics of leukemia cells.
Leukemia is a common type of cancer in adults. Among children and teenagers, it is the most common cancer. It is the second-leading cause of childhood cancer deaths, behind brain and nervous system cancers.
In 2022, experts expect that there will be 60,650 new cases of leukemia and 24,000 deaths associated with the disease.
Several factors may increase the risk of developing leukemia. The risk factors can vary with the type of leukemia. Not all people with risk factors will develop the disease.
Risk factors for leukemia include:
- certain blood disorders, such as myelodysplastic syndromes
- certain genetic disorders, such as Down syndrome
- previous chemotherapy or radiation therapy
- exposure to certain chemicals, such as Agent Orange or benzene
- exposure to large amounts of radiation
- a family history of leukemia
Disease prevention relies on changing risk factors under your control, such as reducing your exposure to tobacco and toxic chemicals.
Childhood leukemias have very few risk factors that you can change. Therefore, most cases of leukemia are not preventable.
Are there regular screenings for leukemia?
There are no regular screening tests for leukemia. However, adults and children with an increased risk of leukemia need careful and regular medical care, which includes being vigilant for possible signs and symptoms that leukemia is developing. In some cases, doctors may recommend blood tests to check blood counts.
Treatment advances have greatly improved the outlook and survival rate for leukemia. Many people with leukemia today can treat or manage the disease effectively and live long, healthy lives.
A relative survival rate looks at people with leukemia five years after diagnosis. It compares them to people of the same age and sex assigned at birth in the general population. The comparison shows how much leukemia can shorten lifespans.
It is an estimate of survival five years after their diagnosis. It is important to remember that each patient is unique. Survival rates may continue to improve with the development of new treatments.
The 5-year relative survival rate for leukemia has improved greatly in the past few decades, reaching 65.7% across all patients from 2012 to 2018.
In that same time frame, the survival rates by leukemia type break down as follows.
Acute lymphocytic leukemia 5-year relative survival rate
- 72.1% overall
- 92.5% for children and adolescents under 15 years
- 94.4 % for children under 5 years
Acute myeloid leukemia 5-year relative survival rate
- 29.8% overall
- 70.6% for children and adolescents under 15 years
Chronic lymphocytic leukemia 5-year relative survival rate
- 88.6% overall
Chronic myeloid leukemia 5-year relative survival rate
- 71.7% overall
The following are some other frequently asked questions about leukemia.
What is the first symptom of leukemia?
Symptoms vary from person to person and with the type of leukemia. There may be no symptoms in the early stages of the disease. Common symptoms include fatigue, frequent infections, and problems with bleeding or bruising.
How long can you have leukemia without knowing?
It is possible to have chronic leukemia and not know it. Doctors may find the problem when ordering blood tests for a routine exam or as part of a diagnosis for another condition.
Does leukemia run in families?
Researchers have linked AML and CLL to a familial risk. For CLL, although still small, the risk is higher for some people when a first-degree relative has the disease. In addition, ALL is more common in people with certain genetic disorders.
Does leukemia cause hair loss?
Does leukemia affect the eyes?
Although leukemia can affect the eyes, this is rare.
Leukemia is a group of cancers that affect the blood and bone marrow. The four most common types are ALL, AML, CLL, and CML. Common symptoms include frequent infections, fatigue, and bleeding problems. However, it is possible to have chronic leukemia and not have any symptoms.
In most cases, leukemia is not preventable. However, it may be highly treatable. Chemotherapy is the main treatment option for most types of leukemia. Doctors may recommend other treatments depending on the type and severity of the disease. Treatment advances have led to improved survival rates for people with leukemia.