Leukemia is a type of cancer that affects the blood and bone marrow, where blood cells are produced. In older adults, certain forms of leukemia are more common due to changes in the body’s cells and immune system as people age. The most common types of leukemia in older adults are chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML), and acute myeloid leukemia (AML).
**Chronic Lymphocytic Leukemia (CLL)** is the most frequently diagnosed leukemia in older adults. It usually develops slowly and often affects people over the age of 60. CLL involves the overproduction of abnormal lymphocytes, a type of white blood cell that plays a role in the immune system. These abnormal cells accumulate in the blood, bone marrow, and lymph nodes, crowding out healthy cells and impairing the immune response. Because CLL progresses slowly, many patients may not experience symptoms initially and might be diagnosed during routine blood tests. When symptoms do appear, they can include fatigue, swollen lymph nodes, frequent infections, and easy bruising or bleeding. Treatment for CLL varies depending on the stage and symptoms, ranging from careful monitoring to targeted therapies that help control the disease.
**Chronic Myeloid Leukemia (CML)** can occur at any age but is also common in older adults. It arises from a genetic change in the myeloid cells, which are responsible for producing red blood cells, platelets, and some types of white blood cells. CML typically progresses through three phases: a chronic phase where symptoms are mild or absent, an accelerated phase with worsening symptoms, and a blast crisis phase that resembles acute leukemia and is more aggressive. Symptoms may include fatigue, night sweats, weight loss, and an enlarged spleen causing abdominal discomfort. The discovery of targeted drugs called tyrosine kinase inhibitors has revolutionized CML treatment, allowing many patients to live long, manageable lives with the disease.
**Acute Myeloid Leukemia (AML)** is more aggressive and develops quickly, making it a serious concern in older adults. Unlike chronic leukemias, AML involves the rapid growth of immature myeloid cells (blasts) that do not function properly and crowd out normal blood cells. This leads to symptoms such as severe fatigue, frequent infections, easy bruising or bleeding, and sometimes bone pain. AML is more common in adults than in children and tends to occur more frequently as people age. Treatment often involves intensive chemotherapy to try to eliminate the abnormal cells, but older patients may face challenges due to other health conditions and the aggressive nature of the disease.
In addition to these, there are other less common leukemias and related blood cancers that can affect older adults, such as certain types of lymphomas that involve lymphatic tissues but can overlap with leukemia in symptoms and cell types. However, CLL, CML, and AML remain the primary leukemia types seen in the older population.
Understanding the differences between these leukemias is important because they vary in how quickly they progress, the types of blood cells they affect, and how they respond to treatment. Chronic leukemias like CLL and CML tend to develop slowly and may allow for longer periods of symptom-free living, whereas acute leukemias like AML require prompt and aggressive treatment due to their rapid progression.
Older adults diagnosed with leukemia often require a tailored approach to treatment that considers their overall health, other medical conditions, and the specific characteristics of their leukemia. Advances in medicine have improved outcomes for many patients, but managing leukemia in older adults remains complex due to the balance between effective treatment and quality of life.
