Leukemia: Difference between revisions

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

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Revision as of 02:14, 27 November 2017

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For patient information click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2] Usama Talib, BSc, MD [3]

Synonyms and keywords: Leukaemia

Overview

Leukemia (Greek leukos, “white”; haima, “blood”) could be defined as a group of hematopoietic stem cell malignancies that genetic abnormalities may lead to clonal proliferation of these cells. These group of diseases are classified based on type of hematopoietic stem cell involvement and duration of disease. The leukemias are the most common malignancies among children younger than 15 years. Among them, ALL is the most common leukemia accounts for 77% of childhood leukemia. However, CLL is the most common form of leukemia in adults, it accounts for 30% of all leukemias in the United states. The increased rate of proliferation and decreased rate of apoptosis in this progeny of cells may compromise normal bone marrow function and ultimately marrow failure. Clinical manifestations, diagnosis, laboratory findings, and therapy are different according to the type of malignancy.

Classification

Leukemia may be classified as follows:

Leukemia

Lymphoid progeny

Myeloid progeny

Acute lymphoblastic leukemia (ALL)

Chronic lymphocytic leukemia (CLL)

Acute Myeloid Leukemia (AML)

Chronic myeloid leukemia (CML)

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:^[1]

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

Epidemiology and Demographics

Prevalence

In the United States, the age-adjusted prevalence of leukemia is 75.3 per 100,000 in 2011.^[2]

Incidence

The delay-adjusted incidence of leukemia in 2011 was estimated to be 15.48 per 100,000 persons in the United States.^[2]

In 2011, the age-adjusted incidence of leukemia was 13.66 per 100,000 persons in the United States.^[2]

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:^[2]
- 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.^[2]

	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:^[2]
- 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:^[2]
- 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:^[2]
- 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.^[2]

Race

Shown below is a table depicting the age-adjusted prevalence of leukemia by race in 2011 in the United States.^[2]

	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.^[2]

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%.^[2]

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.^[2]

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

↑ Hoffbrand V, Moss P. Essential Haematology. John Wiley & Sons; 2011
↑ ^2.00 ^2.01 ^2.02 ^2.03 ^2.04 ^2.05 ^2.06 ^2.07 ^2.08 ^2.09 ^2.10 ^2.11 ^2.12 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.

Template:Blood

Template:WikiDoc Sources

[H-1] Hoffbrand V, Moss P. Essential Haematology. John Wiley & Sons; 2011

[SEER-2] 2.00 ^2.01 ^2.02 ^2.03 ^2.04 ^2.05 ^2.06 ^2.07 ^2.08 ^2.09 ^2.10 ^2.11 ^2.12 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.

[1]

[2]

v t e Myeloid Hematological malignancy/leukemia histology (ICD-O 9590-9989, C81-C96, 200-208)
CFU-GM/ and other granulocytes	Template:Navbox subgroup
MEP	Template:Navbox subgroup
CFU-Mast	Mastocytoma (Mast cell leukemia, Mast cell sarcoma, Systemic mastocytosis)
Multiple/unknown	AML (Acute panmyelosis with myelofibrosis, Myeloid sarcoma) · MP (Myelofibrosis) · Acute biphenotypic leukaemia
See also hematology, lymphoid malignancy

