Many people think that “acute leukemia” and “chronic leukemia” are different periods of the same disease. This is a misconception: they are two different diseases.
Leukemia is a malignancy that originates from hematopoietic stem cells and is divided into two categories: acute and chronic, depending on the degree of differentiation of the leukemia cells and the natural course of the disease:
- Acute leukemia cells have stalled differentiation at an early stage, mostly primitive and early naïve cells, and the disease progresses rapidly.
- Chronic leukemia cells have stagnant differentiation in the late stages, mostly more mature cells or mature cells, with relatively slow disease progression and a natural course of up to several years.
Therefore, the treatment of choice is different for leukemic cells with different traits.
Acute leukemia
- Acute leukemia cells are predominantly primitive and naive. These immature leukemia cells proliferate and accumulate in the bone marrow and peripheral blood, leading to suppression of normal hematopoiesis, which manifests as fever, bleeding, and anemia. They also infiltrate normal tissues and organs such as the liver, spleen, and lymph nodes, exhibiting different symptoms such as enlargement and pain.
- Although the onset of acute leukemia is inconsistent, the disease progresses rapidly and death usually occurs within a few months if not treated promptly and effectively.
- Acute leukemia must be treated with chemotherapeutic agents of choice to induce remission. Treatment principles follow early, combination chemotherapy and a full course of therapy. After remission is achieved then consolidation, maintenance therapy, and hematopoietic stem cell transplantation are selected according to the stratification of disease risk.
- Therapy also requires close monitoring and timely correction of bleeding and anemia, and active prevention of infection.
Chronic leukemia
Chronic leukemia progresses relatively slowly compared to the rapid progression of acute leukemia. Chronic leukemia is mainly divided into chronic myeloid leukemia (also known as slow-onset) and chronic lymphocytic leukemia.
Chronic myeloid leukemia (slow granulocytosis)
- The natural course of lentile is divided into a chronic phase, an accelerated phase, and an acute phase. The pathogenesis is the formation of BCR-ABL fusion genes in cells, which affects cell proliferation, differentiation and apoptosis, ultimately leading to the production of slow granules.
- International and national authoritative guidelines recommend that the treatment of choice for slow-onset granulocytes is imatinib mesylate, a tyrosine kinase inhibitor that inhibits leukemic cell proliferation by selectively inhibiting the tyrosine kinase activity of the BCR-ABL protein, and is the first targeted therapy for slow-onset granulocytes.
- Imatinib mesylate can be used in different stages of lentile, and periodic efficacy evaluations are needed to make appropriate adjustments to the treatment strategy. For example, increasing the dose, switching to a second-generation tyrosine kinase inhibitor, or receiving a hematopoietic stem cell transplant as soon as possible.
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Chronic lymphocytic leukemia
- Chronic lymphocytic leukemia is a low-grade malignant B-lymphocytic neoplasm. It occurs in the elderly, and the early symptoms are not obvious, and most of them show a chronic, inert course. Therefore, no treatment is needed in the early stage, and follow-up observation is the main focus. Treatment is started only when the disease progresses with symptoms such as fever, wasting, anemia and thrombocytopenia.
- Single-agent chemotherapy is usually preferred for chronic lymphocytic leukemia, such as benztropine, bendamustine, and fludarabine. Combination chemotherapy is not more effective than single-agent chemotherapy.
- More immunotherapeutic agents are now being used in chronic lymphocytic leukemia and have shown significant efficacy. For example, CD20 monoclonal antibodies, ibrutinib, and others.