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Acute Lymphoblastic Leukemia (ALL) vs. Acute Myeloid Leukemia (AML): Understanding the Difference

Posted on June 03, 2021
Medically reviewed by
Mark Levin, M.D.
Article written by
Maureen McNulty

Lymphoid vs. Myeloid Cells | Who Gets It? | ALL and AML Symptoms | Treatments | Outlook | Support

Acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) are different cancers of the blood. ALL and AML develop from two different cell types, respectively known as lymphoid cells and myeloid cells. Each different type of leukemia is likely to affect different types of people based on factors such as age and other conditions. Each may cause different symptoms, have different prognoses, and be treated with different therapies.

Lymphoid vs. Myeloid Cells

There are many different types of blood cells, all made by stem cells in the bone marrow tissue found inside certain bones. Different blood cells go on to have different jobs in the body. Blood cells are generally categorized into two main categories: lymphoid cells and myeloid cells.

Lymphoid cells are white blood cells that play a role in the immune system and help fight infections. Lymphocytes (B cells and T cells) and natural killer cells are all types of lymphoid cells.

Granulocytes are types of white blood cells, also called myeloid cells. There are a few types of granulocytes: neutrophils, eosinophils, and basophils. Other blood cells include red blood cells, which deliver oxygen to all of the body’s tissues, and platelets, which help clot the blood.

Types of Leukemia

Blood cells can develop gene changes, which make them grow out of control. This, in turn, can cause leukemia. Experts group different types of leukemia together based on different features.

First, leukemia can be either acute or chronic: Acute leukemia cells are underdeveloped, don’t work properly, and grow quickly. Chronic leukemia cells are more mature, can carry out some of their normal jobs within the body, and grow slowly. In some cases, chronic myeloid leukemia (CML) is even curable.

Second, leukemia is classified into lymphoid or myeloid groups. Lymphoblastic or lymphocytic leukemias develop from lymphoid cells. Myeloid or myelogenous leukemias form from myeloid cells.

Putting the two categories together, there are four main types of leukemia:

  • Acute lymphoblastic leukemia, also called acute lymphocytic leukemia
  • Acute myeloid leukemia, also known as acute myelogenous leukemia
  • Chronic lymphocytic leukemia (CLL)
  • Chronic myeloid leukemia, also known as chronic myelogenous leukemia

Who Gets ALL vs. AML?

AML is more common than ALL. In 2020, nearly 20,000 people were diagnosed with AML for the first time. On the other hand, a little over 6,000 people were diagnosed with ALL. These two types of cancers are both slightly more likely to affect men than women and occur more often in white people.

One major difference between these leukemias is that ALL is much more likely to affect children. Children make up about 60 percent of ALL cases. A child’s risk of developing ALL is highest under the age of 5. AML, however, usually affects older adults. The average age at diagnosis for a person with AML is 68 years old.

Risk Factors

Some characteristics can increase a person’s chances of developing ALL or AML. Both leukemias share some of the same risk factors, including exposure to radiation or chemicals. ALL and AML are also both more likely to develop in people with certain genetic disorders, including:

  • Ataxia-telangiectasia
  • Down syndrome
  • Fanconi anemia
  • Li-Fraumeni syndrome

Viral infections are also a risk factor for ALL, but not for AML. People who have previously been infected with HTLV-1 or the Epstein-Barr virus (EBV) have a slightly higher chance of developing ALL.

Other risk factors for developing AML include:

  • Smoking
  • Having previously undergone cancer treatment, including chemotherapy or radiation therapy
  • Having a history of other blood cell diseases, including types of myeloproliferative neoplasms (MPN) or myelodysplastic syndrome (MDS)

ALL and AML Symptoms

Both ALL and AML cause many of the same symptoms. Each of these types of leukemia can lead to general symptoms such as:

  • Fever
  • Loss of appetite
  • Night sweats
  • Weight loss

ALL and AML also lead to low levels of healthy blood cells, which can lead to additional conditions, including:

  • Anemia (low red blood cell counts), which can cause tiredness, headaches, pale skin, shortness of breath, and feelings of weakness or dizziness
  • Leukopenia (low levels of white blood cells), which leads to frequent infections and fevers
  • Thrombocytopenia (low platelet levels), which causes easy bruising and bleeding problems, including nosebleeds, bleeding gums, and heavy periods

ALL can also cause swollen lymph nodes, which appear as lumps in the neck, armpit, or groin. Swollen lymph nodes are also possible in AML, but this symptom is rare.

When ALL affects the T cells, it frequently leads to problems with the thymus (an organ in the chest, behind the breastbone). People with T-cell ALL may cough or have breathing difficulties. Thymus problems aren’t usually seen in B-cell ALL or in AML.

Learn more about the symptoms of ALL and AML.

Treatments for ALL and AML

Leukemia treatment is often given in phases, each of which has a distinct purpose.

ALL treatment phases include:

  • Induction therapy — This is the first treatment a person receives. Its purpose it to kill as many cancer cells as possible and reduce leukemia signs and symptoms.
  • Consolidation or intensification therapy — This phase often includes some of the same drugs used during induction therapy, but in higher doses to kill any remaining cancer cells.
  • Maintenance therapy — During this phase, lower-dose medications are taken for a longer period of time to help prevent relapse (return of the leukemia).

AML is also typically treated with induction and consolidation therapy. Doctors have not traditionally used maintenance therapy when treating myeloid leukemias. This approach may change as new, more effective treatment options become available.

