What are the differences between Acute Myeloid Leukemia (AML) and Chronic Lymphocytic Leukemia (CLL)?

From the Guidelines

Acute myeloid leukemia (AML) has a poorer prognosis compared to chronic lymphocytic leukemia (CLL), with a 5-year survival rate of about 30% for AML, whereas CLL has a better prognosis with many patients living 10+ years after diagnosis. The main difference between AML and CLL lies in their cell origin, progression, patient demographics, and treatment approaches. AML affects myeloid cells, which develop into red blood cells, platelets, and certain white blood cells, and progresses rapidly, requiring immediate treatment 1. In contrast, CLL affects lymphocytes, a type of white blood cell, and progresses slowly, often not requiring immediate treatment.

Key Differences in Treatment Approaches

• AML treatment usually involves intensive chemotherapy with drugs like cytarabine and daunorubicin, followed by possible stem cell transplantation 1.
• CLL patients typically receive targeted therapies like BTK inhibitors (ibrutinib, acalabrutinib), BCL-2 inhibitors (venetoclax), or chemoimmunotherapy combinations.
• Recent advances in sequencing techniques have broadened our understanding of the molecular basis of AML, increasing the number of treatment options, including new targeted agents, like venetoclax, and alternative formulations of existing therapies 1.

Patient Demographics and Prognosis

• AML typically affects older adults but can occur at any age, presenting with symptoms like fatigue, frequent infections, easy bruising, and bleeding 1.
• CLL primarily affects older adults over 65 and may be asymptomatic or present with swollen lymph nodes, fatigue, and frequent infections.
• The prognosis for AML is generally poorer, with a 5-year survival rate of about 30%, while CLL has a better prognosis with many patients living 10+ years after diagnosis, though neither condition is typically curable outside of stem cell transplantation 1.

From the Research

Comparison of Acute Myeloid Leukaemia and Chronic Lymphocytic Leukaemia

• Acute myeloid leukaemia (AML) is a heterogeneous disease with a poor long-term survival rate and high relapse rate 2
• The standard treatment for AML is intensive induction chemotherapy, which has remained largely unchanged over the past 40 years 2, 3
• Recent studies have shown that the addition of new agents, such as targeted therapies and immunotherapies, can improve outcomes for patients with AML 4, 5
• In contrast, chronic lymphocytic leukaemia (CLL) is a type of cancer that affects the blood and bone marrow, but there is no direct comparison with AML in the provided studies
• The treatment landscape for AML is complex and continues to evolve, with new therapies and combinations being approved for treatment 4

Treatment Options for AML

• Intensive chemotherapy with cytarabine and an anthracycline is the standard of care for untreated AML 2, 3
• The addition of new agents, such as nilotinib, can improve outcomes for patients with AML and KIT expression 5
• Low-intensity regimens, such as low-dose cytarabine and hypomethylating agents, can be used in older patients or those not eligible for intensive therapy 3
• Allogeneic hematopoietic cell transplantation (HCT) can be an effective treatment option for patients with AML, particularly those who achieve complete remission 5

Challenges in Treating AML

• AML is a heterogeneous disease, making it challenging to develop effective treatment strategies 4
• The disease has a high relapse rate, and patients often develop resistance to available therapies 2
• The treatment landscape is complex, and choosing the best treatment option for each patient can be difficult 4