@@ Line 1: / Line 1: @@
-'''For patient information click [[Leukemia (patient information)|here]]'''
 __NOTOC__
 {{DiseaseDisorder infobox |
    Name           = Leukemia |
-  ICD10          = {{ICD10|C|91||c|81}}-{{ICD10|C|95||c|81}} |
-  ICD9           = {{ICD9|208.9}} |
-  ICDO           = 9800-9940 |
    Image          = acute_leukemia-ALL.jpg |
    Caption        = A Wright's stained bone marrow aspirate smear of patient with precursor B-cell acute lymphoblastic leukemia.|
-   OMIM           = |
+   }}
-  MedlinePlus    = |
+{{Leukemia}}
-  eMedicineSubj  = |
-  eMedicineTopic = |
+'''For patient information click [[Leukemia (patient information)|here]]'''
-  DiseasesDB     = 7431 |
-  MeshID         = D007938 |
-}}
+{{CMG}}; {{AE}} {{SMP}} {{USAMA}}
+{{SK}} Leukaemia
+==Overview==
+'''Leukemia''' (Greek leukos, “white”; haima, “blood”) could be defined as a group of [[hematopoietic stem cell]] [[malignancies]] that [[genetic]] abnormalities may lead to clonal proliferation of these cells. These group of diseases are classified based on type of [[hematopoietic stem cell]] involvement and duration of disease. The leukemias are the most common malignancies among children younger than 15 years. Among them, [[ALL]] is the most common leukemia accounts for 77% of childhood leukemia. However, [[CLL]] is the most common form of leukemia in adults, it accounts for 30% of all leukemias in the United states. The increased rate of proliferation and decreased rate of [[apoptosis]] in this progeny of cells may compromise normal [[bone marrow]] function and ultimately marrow failure. Clinical manifestations, diagnosis, laboratory findings, and therapy are different according to the type of malignancy.
+==Classification==
+Leukemia may be classified as follows:
+<br><br>
+{{Family tree/start}}
+{{Family tree | | | | | | | | | B01 | | | |B01= Leukemia}}
+{{Family tree | | | | |,|-|-|-|-|^|-|-|-|-|.| | }}
+{{Family tree | | | | C01 | | | | | | | | C02 |C01= Lymphoid progeny| C02= Myeloid progeny}}
+{{Family tree | |,|-|-|^|-|-|.| | | |,|-|-|^|-|-|.| | }}
+{{Family tree | D01 | | | | D02 | | D03 | | | | D04 | D01= [[Acute lymphoblastic leukemia]] (ALL) | D02= [[Chronic lymphocytic leukemia]] (CLL) | D03= [[Acute Myeloid Leukemia]] (AML) | D04= [[Chronic myeloid leukemia]] (CML)}}
+{{Family tree/end}}
+<br><br><br>
+==Differentiating Leukemia from other Diseases==
+Leukemia must be differentiated from various diseases that cause [[weight loss]],  [[night sweats]], [[hepatosplenomegaly]], and palpable [[lymph node]]s, 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:<ref name="H">Hoffbrand V, Moss P. Essential Haematology. John Wiley & Sons; 2011</ref>
-{{CMG}}
-{{Leukemia}}
-{{Editor Join}}
-==[[Leukemia overview|Overview]]==
-==Symptoms==
+<br>
-Damage to the [[bone marrow]], by way of displacing the normal bone marrow cells with higher numbers of immature white blood cells, results in a lack of blood [[platelet]]s, which are important in the [[Coagulation of human blood|blood clotting]] process. This means people with leukemia may become [[purpura|bruised]], [[hemorrhage|bleed]] excessively, or develop pinprick bleeds ([[petechia]]e).
-[[White blood cell]]s, which are involved in fighting [[pathogen]]s, may be suppressed or dysfunctional. This could cause the patient's immune system (white blood cells etc.) to start attacking other body cells.
+{| class="wikitable"
+!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]]
-Finally, the red blood cell deficiency leads to [[anemia]], which may cause [[dyspnea]]. All symptoms can be attributed to other diseases; for [[diagnosis]], [[blood test]]s and a [[bone marrow examination]] are required.
+* [[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]]
+|}
-Some other related symptoms:
+==Epidemiology and Demographics==
-{{div col}}
+===Prevalence===
-* [[Fever]], [[chills]], [[night sweat]]s and other [[flu]]-like symptoms
-* [[Weakness]] and [[fatigue]]
-* Swollen or bleeding gums
-* Neurological symptoms ([[headache]]s)
-* [[hepatomegaly|Enlarged liver]] and [[splenomegaly|spleen]]
-* Frequent [[infection]]
-* Bone pain
-* [[Joint pain]]
-* [[Dizziness]]
-* [[Nausea]]
-* Swollen [[tonsils]]
-* [[Diarrhea]]
-* [[Paleness]]
-* [[Malaise]]
-* Unintentional [[Weight_loss#Unintentional_weight_loss | weight loss]]
-{{div col end}}
-The word leukemia, which means 'white blood,' is derived from the disease's namesake high white blood cell counts that most leukemia patients have before treatment.  The high number of white blood cells are apparent when a blood sample is viewed under a microscope.  Frequently, these extra white blood cells are immature or dysfunctional.  The excessive number of cells can also interfere with the normal function of other cells.
+* In the United States, the age-adjusted [[prevalence]] of leukemia is 75.3 per 100,000 in 2011.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
