Eunice Wang, MD, Chief of the Leukemia Service at Roswell Park, talks about the difference between acute and chronic leukemia, and describes how quickly they develop and progress.
Leukemia is a cancer of the blood. It begins when the bone marrow starts to rapidly produce abnormal white blood cells called leukemia cells. They may crowd out normal white blood cells, red blood cells, and platelets, making it hard for the normal cells to do their work.
There are four main types of leukemia:
- Acute lymphocytic leukemia
- Chronic lymphocytic leukemia
- Acute myeloid leukemia
- Chronic myeloid leukemia
Chronic and acute leukemias are completely different diseases, and they progress at different speeds. The way they’re treated can be very different.
Adult Leukemia & Other Blood Disorders
Leukemia is the name given to several types of cancer that begin in the tissue that creates blood cells. To understand leukemia, it helps to know how normal blood cells form.
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Acute Leukemia: The Most Rapidly Progressing Cancer We Know Of
Acute leukemias — which are incredibly rare — are the most rapidly progressing cancer we know of. The white cells in the blood grow very quickly, over a matter of days to weeks. Sometimes a patient with acute leukemia has no symptoms or has normal blood work even a few weeks or months before the diagnosis. The change can be quite dramatic.
Extreme fatigue is usually the first symptom that causes acute leukemia patients to seek medical care. They’re tired for no apparent reason. They can’t move and they’re not able to walk, and it comes on fairly quickly. When we check their blood count, their red blood cell count might be half of what’s normal. That’s why they’re exhausted — because they’re not getting enough oxygen.
It’s also common for these patients to develop pneumonia or some sort of infection. They don’t get better after taking antibiotics, so they take more and more, but they still don’t get better. Then finally someone checks their blood count and discovers that they’re not responding because their immune system is very low because of the acute leukemia.
Effects of Too Many White Blood Cells
At the time of diagnosis, patients can have very, very high white blood cell counts. Typically a healthy person has a white blood cell count of about 4,000-11,000. Patients with acute or even chronic leukemia may come in with a white blood cell count up into the 100,000-400,000 range.
When you have that many white cells in your blood vessels, it can impair blood flow, because you have 20 to 40 times the normal number of cells in the blood vessels. And these are not normal cells — they are tumor cells, so they can stick together, and they can also stick to the blood vessels.
When patients have very high white blood cell counts, the leukemia cells will usually spill over from the blood vessels into some of the organs. If the lungs are affected, the patient can have respiratory failure. Patients can have strokes because of interrupted blood flow in the brain. They can have heart attacks or neurological changes. So when someone comes in with a very high white blood cell count, we are very concerned about these risks. In those cases, we usually try to quickly remove the abnormal cells from the blood and start chemotherapy to begin killing them off as soon as possible.
Leukemia can also cause the body to make fewer platelets, which help the blood to clot. When that happens, patients have a higher risk of bleeding, so they may wind up in the emergency room or urgent care center after developing a nose bleed that lasts for two hours. So if you have abnormal bleeding from a small injury or you wake up with enormous bruises and don’t remember having injured yourself, that could mean that something is wrong with your platelets and your clotting system.
Low platelets can also cause petechiae, little breaks in the smallest blood vessels that cause blood to leak into the skin. Petechiae cause dark-red spots to appear on the skin, looking very much like a rash.
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Chronic Leukemia May Go Undetected
Unlike acute leukemia, chronic leukemia develops slowly. It may take months or even several years before the disease begins to cause symptoms that alert the patient that something is wrong.
Because chronic leukemia is very slow-growing and may not cause symptoms, it’s common for the disease to first be detected in normal blood work when a patient goes to the doctor for a regular checkup. If a patient doesn’t see a doctor for several years, the disease can go undetected over a long period of time, and the abnormal cells can build up and cause an enlarged spleen.
Why We Don't Stage Most Leukemias
With solid tumors, at the time of diagnosis, we usually say that the cancer is stage I, II, III, or IV, based on how far away the cancer cells have spread from where they began. If you have breast cancer and the cancer is located just in your breast, that is stage I. If it has traveled far from the breast, into the brain or liver, we would consider that stage IV.
