Leukemia is a type of blood cancer. In leukemia, cancer cells crowd out healthy white blood cells, red blood cells, and platelets in the bone marrow. If you have leukemia, having other health conditions at the same time can make leukemia harder to treat and may even influence your cancer prognosis. Understanding how other health conditions are related to leukemia can help you talk to your doctor about treatment and lifestyle changes. Addressing related conditions may improve your quality of life, prolong survival, and lower the risk for life-threatening complications.

What Is a Comorbidity?

When someone has more than one health condition at the same time, the conditions are known as comorbidities. Comorbid conditions may be related to leukemia in different ways. When an additional medical condition makes an existing disease harder to treat, it is known as a complication. In people with leukemia, having a comorbidity can complicate cancer treatment and add to the disease burden.

Age plays a role in the risk for developing comorbidities. The longer a person lives, the more likely they are to be diagnosed with a chronic condition. Older people are more likely to have multiple chronic conditions. Some types of leukemia are also more likely to occur in older adults.

Here are the average ages at diagnosis of the four main types of leukemia:

• Acute lymphoblastic leukemia (ALL) — 15 years
• Acute myeloid leukemia (AML) — 67 years
• Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) — 71 years
• Chronic myeloid leukemia (CML) — 64 years

Older people are more likely to have certain types of leukemia as well as other health conditions at the same time.

Why Do Comorbidities Matter?

When you are diagnosed with leukemia, cancer may seem like your biggest worry. In fact, having comorbidities may influence your leukemia prognosis. One large study on comorbidity in blood cancer included 2,550 people with AML, 1,000 people with CML, and 4,584 people with myeloma — a closely related form of blood cancer. Results of the study showed that people with cancer plus comorbidities were more likely to die from all causes, including blood cancer.

The related conditions that were the biggest prognostic factors for overall survival with leukemia included:

• Kidney disease
• Liver disease
• Heart and lung disease
• Brain diseases, including dementia, psychiatric conditions, and cerebrovascular disease (such as stroke)

Comorbidities can also lower your tolerance for leukemia treatment and limit your treatment options.

Common Comorbidities in Adult ALL

About 4 in 10 cases of acute lymphoblastic leukemia occur in adults. Treatment is more challenging in adults with ALL than in children due to the presence of comorbidities.

According to one study involving more than 1,200 people, the most common comorbid conditions in adults with ALL include:

• Infections
• Previous cancers
• Diabetes
• Heart disease
• Moderate lung disease
• Obesity
• Mild liver disease

Common Comorbidities in AML

Studies have shown that among older adults with acute myeloid leukemia, people with a higher comorbidity burden tend to have worse reactions to leukemia treatment and worse overall survival rates. People with AML may also be more likely to have certain chronic conditions. One study compared 3,911 people aged 65 or older with AML with the same number of similarly aged people without AML. Compared with those who did not have AML, those with AML were more likely to also have:

• Cardiovascular disease
• Type 2 diabetes
• Stroke

Common Comorbidities in CML

In one study of 1,519 people with chronic myeloid leukemia, those who had comorbidities at the time of their leukemia diagnosis did not live as long as those who did not have other conditions.

The most common comorbidities seen in people with CML include:

• Type 2 diabetes (diabetes mellitus)
• Other types of cancer
• Chronic pulmonary disease
• Renal disease
• Cardiovascular disease, including heart attack, heart failure, peripheral vascular disease, and cerebrovascular disease (including stroke)

Common Comorbidities in CLL/SLL

A large study looked at 8,055 people with chronic lymphocytic leukemia over several years. Among the participants, 35 percent had one comorbidity, and 12 percent had multiple comorbidities. The most common comorbidities included:

• Chronic heart failure or history of heart attack
• Cerebrovascular disease, such as stroke
• Type 1 or type 2 diabetes
• Chronic lung disease
• Peripheral vascular disease (diseases of the veins and arteries)

Those with comorbidities were 14 percent more likely to die during the period of the study than those without comorbidities.

Conditions That Develop After Leukemia Treatment

Treatments for leukemia can cause long-term and delayed effects, beginning months or years after treatment for leukemia is complete. These long-term or late effects are known as sequelae. The term refers to conditions that follow after another disease or injury.

Some common sequelae after treatment for leukemia include:

• Cognitive problems, such as difficulties with memory or concentration
• Psychological problems, such as depression or post-traumatic stress disorder (PTSD)
• Heart failure or damage to the heart muscle
• Thyroid issues that affect the metabolism
• Lung damage or breathing problems
• Osteoporosis (thinning of the bones)
• Infertility
• Other types of cancer
• Problems with the immune system
• Hearing loss
• Cataracts
• Other types of cancer

Many leukemia survivors do not develop any sequelae. An individual’s risk for developing sequelae from leukemia treatment includes factors like the type of leukemia treatment, age, overall health, and gender.

Talking to Your Doctor About Related Conditions

Your doctor can help you better understand your individual risk factors for developing related conditions and recommend steps to lower your risk. When you are treating multiple conditions, be aware that some medications can cause dangerous interactions. Always make sure your health care provider is aware of every medication you are taking for every condition, whether it is available over the counter or by prescription, including any vitamins or herbal supplements.

Leukemia Condition Guide

• Leukemia — An Overview
• Types of Leukemia
• What Causes Leukemia?
• Symptoms of Leukemia
• Treatments for Leukemia
• Leukemia — The Path to Diagnosis