Cancer categorization can often be complicated. Since September is leukemia awareness month, we wanted to break down how leukemia types are categorized and the treatment options. Before we list them, it is important to understand what exactly leukemia is and how it occurs fully.
“Leukemia is a cancer of the blood,” says Jorge Cortes, MD, Director of the Georgia Cancer Center at Augusta University. Cortes has been in the field of leukemia for over 20 years and previously spent 27 years at MD Anderson Cancer Center as Deputy Chair Department of Leukemia, Chair of AML and CML Sections, and Leukemia Fellowship Program Director. “It occurs when there is a disturbance in the production of blood cells in the bone marrow.”
Blood cells are mostly developed in a person’s bone marrow, where they can become either lymphoid or myeloid, both of which become white blood cells. Lymphoids become lymphoblasts, then lymphocytes, which produce antibodies to attack bacteria and viruses, and T cells, which alert other immune cells to the infection. Myeloid become myeloblasts then monocytes and granulocytes, both fight diseases in the body.
When there is a mutation in the production, the cells can become cancerous and multiply.
“In general, we classify leukemias into two types: acute and chronic leukemias,” says Cortes. “They are categorized by which type of white blood cell is involved, lymphoid or myeloid, and the developing pace of the illness. Acute are quicker and more aggressive, while the chronic types are a bit of a slower progression.”
The most common types of leukemia include:
- Acute lymphocytic leukemia (ALL)
- Acute myeloid leukemia (AML)
- Chronic lymphocytic leukemia (CLL)
- Chronic myeloid leukemia (CML)
“Acute lymphoblastic leukemia is the most common cancer that children have. The counterpart of that is that it is highly curable in children. Fortunately, the treatment is good, and a large majority of the patients are cured. So, the possibility of cure is much better in children than it is in adults for this leukemia.”
As there are multiple types of leukemia, there are also multiple types of treatment that a patient might go through during their cancer journey. Chemotherapy, stem cell transplants, and radiation are just a few of the options a patient has available to them, but the treatment that Cortes typically recommends first is Tyrosine Kinase Inhibitor (TKI) Therapy. TKIs are pills that identify and attack specific types of cancer cells, which cause less damage to the normal cells.
Currently, there are six kinds of TKI available, four that are seen as ‘first-line’ treatments and two that are used as secondary options if the ‘first-line’ treatments do not work.
“The advantage of having all these choices is that you can select them based on the patient characteristics, not only the disease. For example, if the patients have diabetes, they have high blood pressure, and cholesterol issues, some of these drugs may have a higher risk of giving you some side effects versus others, so you can tailor the treatment to your patients.”
The goal that providers and researchers, including Cortes, are aiming for is at least 50% of patients who take these TKIs to respond well to them and can eventually stop this therapy treatment without having to undergo other treatment options. However, the current success rate is about 25%-30%.
Another goal that Cortes feels strongly about is developing new treatments that have fewer side effects and get the patient to the remission stage quicker.
“The side effects are not usually very severe, but they’re chronic and they’re constant. Most of us can handle having a little bit of discomfort, a little bit of pain, a little bit of something if it’s going to be short-lived. However, if it’s going to be forever, then then we need drugs that work better.”
To learn more about Cortes’ work and to keep up with his research, follow him on X, formally known as twitter. If you would like to learn more about leukemia from a patient’s point of view, check out the patient profiles of Gus Letson, Valencia Williamson, and Lesley Letson. For more information about leukemia, visit Wellstar MCG Health’s website or visit the Leukemia and Lymphoma Society website.