Chemotherapy

Induction therapy for both ALL and AML often begins with chemotherapy drugs. Chemotherapy may include one or a combination of medications. Sometimes, a targeted therapy is also added to the treatment plan, depending on which gene changes a person has.

Targeted Therapy

Targeted therapy can attack specific genes or proteins that are found in cancer cells. For example, about 1 out of 4 adults with ALL has a change called the Philadelphia chromosome, in which two chromosomes (pieces of DNA) are abnormally attached. Leukemia cells that have this change can be killed with targeted therapy drugs like Gleevec (imatinib).

Likewise, people with AML caused by certain gene mutations may be able to use different targeted therapies.

Radiation Therapy

If ALL or AML has spread to the brain or spinal cord, radiation therapy may be used to kill those cancer cells.

Stem Cell Transplant

Both ALL and AML can be treated with a stem cell transplant. During this procedure, both the normal and leukemic cells in the bone marrow are destroyed with chemotherapy or radiation. Next, the recipient receives an infusion of healthy stem cells that make new, normal blood cells. ALL and AML are usually treated with allogeneic stem cell transplantation, in which the new stem cells come from a matched donor.

Learn more about treatments for ALL and AML.

ALL vs. AML Outlook

People with ALL often have a better prognosis (outlook) than people with AML do. About 69 percent of people with ALL live at least five years after diagnosis, whereas about 29 percent of people with AML live at least five years after diagnosis.

ALL Outlook

Some characteristics are linked to a better prognosis for people with ALL. Age makes a big difference in a person’s survival rate. Among adults over the age of 65, about 15 percent will live for at least five years. However, among children under the age of 15, more than 90 percent will live for at least five years.

A person’s ALL subtype also plays a large role. People with ALL that affects immature B cells tend to have a better outlook than people with ALL that developed from mature B cells.

Other prognostic factors that can lead to a good outcome include:

  • Having lower levels of white blood cells at the time of diagnosis
  • Having certain changes to a cell’s chromosomes, such as hyperdiploidy (having too many chromosomes)
  • Going into remission (having the leukemia go away) more quickly
  • Not having any cancer cells in the central nervous system, which includes the brain and spinal cord

AML Outlook

Age also plays a significant role in a person’s AML outlook. Although AML is not very common in younger people, children and younger adults have a better prognosis than older adults.

AML shares some of the same prognostic factors as ALL, but it has also been linked to other factors. Factors that may lead to a better outlook for people with AML include:

  • Having lower levels of white blood cells at the time of diagnosis
  • Having certain chromosome changes, such as a translocation (abnormal connection) between chromosomes 8 and 21, or a translocation between chromosomes 15 and 17
  • Having mutations in certain genes, including the NPM1 gene or CEBPA gene
  • Going into remission more quickly
  • Not having any cancer cells in the central nervous system

If a person with AML previously had another blood disorder — such as an MPN or MDS — they are likely to have a worse prognosis. Additionally, AML that developed following treatment for a different cancer usually leads to a worse outlook.

Talk With Others Who Understand

MyLeukemiaTeam is the social network for people with leukemia and their loved ones. On MyLeukemiaTeam, more than 8,300 members come together to ask questions, give advice, and share their stories with others who understand life with leukemia.

Are you living with ALL or AML? Share your experiences in the comments below, or start a conversation by posting on MyLeukemiaTeam.

References
  1. Leukemia — Cleveland Clinic
  2. Leukemia — Mayo Clinic
  3. Cancer Stat Facts: Leukemia — Acute Myeloid Leukemia (AML) — National Cancer Institute
  4. Cancer Stat Facts: Leukemia — Acute Lymphocytic Leukemia (ALL) — National Cancer Institute
  5. Key Statistics for Acute Lymphocytic Leukemia (ALL) — American Cancer Society
  6. Key Statistics for Acute Myeloid Leukemia (AML) — American Cancer Society
  7. Leukemia — Acute Myeloid — AML: Risk Factors — American Society of Clinical Oncology
  8. Leukemia — Acute Lymphocytic — ALL: Risk Factors — American Society of Clinical Oncology
  9. Signs and Symptoms of Acute Lymphocytic Leukemia (ALL) — American Cancer Society
  10. Signs and Symptoms of Acute Myeloid Leukemia (AML) — American Cancer Society
  11. Chemotherapy — Leukemia & Lymphoma Society
  12. Typical Treatment of Acute Myeloid Leukemia (Except APL) — American Cancer Society
  13. Maintenance Therapy for AML: Are We There Yet? — Blood
  14. Leukemia — Acute Lymphocytic — ALL: Treatment Options — American Society of Clinical Oncology
  15. Ph-Positive ALL Therapy — Leukemia & Lymphoma Society
  16. Leukemia — Acute Myeloid — AML: Treatment Options — American Society of Clinical Oncology
  17. Acute Lymphoblastic Leukaemia (ALL): Survival — Cancer Research UK
  18. Prognostic Factors in Childhood Leukemia (ALL or AML) — American Cancer Society
  19. Prognosis and Survival for Acute Lymphocytic Leukemia — Canadian Cancer Society
  20. Acute Myeloid Leukaemia (AML): Survival — Cancer Research UK
  21. Prognosis and Survival for Acute Myelogenous Leukemia — Canadian Cancer Society
All updates must be accompanied by text or a picture.
Mark Levin, M.D. is a hematology and oncology specialist with over 37 years of experience in internal medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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