-Some leukemia patients do not have high white blood cell counts visible during a regular blood count.  This less-common condition is called '''aleukemia'''.  The bone marrow still contains cancerous white blood cells which disrupt the normal production of blood cells.  However, the leukemic cells are staying in the marrow instead of entering the bloodstream, where they would be visible in a blood test. For an aleukemic patient, the white blood cell counts in the bloodstream can be normal or low.  Aleukemia can occur in any of the four major types of leukemia, and is particularly common in [[hairy cell leukemia]].
+===Incidence===
-==Classification==
+* The delay-adjusted [[incidence]] of leukemia in 2011 was estimated to be 15.48 per 100,000 persons in the United States.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
-Leukemia is clinically and pathologically subdivided into several large groups.  The first division is between its ''[[Acute (medical)|acute]]'' and ''[[chronic (medicine)|chronic]]'' forms:
-* ''[[Acute leukemia]]'' is characterized by the rapid increase of immature blood cells. This crowding makes the bone marrow unable to produce healthy blood cells. Acute forms of leukemia can occur in children and young adults. (In fact, it is a more common cause of death for children in the [[United States|US]] than any other type of malignant disease). Immediate treatment is required in acute leukemias due to the rapid progression and accumulation of the malignant cells, which then spill over into the bloodstream and spread to other organs of the body. Central nervous system (CNS) involvement is uncommon, although the disease can occasionally cause cranial nerve palsies.
+* In 2011, the age-adjusted [[incidence]] of leukemia was 13.66 per 100,000 persons in the United States.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
-* ''[[Chronic leukemia]]'' is distinguished by the excessive build up of relatively mature, but still abnormal, blood cells. Typically taking months or years to progress, the cells are produced at a much higher rate than normal cells, resulting in many abnormal white blood cells in the blood. Chronic leukemia mostly occurs in older people, but can theoretically occur in any age group. Whereas acute leukemia must be treated immediately, chronic forms are sometimes monitored for some time before treatment to ensure maximum effectiveness of therapy.
-Additionally, the diseases are subdivided according to which kind of blood cell is affected.  This split divides leukemias into lymphoblastic or ''[[lymphocytic leukemia]]s'' and myeloid or ''[[myelogenous leukemia]]s'':
+===Age===
-* In lymphoblastic or ''[[lymphocytic leukemia]]s'', the cancerous change takes place in a type of marrow cell that normally goes on to form [[lymphocyte]]s.
+* 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:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
-* In myeloid or ''[[myelogenous leukemia]]s'', the cancerous change takes place in a [[myeloid cells|type of marrow cell]] that normally goes on to form red cells, some types of white cells, and [[platelets]].
+** Under 65 years: 6.5 per 100,000
+** 65 and over: 57.9 per 100,000
-Combining these two classifications provides a total of four main categories:
+* 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.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
-{| class="wikitable"
+{| style="cellpadding=0; cellspacing= 0; width: 600px;"
-|+Four major kinds of leukemia
+|-
-! Cell type !! Acute !! Chronic
+| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" | || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Acute lymphoblastic leukemia'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" | '''Chronic lymphocytic leukemia'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Acute myeloid leukemia'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Chronic myeloid leukemia'''
- |-
+|-
- | '''Lymphocytic leukemia''' <br />(or "lymphoblastic") || [[Acute lymphoblastic leukemia]] (ALL) || [[Chronic lymphocytic leukemia]] (CLL)
+| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''All ages'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | 1.7 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |4.4|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |3.8 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |1.7
- |-
+|-
- | '''Myelogenous leukemia''' <br />(also "myeloid" or "nonlymphocytic") || [[Acute myeloid leukemia|Acute myelogenous leukemia]] (AML) || [[Chronic myelogenous leukemia]] (CML)
+| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''<65''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |1.7 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |1.4|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | 1.8 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |0.9
+|-
+| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''≥65''' || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | 1.6 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |25.2 || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |17.5|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |6.8
