2 Leukemia
Understand how leukemia is classified, diagnosed, and treated, and how to recognize important complications requiring urgent response.
Classification by lineage and disease tempo
is classified along two dimensions: the cell lineage affected—myeloid or lymphoid—and the usual pace of disease progression—acute or chronic. Acute leukemias involve immature cells and can progress rapidly; chronic leukemias generally involve more mature cells and may develop more slowly.
The main adult types are acute myeloid (), acute lymphoblastic (), chronic myeloid (), and chronic lymphocytic (). and are myeloid-lineage leukemias; and are lymphoid-lineage leukemias.
Effects on normal blood-cell production
Leukemic cells can crowd out normal bone-marrow production. Reduced red blood cells can cause anemia-related fatigue and pallor, while reduced functional neutrophils increase infection risk. Low platelet levels can lead to bruising and bleeding, including petechiae and gum bleeding.
A very high white blood cell count does not necessarily mean that a patient has enough functional infection-fighting cells. Findings such as anemia, thrombocytopenia, and numerous immature myeloid cells may support concern for acute myeloid , but symptoms alone do not confirm the classification.
Diagnostic evaluation
Evaluation commonly includes a complete blood count (CBC) with differential, bone-marrow aspirate and biopsy, and examination of cells by morphology and . Cytogenetic and molecular studies help define the subtype and guide treatment.
Detection of BCR::ABL1 supports and can also be relevant in some cases of . Laboratory and genetic testing are needed to confirm classification rather than relying on symptoms alone.
Treatment approaches by subtype
Treatment depends on the subtype and patient-specific findings. For newly diagnosed chronic-phase with BCR::ABL1, a BCR::ABL1-targeting tyrosine kinase inhibitor is a standard treatment approach.
For asymptomatic without signs of progression, active surveillance, also called watchful waiting, is commonly used. Treatment is considered if the disease becomes symptomatic or progressive.
Newly diagnosed is commonly treated with -trans retinoic acid (ATRA) with arsenic trioxide and/or chemotherapy, depending on risk and clinical circumstances.
Fever during
In a patient receiving treatment who has and a temperature of (), treat the situation as a potential urgent infection. Notify the oncology team immediately and follow the facility’s febrile- protocol for prompt assessment, cultures, and empiric antimicrobial treatment.
Do not wait for other symptoms to develop: infection during cancer treatment can become life-threatening. Follow the patient’s specific fever instructions because thresholds and protocols may vary.
Bleeding complications in
-associated coagulopathy, including , can cause severe hemorrhage. Gum bleeding and widespread bruising together with low fibrinogen and prolonged clotting times are concerning findings that require immediate hematology/oncology attention and supportive management.
Under the treating team’s direction, ATRA is initiated as soon as is suspected. Prompt recognition and treatment are critical.
can occur after treatment for . Its laboratory pattern can include increased uric acid, potassium, and phosphate; decreased calcium; and kidney injury. Nausea, muscle cramps, and reduced urine output are clinical findings that warrant prompt attention.
Notify the oncology team promptly. Monitor laboratory results, renal function, cardiac status, and urine output, and carry out ordered prevention or treatment, such as hydration and uric-acid-lowering therapy.