But leukemias are in the blood, so at the time of diagnosis, the leukemia cells are already in your blood and bone marrow. They are already throughout the whole body. That’s why we don’t stage most of the leukemias as we do with solid tumors. Instead, we say that either you have active disease or the disease is in remission.
The only exception to that is chronic lymphocytic leukemia, or CLL, which acts a little bit more like a lymphoma and can spread throughout the body through lymph, blood, or bone marrow and lymph nodes throughout the body. For that particular type of chronic leukemia, we do say there are stages.
We Have Time to Develop the Best Treatment Plan
We were always taught that acute leukemia is an emergency and that we need to start therapy right away. That is still true for some patients. The urgency is to manage any life-threatening complications, such as those mentioned earlier — for example, stroke or respiratory failure.
However, over the last few years, several drugs have been approved for acute leukemias that focus on destroying cells that have specific mutations. We know there are patients who won’t benefit from chemotherapy but who might benefit from these types of targeted approaches. So now the recommendation is that if a patient with acute leukemia does not have a life-threatening complication, you may be able to wait a few days to get additional information about the disease that can help identify the best treatments.
At Roswell Park we still keep an eye on those patients, either in the inpatient center or with very close monitoring while they are at home. We still want to start treatment as soon as possible, but with most patients, we don’t need to do that within an hour or two after they come to us. We have time to complete testing that will help us design the best therapy.
Chronic leukemias can be controlled or treated in much the same way as other chronic disorders, such as high blood pressure. Patients may just be monitored with blood work and physical exams over a period of months to years before they need treatment.
FAQs
How quickly does all leukemia develop? ›
Acute lymphoblastic leukaemia (ALL) is a type of blood cancer. It starts from white blood cells called lymphocytes in the bone marrow. The bone marrow is the soft inner part of the bones, where new blood cells are made. ALL usually develops quickly over days or weeks.
Can leukemia develop in 3 months? ›Chronic Leukemia May Go Undetected
Unlike acute leukemia, chronic leukemia develops slowly. It may take months or even several years before the disease begins to cause symptoms that alert the patient that something is wrong.
Acute leukemia symptoms can often appear suddenly
With acute leukemia, symptoms tend to develop very quickly. You may suddenly spike a fever that won't go away, develop an infection for no apparent reason, or start bleeding spontaneously from your nose or gums and not be able to stop it.
CLL is a slow-progressing form of cancer. It can take several years for symptoms to manifest. Doctors and researchers in the United States typically follow the Rai staging system, which classifies CLL into five stages , ranging from 0 to 4.
How long can leukemia last without knowing? ›Chronic leukemia involves more-mature blood cells. These blood cells replicate or accumulate more slowly and can function normally for a period of time. Some forms of chronic leukemia initially produce no early symptoms and can go unnoticed or undiagnosed for years.
Does leukemia develop slowly? ›The cancer (leukemia) cells start in the bone marrow but then go into the blood. In CLL, the leukemia cells often build up slowly. Many people don't have any symptoms for at least a few years. But over time, the cells grow and spread to other parts of the body, including the lymph nodes, liver, and spleen.
What causes sudden leukemia? ›Acute lymphocytic leukemia occurs when a bone marrow cell develops changes (mutations) in its genetic material or DNA. A cell's DNA contains the instructions that tell a cell what to do. Normally, the DNA tells the cell to grow at a set rate and to die at a set time.
What triggers ALL leukemia? ›Cancers (including ALL) can be caused by mutations (changes) that turn on oncogenes or turn off tumor suppressor genes. These types of changes can stop bone marrow cells from maturing the way they normally would, or help the cells grow out of control.
What are the first signs of having leukemia? ›- Fatigue.
- Loss of appetite.
- Bone/joint pain.
- Headaches.
- Fever, chills.
- Unexplained weight loss.
- Night sweats.
- Abdominal discomfort.
