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Leukemia

Last updated: January 2025 | Medical Reviewer: Oncol.net Editorial Board

What is Leukemia? Leukemia is cancer of the blood-forming tissues, including bone marrow and the lymphatic system. Unlike solid tumors, leukemia involves abnormal white blood cells that multiply uncontrollably and crowd out normal blood cells, impairing the body's ability to fight infection, carry oxygen, and control bleeding.

Overview

Leukemia comprises a group of blood cancers that begin in the bone marrow - the soft, spongy tissue inside bones where blood cells are produced. In leukemia, the bone marrow makes abnormal white blood cells that don't function properly. These leukemia cells accumulate in the bone marrow and blood, eventually crowding out healthy blood cells.

Approximately 60,000 people are diagnosed with leukemia annually in the United States. It is the most common cancer in children under 15 (accounting for about 30% of childhood cancers), but it predominantly affects adults - about 90% of all leukemias occur in adults. Outcomes vary dramatically depending on the specific type of leukemia, patient age, and other factors.

Types of Leukemia

Leukemia is classified by two main factors:

This creates four major types:

Acute Myeloid Leukemia (AML)

Acute Lymphoblastic Leukemia (ALL)

Chronic Myeloid Leukemia (CML)

Chronic Lymphocytic Leukemia (CLL)

Signs and Symptoms

Common Symptoms (All Types)

Symptoms result from abnormal blood cell counts:

From Low Red Blood Cells (Anemia)

From Low Platelets (Thrombocytopenia)

From Abnormal White Blood Cells

From Leukemia Cell Accumulation

Acute Leukemia-Specific Symptoms

Chronic Leukemia-Specific Features

Emergency Symptoms Requiring Immediate Evaluation:
  • High fever (>101°F) with signs of infection
  • Uncontrolled bleeding
  • Severe shortness of breath or chest pain
  • Sudden severe headache, confusion, or vision changes
  • Symptoms of tumor lysis syndrome: nausea, vomiting, decreased urination, muscle cramps

Diagnosis

Blood Tests

Bone Marrow Tests (Usually Required for Diagnosis)

Additional Tests

Treatment Overview by Type

Type First-Line Treatment Key Therapies Transplant Role
AML Induction chemotherapy (7+3) Cytarabine, anthracyclines, FLT3/IDH inhibitors, venetoclax Consolidation for fit patients <60, intermediate/high-risk
ALL Multi-agent chemotherapy (2-3 years total) Vincristine, steroids, asparaginase, TKIs (Ph+), CAR-T (relapsed) High-risk disease, relapsed disease
CML TKI (imatinib, dasatinib, nilotinib) Oral TKI daily, goal: deep molecular response Rarely (TKI failure, blast crisis)
CLL Watch and wait (if asymptomatic); targeted therapy when indicated Venetoclax, BTK inhibitors (ibrutinib, acalabrutinib), anti-CD20 antibodies Rarely (young, high-risk, multiple relapses)

Prognosis and Survival Rates

Type 5-Year Survival (Overall) Key Factors
AML 30% overall
40-50% (<60 years)
10-20% (>60 years)		 Age, cytogenetics, FLT3/NPM1 status, response to treatment
ALL 70% overall
85-90% (children)
40-50% (adults)		 Age (children much better), Ph+ status, MRD, risk stratification
CML 70% overall
80-90% (chronic phase with TKI)		 Phase at diagnosis, TKI response, resistance mutations
CLL 88% overall Stage, IGHV status, del(17p)/TP53, age, fitness

Living with Leukemia

Managing Treatment Side Effects

Long-Term Follow-Up

Quality of Life

Frequently Asked Questions

Is leukemia hereditary?

Leukemia is generally not hereditary. Most cases occur sporadically without family history. However, certain genetic conditions increase risk (Down syndrome, Li-Fraumeni syndrome, Fanconi anemia). Having a first-degree relative with leukemia slightly increases risk (2-4 fold), but absolute risk remains low.

Can leukemia be cured?

Yes, some leukemias are curable. APL (acute promyelocytic leukemia) has >90% cure rate. Childhood ALL has 85-90% cure rate. CML is controlled long-term with TKIs (near-normal lifespan). Other types (adult AML, adult ALL) have cure rates of 30-50% depending on risk factors and age. CLL is generally not curable but can be managed for many years.

Why do children with ALL do better than adults?

Children tolerate intensive chemotherapy better, have more favorable biology (hyperdiploidy), fewer adverse molecular markers, and better treatment adherence over the 2-3 year treatment period. Adults have more high-risk features (Ph+ ALL more common), medical comorbidities, and cannot tolerate the same intensive regimens.

How long does leukemia treatment last?

It varies by type. AML: 6-9 months of intensive treatment (if no transplant). ALL: 2-3 years total (induction, consolidation, maintenance). CML: Lifelong TKI therapy (though some can discontinue). CLL: Variable - some never need treatment, others have multiple lines of therapy over years.

What is a stem cell transplant and who needs one?

Stem cell transplant (bone marrow transplant) replaces diseased bone marrow with healthy stem cells from a donor (allogeneic) or from yourself after collection (autologous). It's used for high-risk or relapsed leukemia. Requires intensive chemotherapy/radiation (conditioning), then stem cell infusion. Recovery takes months. Risks include graft-versus-host disease, infection, organ damage.

Can I work during leukemia treatment?

It depends on treatment intensity. Acute leukemia treatment requires hospitalization for weeks, and work is not possible during intensive phases. CML/CLL patients on oral therapies often continue working with accommodations. Discuss with your healthcare team and employer about disability, FMLA, and workplace accommodations.

What are targeted therapies?

Targeted therapies attack specific molecular abnormalities in leukemia cells. Examples: TKIs for Ph+ leukemias (imatinib, dasatinib), FLT3 inhibitors for FLT3-mutated AML, IDH inhibitors for IDH-mutated AML, venetoclax for CLL. They're often more effective and less toxic than traditional chemotherapy.

What is MRD and why does it matter?

Minimal residual disease (MRD) is the small number of leukemia cells remaining after treatment that can't be seen under a microscope but can be detected by sensitive molecular tests. MRD-negative status indicates deeper remission and better prognosis. It guides treatment decisions (e.g., need for transplant) and predicts relapse risk.

Will my hair fall out?

Depends on treatment. Acute leukemia intensive chemotherapy: Yes, complete hair loss is common (but temporary). TKIs for CML: Minimal to no hair loss. CLL treatments (venetoclax, BTK inhibitors): Usually minimal hair loss. Hair typically regrows 3-6 months after finishing chemotherapy.

Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or qualified health provider with questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of information you have read on this website.

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