Leukemia, a form of cancer that often affects the white blood cells, is a particularly scary diagnosis for a patient, and certain types can develop suddenly and require aggressive treatment.
What should your patients know if they are at risk of or concerned about a leukemia diagnosis?
Leukemia is usually classified in two ways: the progression of the disease (acute vs chronic). and which cells are under attack (lymphoid cells vs myeloid cells). Combinations of these classifications include the following:
- Acute lymphocytic leukemia (ALL) affects the lymphoid cells. Acute leukemias progress rapidly, and they require more immediate and aggressive treatment. ALL is the most common leukemia diagnosed in young children, but adults can also develop it.¹
- Chronic lymphocytic leukemia (CLL) affects the same cells as ALL but progresses more slowly, which means symptoms may not appear at first.
- Acute myeloid leukemia (AML) can also occur in both children and adults. AML is a cancer that can affect both blood and bone marrow.²
- Chronic myeloid leukemia (CML) affects adults predominately and is a slowly growing cancer that may not manifest symptoms for a significant time.
Other more rare forms of leukemia include hairy cell leukemia, a subtype of CLL, which affects bone marrow and makes it harder for the body to produce healthy white and red blood cells.² Myelodysplastic syndromes are other blood cell disorders that can increase a patient’s risk of leukemia.³
The causes of leukemia are not always known, but healthcare providers can explain these risk factors to patients, even though most cannot be modified:
- Smoking. This lifestyle choice has been linked to an increased risk of AML.⁴ Counsel patients to quit smoking or not to start.
- Age. In leukemias affecting adults, older age increases the risk of developing them.
- Past cancer treatment. Radiation therapy and certain forms of chemotherapy may present a risk for a second form of cancer, including leukemia.
- Radiation exposure. Besides radiation used for medical treatment and diagnosis, other forms of exposure to radiation may also increase risk.
- Sex. Statistically, men are more likely to develop leukemia than women.
- Family history. Some patients whose relatives have had leukemia may be at an increased risk of this disease.
Common symptoms of leukemia include the following:
- Night sweats
- Aches and fatigue
- Unexplained weight loss
- Bleeding or bruising easily
- Frequent nosebleeds
- Petechiae, or small red spots on the skin
- Frequent infections
- Bone and joint pain
- Swollen lymph nodes
- Enlarged liver and spleen
The specific treatment depends on the type of cancer, its severity, and how fast it is metastatizing. Treating leukemia may require these treatments:
- Radiation therapy
- Bone marrow stem cell transplantation
- Targeted drug therapy
- Participation in clinical trials
Although the prognosis for a patient with leukemia depends on its type and severity, overall prognoses have improved over the years. According to the American Cancer Society, in 2019 the 5-year survival rate for children with ALL was over 90%, while the 5-year survival rate for children with AML was estimated to be between 65% and 70%.⁵
The Leukemia & Lymphoma Society reports that AML had the lowest 5-year overall survival rate for leukemias in adults from 2009 to 2015, at 29.4%.⁶ Other forms of leukemia in that same timespan, though, had better survival rates: 71.7% for all patients with ALL, 88.2% for patients with CLL, and 69.7% for patients with CML.
- Leukemia – symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/leukemia/symptoms-causes/syc-20374373. Accessed March 3, 2021.
- Types of leukemia. Cancer Treatment Centers of America. https://www.cancercenter.com/cancer-types/leukemia/types. Updated November 5, 2020. Accessed March 3, 2021.
- Myelodysplastic syndromes – symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/myelodysplastic-syndrome/symptoms-causes/syc-20366977. Accessed March 3, 2021.
- Health risks of smoking tobacco. American Cancer Society. https://www.cancer.org/healthy/stay-away-from-tobacco/health-risks-of-tobacco/health-risks-of-smoking-tobacco.html. Updated October 28, 2020. Accessed March 3, 2021.
- Survival rates for childhood leukemias. American Cancer Society. https://www.cancer.org/cancer/leukemia-in-children/detection-diagnosis-staging/survival-rates.html. Updated February 12, 2019. Accessed March 3, 2021.
- Facts and statistics. Leukemia & Lymphoma Society. https://www.lls.org/facts-and-statistics/facts-and-statistics-overview/facts-and-statistics#Leukemia. Accessed March 3, 2021.
This article originally appeared on Hematology Advisor