Leukemia

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Overview
Classification AML CML ALL CLL
Differentiating Leukemia from other Diseases
Epidemiology and Demographics
Prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Leukaemia

Overview

Leukemia (Greek leukos, “white”; haima, “blood”) is a cancer of the blood or bone marrow and is characterized by an abnormal proliferation (production by multiplication) of blood cells, usually white blood cells (leukocytes). It is part of the broad group of diseases called hematological neoplasms.

Classification

Leukemia can be classified as follows:

Differentiating Leukemia from other Diseases

Leukemia must be differentiated from various diseases that cause weight loss, night sweats, hepatosplenomegaly, and palpable lymph nodes, such as hairy cell leukaemia, prolymphocytic leukaemia, follicular lymphoma, and mantle cell lymphoma. Based on the expression of cell surface markers, the table below differentiates different types of leukemia from other diseases that cause similar clinical presentations:

Differential Diagnosis	Surface Immunoglobulin	CD5	CD22/FMC7	CD23	CD79b	CD103
Chronic lymphocytic leukemia	Weakly positive	Positive	Negative	Positive	Negative	Positive/Negative
Prolymphocytic leukemia	Strongly positive	Negative	Positive	Negative	Positive	Negative
Hairy cell leukemia	Strongly positive	Negative	Positive	Negative	Positive/Negative	Positive
Mantle cell lymphoma	Positive	Positive	Strongly positive	Negative	Strongly positive	Negative
Follicular lymphoma	Strongly positive	Negative	Positive	Negative	Strongly positive	Negative

Disease	Differential Diagnosis
AML	Acute lymphoblastic leukemia Chronic myelogenous leukemia Agranulocytosis Aplastic anemia Lymphoma Myelodysplastic syndrome Myeloproliferative disorders
ALL	Acute myelogenous leukemia Hairy cell leukemia Malignant lymphoma
CML	Leukemoid reaction Chronic neutrophilic leukemia Acute myeloid leukemia Thrombocytosis
CLL	Splenic marginal zone lymphoma Nodal marginal zone lymphoma Lymphoplasmacytic lymphoma Sézary syndrome Smoldering adult T cell leukemia
HCL	Mantle cell and follicular lymphoma CLL Prolymphocytic leukemia On basis of fever, splenomegaly, and fatigue Aplastic anemia Myelodysplastic syndrome Splenic marginal zone lymphoma B-cell prolymphocytic leukemia Idiopathic myelofibrosis

Epidemiology and Demographics

Prevalence

• In the United States, the age-adjusted prevalence of leukemia is 75.3 per 100,000 in 2011.

Incidence

• The delay-adjusted incidence of leukemia in 2011 was estimated to be 15.48 per 100,000 persons in the United States.

• In 2011, the age-adjusted incidence of leukemia was 13.66 per 100,000 persons in the United States.

Age

• The overall age-adjusted incidence of leukemia in the United States between 2007 and 2011 is 13 per 100,000, the age-adjusted incidence of leukemia by age category is:
  • Under 65 years: 6.5 per 100,000
  • 65 and over: 57.9 per 100,000

• Shown below is a table depicting the overall age-adjusted incidence of leukemia per 100,000 individuals by age in the United States between 2007 and 2011 for the different types of leukemia.

	Acute lymphoblastic leukemia	Chronic lymphocytic leukemia	Acute myeloid leukemia	Chronic myeloid leukemia
All ages	1.7	4.4	3.8	1.7
<65	1.7	1.4	1.8	0.9
≥65	1.6	25.2	17.5	6.8

Gender

• In the United States, the age-adjusted prevalence of leukemia by gender in 2011 is:
  • In males: 92.7 per 100,000
  • In females: 60.7 per 100,000
• In the United States, the delay-adjusted incidence of leukemia by gender in 2011 is:
  • In males: 19.93 per 100,000 persons
  • In females: 11.89 per 100,000 persons

• In the United States, the age-adjusted incidence of leukemia by gender on 2011 is:
  • In males: 17.58 per 100,000 persons
  • In females: 10.49 per 100,000 persons

• Shown below is an image depicting the delay-adjusted incidence and observed incidence of leukemia by gender and race in the United States between 1975 and 2011. These graphs are adapted from SEER: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.

Race

• Shown below is a table depicting the age-adjusted prevalence of leukemia by race in 2011 in the United States.

	All Races	White	Black	Asian/Pacific Islander	Hispanic
Age-adjusted prevalence	75.3 per 100,000	83.5 per 100,000	45.9 per 100,000	41.2 per 100,000	57.1 per 100,000

• Shown below is an image depicting the incidence of leukemia by race in the United States between 1975 and 2011.

API: Asian/Pacific Islander; AI/AN: American Indian/ Alaska Native

Prognosis

5-Year Survival

• Between 2004 and 2010, the 5-year relative survival of patients with leukemia was 60.3%.

• When stratified by age, the 5-year relative survival of patients with leukemia was 68.5% and 44.1% for patients <65 and ≥ 65 years of age respectively.

• Shown below is a table depicting the 5-year relative survival of patients by the type of leukemia in the United States between 2004 and 2010.

	Acute lymphoblastic leukemia	Chronic lymphocytic leukemia	Acute myeloid leukemia	Chronic myeloid leukemia
5-year survival	70%	83.5%	25.4%	59.9%

References

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