Clinical and epidemiological studies have shown that stress-related biobehavioral factors are associated with accelerated progression of several types of cancer, including solid epithelial tumors and hematopoietic tumors such as leukemia (Antoni et al., 2006; Chida et al., 2008).
Can Stress give you leukemia? ›
No, being stressed doesn't directly increase the risk of cancer. The best quality studies have followed up many people for several years. They have found no evidence that those who are more stressed are more likely to get cancer.
How many months can you live with leukemia? ›Today, the average five-year survival rate for all types of leukemia is 65.8%. That means about 69 of every 100 people with leukemia are likely to live at least five years after diagnosis. Many people will live much longer than five years. The survival rates are lowest for acute myeloid leukemia (AML).
Can leukemia be cured if caught early? ›If caught early, leukemia can be cured by undergoing several cancer treatments.
Do you feel ill with leukemia? ›People often feel ill quite quickly. Most symptoms of acute leukaemia are caused by leukaemia cells filling the bone marrow. This means healthy blood cells do not move into the blood as normal.
Can you have leukemia for 5 years and not know? ›In CLL, the leukemia cells grow out of control and crowd out normal blood cells. These cells often build up slowly over time. Many people don't have any symptoms for at least a few years. In time, the cells can spread to other parts of the body, including the lymph nodes, liver, and spleen.
What diseases can be mistaken for leukemia? ›- Influenza.
- Fever.
- Pathological fracture.
- Bleeding disorders.
- Immune thrombocytopenic purpura.
- Trypanosomiasis.
- Autoimmune lymphoproliferative syndrome.
Leukemia can produce a variety of symptoms, although most are not often apparent in the earliest stages of the malignancy. The most common symptoms of leukemia—fatigue, pale skin, weight loss and night sweats—are often attributed to other less serious conditions, such as the flu.
Is leukemia slow or fast? ›The different types can grow quickly or slowly: Acute leukemia is fast growing. It usually gets worse quickly if it's not treated. Chronic leukemia is slow growing.
What is the slowest form of leukemia? ›Chronic lymphocytic leukemia (CLL) is a type of cancer of the blood and bone marrow — the spongy tissue inside bones where blood cells are made. The term "chronic" in chronic lymphocytic leukemia comes from the fact that this leukemia typically progresses more slowly than other types of leukemia.
Who is at most risk for leukemia? ›Age – Generally speaking, individuals over the age of 65 are more at risk for leukemia. Demographics – While anyone can conceivably develop leukemia, white males are statistically most susceptible. Radiation exposure – Exposure to radiation from an atomic bomb increases the likelihood that leukemia cells will form.
Where does leukemia usually begin? ›
Leukemia starts in the soft, inner part of the bones (bone marrow), but often moves quickly into the blood. It can then spread to other parts of the body, such as the lymph nodes, spleen, liver, central nervous system and other organs.
Can you avoid getting leukemia? ›There is no known way to prevent leukemia, but avoiding tobacco and exposure to pesticides and industrial chemicals might help.
What are the 3 crucial leukemia symptoms? ›Common signs and symptoms of leukemia include: Fatigue, tiring easily. Fever or night sweats. Frequent infections.
How easy is it to detect leukemia? ›By looking at a sample of your blood, your doctor can determine if you have abnormal levels of red or white blood cells or platelets — which may suggest leukemia. A blood test may also show the presence of leukemia cells, though not all types of leukemia cause the leukemia cells to circulate in the blood.
What do early stages of leukemia look like? ›Some symptoms, like night sweats, fever, fatigue and achiness, resemble flu-like symptoms. Unlike symptoms of the flu, which generally subside as you get better, leukemia symptoms generally last longer than two weeks, and may include sudden weight loss, bone and joint pain and easy bleeding or bruising.
Is anxiety a symptom of leukemia? ›Leukemia causes symptoms when abnormal white blood cells begin to crowd out healthy blood cells and spread. Along with physical symptoms — such as pain, fatigue, and shortness of breath — people living with leukemia can also experience psychological symptoms like depression or anxiety.
How does leukemia affect you emotionally? ›This may include dealing with difficult emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people do not know what to say in response.