 |}
-Within these main categories, there are typically several subcategories. Finally, [[hairy cell leukemia]] is usually considered to be outside of this classification scheme.
+===Gender===
-* ''Acute lymphoblastic leukemia'' (ALL) is the most common type of leukemia in young children. This disease also affects adults, especially those age 65 and older.  Standard treatments involve chemotherapy and radiation.  The survival rates vary by age:  85% in children and 50% in adults.<ref>[http://www.accessmedicine.com/content.aspx?aID=65842 Harrison's Principles of Internal Medicine, 16th Edition,] Chapter 97. Malignancies of Lymphoid Cells. Clinical Features, Treatment, and Prognosis of Specific Lymphoid Malignancies.</ref>
+* In the United States, the age-adjusted [[prevalence]] of leukemia by gender in 2011 is:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
+** 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:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
+** In males: 19.93 per 100,000 persons
+** In females: 11.89 per 100,000 persons
-* ''Chronic lymphocytic leukemia'' (CLL) most often affects adults over the age of 55. It sometimes occurs in younger adults, but it almost never affects children. Two-thirds of affected people are men. The five-year survival rate is 75%.<ref>[http://seer.cancer.gov/statfacts/html/clyl.html Finding Cancer Statistics » Cancer Stat Fact Sheets »Chronic Lymphocytic Leukemia] National Cancer Institute</ref> It is incurable, but there are many effective treatments.
+* In the United States, the age-adjusted [[incidence]] of leukemia by gender on 2011 is:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
+** In males: 17.58 per 100,000 persons
+** In females: 10.49 per 100,000 persons
-* ''Acute myelogenous leukemia'' (AML) occurs more commonly in adults than in children, and more commonly in men than women.  AML is treated with chemotherapy.  The five-year survival rate is 40%.<ref>{{cite journal |author=Colvin GA, Elfenbein GJ |title=The latest treatment advances for acute myelogenous leukemia |journal=Med Health R I |volume=86 |issue=8 |pages=243–6 |year=2003 |pmid=14582219 |doi=}}</ref>
+* 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.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
-* ''Chronic myelogenous leukemia'' (CML) occurs mainly in adults.  A very small number of children also develop this disease.  Treatment is with [[imatinib]] (Gleevec) or other drugs.  The five-year survival rate is 90%.<ref>[http://www.medscape.com/viewarticle/536049 Patients with Chronic Myelogenous Leukemia Continue to Do Well on Imatinib at 5-Year Follow-Up] Medscape Medical News 2006</ref><ref>[http://professional.cancerconsultants.com/conference_asco_2006.aspx?id=37519 Updated Results of Tyrosine Kinase Inhibitors in CML] ASCO 2006 Conference Summaries</ref>
+[[Image:Incidence of leukemia by gender and race in USA.PNG|700px|Delay-adjusted [[incidence]] and observed [[incidence]] of leukemia by gender and race in the United States between 1975 and 2011]]
-* ''Hairy cell leukemia'' (HCL) is sometimes considered a subset of CLL, but does not fit neatly into this pattern.  About 80% of affected people are adult men.  There are no reported cases in young children.  HCL is incurable, but easily treatable.  Survival is 96% to 100% at ten years.<ref name="pmid16245328">{{cite journal |author=Else M, Ruchlemer R, Osuji N, ''et al'' |title=Long remissions in hairy cell leukemia with purine analogs: a report of 219 patients with a median follow-up of 12.5 years |journal=[[Cancer]] |volume=104 |issue=11 |pages=2442–8 |year=2005 |pmid=16245328 |doi=10.1002/cncr.21447}}</ref>
+===Race===
-==Causes and risk factors==
+* Shown below is a table depicting the age-adjusted [[prevalence]] of leukemia by race in 2011 in the United States.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
-There is no single known cause for all of the different types of leukemia. The different leukemias likely have different causes, and very little is certain about what causes them. Researchers have strong suspicions about four possible causes:
-* natural or artificial ionizing radiation
+{| style="cellpadding=0; cellspacing= 0; width: 600px;"
-* certain kinds of chemicals
+|-
-* some viruses
+| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" | || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''All Races''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''White''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Black''' || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Asian/Pacific Islander'''  || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Hispanic'''
-* genetic predispositions
+|-
+| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Age-adjusted [[prevalence]]'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |75.3 per 100,000|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |83.5 per 100,000|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |45.9 per 100,000|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |41.2 per 100,000|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |57.1 per 100,000
