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Leukemia is a type of cancer that starts in the soft, inner
part of the bones called the bone marrow. It often moves quickly into
the blood where it can spread to other parts of the body such as the
lymph nodes, spleen, liver, central nervous system (brain and spinal
cord), and other organs. In contrast, other types of cancer can start
in these organs and then spread to the bone marrow (or elsewhere).
Those cancers are not
leukemia. Both children and adults can get leukemia.
The term "acute" means that the cancer grows quickly, and if
not treated, could be fatal in a few months. "Lymphocytic" means that
the cancer starts from cells called lymphocytes. Acute lymphocytic
leukemia (ALL) is a type of cancer that starts from these white blood
cells in the bone marrow. ALL is sometimes called acute lymphoblastic
leukemia.
Other types of cancer that start in lymphocytes are known as
lymphomas (non-Hodgkin lymphoma and Hodgkin disease). The main
difference between these types of cancers is that ALL starts in the
bone marrow and may spread to other places, while lymphomas start in
lymph nodes or other organs and then may spread to the bone marrow. For
more information on lymphomas, see our documents, Non-Hodgkin Lymphoma
and Hodgkin Disease.
Normal bone marrow, blood, and lymphoid
tissue
In order to understand the different types of leukemia, it
helps to know something about the blood and lymph systems.
Bone marrow
Bone marrow is the soft, spongy, inner part of bones. All of
the different types of blood cells are made in the bone marrow. Bone
marrow is made up of a small number of blood stem cells, blood-forming
cells, fat cells, and tissues that help the blood cells grow.
Blood stem cells go through a series of changes to make new
blood cells. They are different from embryonic stem cells which are
formed from a developing fetus and can grow to become other kinds of
cells in the body. The blood-forming cells can develop into 1 of the 3
main types of blood cell:
- red blood cells
- white blood cells
- platelets
Red blood cells
Red blood cells carry oxygen from the lungs to all other
tissues of the body. They also carry away carbon dioxide, a waste
product of cell activity. A shortage of red blood cells causes
weakness, shortness of breath, and tiredness.
Platelets
Platelets help stop bleeding by plugging up holes in blood
vessels caused by cuts or bruises. A shortage of platelets can cause a
person to bleed or bruise easily.
White blood cells
White blood cells help the body fight infections. There are
quite a few types of white blood cells. Each has a special role to play
in protecting the body against infection. The 3 main types of white
blood cells are granulocytes, monocytes, and lymphocytes.
Lymphocytes:
These are the main cells that make up lymphoid tissue (or lymphatic
tissue), a major part of the immune system. Lymphocytes are a
kind of white blood cell. The 2 main types of lymphocytes are called B-cells and T-cells. Normal
T-cells and B-cells do different jobs within the immune system.
Any of the blood-forming cells can turn into a leukemia cell.
Once that happens, the cell can grow and divide to form many new cancer
cells. These cells can take over the bone marrow, spill out into the
bloodstream, and spread to other organs. Acute lymphocytic leukemia
starts from early forms of the lymphocytes.
Types of leukemia
Not all leukemias are the same. Leukemia is a complex disease
with many different types and sub-types. The kind of treatment given
and the outlook for the person with leukemia vary greatly according to
the exact type of leukemia and other factors.
Leukemias are divided into 4 main types. Knowing the exact
type of leukemia can help doctors better predict each patient's outlook
(prognosis) and select the best treatment.
The major types of leukemia are based on these factors:
- acute or chronic
- lymphocytic or myeloid
Acute leukemia versus chronic leukemia
The first factor to take into account is whether most of the
abnormal cells look like normal mature white blood cells or whether
they look more like stem cells (they have not matured).
Acute leukemia:
In acute leukemia, the bone marrow cells don't mature the way they
should. These immature cells build up and crowd out normal cells.
Without treatment, most patients with acute leukemia would live only a
few months. Some types of acute leukemia respond well to treatment and
many patients are cured. People with other types often do not do as
well.
Chronic leukemia:
In chronic leukemia the cells may look fairly normal, but they are not.
They don't fight infection they way they should. They also live too
long, so that they build up and crowd out normal bone marrow cells.
Chronic leukemias tend to progress over a longer time, and most
patients can live for many years. But chronic leukemias are often
harder to cure than acute leukemias.
Myeloid leukemia versus lymphocytic
leukemia
The second factor to take into account is the type of bone
marrow cells that are involved.
Myeloid leukemia:
Myeloid leukemia mainly develops from white blood cells that are not
lymphocytes, such as granulocytes or monocytes. But it can also start
in the cells that mature into platelets or red blood cells.
Lymphocytic
leukemia: Lymphocytic leukemias develop from lymphocytes
(a type of white blood cell) in the bone marrow.
Most cases of leukemia can be sorted into 1 of the 4 main
types shown in the table below.
| Acute lymphocytic leukemia (ALL) |
Acute myeloid leukemia (AML) |
| Chronic lymphocytic leukemia (CLL) |
Chronic myeloid leukemia (CML) |
Although ALL is the most common of the 4 major types of
leukemia among children, it is the least common type among adults.
The rest of this
document contains information on ALL of adults only.
Chronic leukemias of adults and acute myelocytic leukemia (AML) of
adults are discussed in other American Cancer Society documents. For
information about ALL in children, please see the separate document, Childhood Leukemia.
Last Medical Review: 08/07/2009 Last Revised: 08/07/2009
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