Can you get leukemia in your 30s? ›Leukemia can develop at any age, but certain types of leukemia are more common in different stages of life. Some are more common in children or in adults.
Does stress cause GREY hair? ›A new study shows that stress really can give you gray hair. Researchers found that the body's fight-or-flight response plays a key role in turning hair gray. Your hair color is determined by pigment-producing cells called melanocytes.
What age is leukemia most common? ›Age: The risk of most leukemias increase with age. The median age of a patient diagnosed with acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL) or chronic myeloid leukemia (CML) is 65 years and older. However, most cases of acute lymphocytic leukemia (ALL) occur in people under 20 years old.
What are the odds of beating leukemia? ›
This number represents the percentage of people who are still alive 5 years after a diagnosis. The 5-year relative survival rate for all types of leukemia is 65 percent, according to the National Cancer Institute (NCI) .
Is leukemia always terminal? ›There are different types of leukemia which can be grouped into acute leukemias and chronic leukemias, and it's a complete myth that leukemia is incurable. Thanks to advancements in treatment such as better chemotherapy and transplant regimens, many patients can be cured of their disease.
What is the most curable leukemia? ›Treatment for patients with acute promyelocytic leukemia (APL) differs from treatment for patients with other AML subtypes. Because of advances in diagnosis and treatment of this disease, APL is now considered the most curable form of adult leukemia.
Can you feel fine and have leukemia? ›Chronic leukemia often causes only a few symptoms or none at all. Signs and symptoms usually develop gradually. People with a chronic leukemia often complain that they just do not feel well.
What hurts if you have leukemia? ›Leukemia or myelodysplastic syndromes (MDS) can cause bone or joint pain, usually because your bone marrow has become overcrowded with cancer cells. At times, these cells may form a mass near the spinal cord's nerves or in the joints.
Does leukemia hurt all over? ›Bone or joint pain is a common form of pain in leukemia — members have discussed feeling pain in their back, neck, legs, and other joints. As one member wrote, “I have had pain in my shoulders, both arms, and thigh bones.”
What is the fastest growing leukemia? ›AML is fast growing. The leukemia cells enter the blood quickly and sometimes can spread to the liver, spleen, central nervous system (brain and spinal cord), and testicles. There are many different types of AML. In some, the AML cells have gene changes that can affect how well treatment works.
What is the incubation period of leukemia? ›| Exposure | Clinical Effect | Incubation/Latency Period |
|---|---|---|
| Human immunodeficiency virus | AIDS | <1 to 15+ years |
| Atomic bomb radiation (Japan) | Leukemia | 2–12 years |
| Radiation (Japan, Chernobyl) | Thyroid cancer | 3–20+ years |
| Radium (watch dial painters) | Bone cancer | 8–40 years |
The 5-year relative survival rate for all types of leukemia is 65 percent, according to the National Cancer Institute (NCI) .
What were your first signs of leukemia? ›- Shortness of breath.
- Fatigue.
- Unexplained fever.
- Night sweats.
- Unexplained weight loss.
- Loss of appetite.
- Bone pain.
- Bruising.
Can leukemia come from stress? ›
Clinical and epidemiological studies have shown that stress-related biobehavioral factors are associated with accelerated progression of several types of cancer, including solid epithelial tumors and hematopoietic tumors such as leukemia (Antoni et al., 2006; Chida et al., 2008).
Can stress causes leukemia? ›No, being stressed doesn't directly increase the risk of cancer. The best quality studies have followed up many people for several years. They have found no evidence that those who are more stressed are more likely to get cancer.
Who is most at risk for leukemia? ›Age – Generally speaking, individuals over the age of 65 are more at risk for leukemia. Demographics – While anyone can conceivably develop leukemia, white males are statistically most susceptible. Radiation exposure – Exposure to radiation from an atomic bomb increases the likelihood that leukemia cells will form.
Why does leukemia occur early in life? ›The combination of genetics and exposure might increase their risk for leukemia. Some research suggests that some childhood leukemias might be caused by a combination of certain gene changes that happen very early in life, along with being exposed to certain viruses later than normal.