+|}
-Leukemia, like other cancers, result from [[somatic mutation]]s in the [[DNA]] which activate [[oncogene]]s or deactivate [[tumor suppressor gene]]s, and disrupt the regulation of cell death, differentiation or division.  These mutations may occur spontaneously or as a result of exposure to [[ionizing radiation|radiation]] or [[carcinogen]]ic substances and are likely to be influenced by genetic factors.  Cohort and case-control studies have linked exposure to [[petrochemicals]], such as [[benzene]], and hair dyes to the development of some forms of leukemia.
+* Shown below is an image depicting the [[incidence]] of leukemia by race in the United States between 1975 and 2011.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
-[[virus (biology)|Viruses]] have also been linked to some forms of leukemia.  For example, certain cases of ALL are associated with viral infections by either the [[human immunodeficiency virus]] (HIV, responsible for [[AIDS]]) or [[human T-lymphotropic virus]] (HTLV-1 and -2, causing [[adult T-cell leukemia/lymphoma]]).
+[[Image:Incidence of leukemia by race in USA.PNG|Incidence of leukemia by race in the United States between 1975 and 2011]]
-[[Fanconi anemia]] is also a risk factor for developing [[Acute myeloid leukemia|acute myelogenous leukemia]].
+<small> API: Asian/Pacific Islander; AI/AN: American Indian/ Alaska Native</small>
-Until the cause or causes of leukemia are found, there is no way to prevent the disease.  Even when the causes become known, they may prove to be things which are not readily controllable, such as naturally occurring background radiation, and therefore not especially helpful for prevention purposes.
+==Prognosis==
+===5-Year Survival===
-==References==
+* Between 2004 and 2010, the 5-year relative survival of patients with leukemia was 60.3%.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
-{{Reflist|2}}
-== Research ==
+* 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.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
-Significant research into the causes, diagnosis, treatment, and prognosis of leukemia is being done.  Hundreds of [[clinical trials]] are being planned or conducted at any given time.  Studies may focus on effective means of treatment, better ways of treating the disease, improving the quality of life for patients, or appropriate care in remission or after cure.
+* 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.
-==External links==
+{| style="cellpadding=0; cellspacing= 0; width: 600px;"
-'''Images of leukemias'''
+|-
-*[http://www.healthsystem.virginia.edu/internet/hematology/HessIDB/stages-of-acute-leukemia.cfm UVA Healthsystem] -- Images of acute leukemias by stage
+| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" | || style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Acute lymphoblastic leukemia'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" | '''Chronic lymphocytic leukemia'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Acute myeloid leukemia'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Chronic myeloid leukemia'''
+|-
+| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''5-year survival'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | 70% || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |83.5%|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |25.4% || style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |59.9%
+|}
-'''Research organizations'''
+==References==
-*[http://www.tacl.us/ The Therapeutic Advances in Childhood Leukemia (TACL) Consortium] -- US research group
+{{Reflist|2}}
-*[http://atlasgeneticsoncology.org/Educ/Hempat_e.html "Chromosomes, Leukaemias, Solid Tumors, Hereditary Cancers"] in AtlasGeneticsOncology.
 {{Blood}}
 {{Hematological malignancy histology}}
-[[af:Leukemie]]
-[[ar:ابيضاض الدم]]
-[[bs:Leukemija]]
-[[cs:Leukemie]]
-[[da:Leukæmi]]
-[[de:Leukämie]]
-[[es:Leucemia]]
-[[eo:Leŭkemio]]
-[[fr:Leucémie]]
-[[ko:백혈병]]
-[[id:Leukemia]]
-[[ia:Leucemia]]
-[[it:Leucemia]]
-[[he:לוקמיה]]
-[[la:Leucaemia]]
-[[lt:Leukemija]]
-[[hu:Leukémia]]
-[[mk:Леукемија]]
-[[ms:Leukemia]]
-[[nl:Leukemie]]
-[[ja:白血病]]
-[[no:Leukemi]]
-[[nn:Leukemi]]
-[[pl:Białaczka]]
-[[pt:Leucemia]]
-[[ru:Лейкозы]]
-[[sq:Leukoza]]
-[[simple:Leukemia]]
-[[sk:Leukémia]]
-[[sr:Леукемија]]
-[[su:Leukemia]]
-[[fi:Leukemia]]
-[[sv:Leukemi]]
-[[th:มะเร็งเม็ดเลือดขาว]]
-[[vi:Ung thư bạch cầu]]
-[[tr:Lösemi]]
-[[uk:Лейкоз]]
-[[yi:לאקימיע]]
-[[bat-smg:Leukemėjė]]
-[[zh:白血病]]
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+[[Category:primary care]]
 [[Category:Disease]]
 [[Category:Hematology]]
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 [[Category:Oncology]]
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+ [[Category:Up-To-Date]]
+[[Category:Oncology]]
+[[Category:Medicine]]
+[[Category:Hematology]]
+[[Category:Immunology]]