What to Expect with Leukemia as An Older Adult

What are the most common types of leukemia in older adults?

There are four main types of leukemia. The types are based on whether the leukemia spreads slowly (chronic leukemias) or quickly (acute leukemias) and where the leukemia starts.

The four main types are:

• Acute lymphocytic leukemia (ALL): ALL forms in immature lymphocytes, a type of white blood cell found in bone marrow. ALL tends to grow and spread quickly. It’s relatively rare and mostly affects children.
• Acute myeloid leukemia (AML): AML starts in the bone marrow in nonlymphocytic white blood cells. It often grows and spreads quickly. AML is a common type of leukemia in older adults, but it’s still relatively rare compared with other forms of cancer. The average age of diagnosis is about 69 years old. AML is rarely diagnosed in people under age 45.
• Chronic lymphocytic leukemia (CLL): CLL starts in the lymphocytes. It usually progresses slowly over time. It’s the most common type of leukemia in adults. CLL is usually diagnosed in people around age 70. It’s very rarely diagnosed in people under 40 years old.
• Chronic myeloid leukemia (CML): CML occurs when the bone marrow makes too many myeloid white blood cells. CML is slow growing. The average age at diagnosis is 66 years old. About half of cases occur in people 65 years and older.

What causes leukemia in seniors?

Changes in the DNA of bone marrow cells cause leukemia. However, researchers have not determined why these changes occur.

AML is more common in older adults because bone marrow collects genetic changes as you age. These changes usually don’t cause problems at first, but over time, they can accumulate. When enough of these changes affect how blood cells grow and divide, AML can develop.

Chronic leukemias are most often found in older adults. This is because genetic changes in blood cells become more common as you age. These leukemias also tend to grow slowly and may not cause symptoms at first, which is why many people are diagnosed during routine blood tests.

What are the signs of leukemia in seniors?

Some of the most common symptoms of leukemia in older adults include:

• weight loss
• fatigue
• night sweats
• loss of appetite
• weakness
• shortness of breath
• bruising easily
• paleness
• chronic infections
• bleeding easily, such as nosebleeds or bleeding gums
• swelling or feeling fullness in your abdomen
• joint and bone pain
• enlarged lymph nodes

However, chronic leukemia may not show symptoms until much later in the course of the disease.

How is leukemia diagnosed in older adults?

A healthcare professional can search for signs of leukemia via a complete blood count (CBC).

This is a routine test, so they may identify an issue even before you have symptoms. In this case, the test will show too many white blood cells or cells that look out of the ordinary.

If a doctor suspects you have leukemia, they might recommend some of these additional tests:

• physical exam to see whether your lymph nodes, liver, or spleen are swollen (enlarged)
• bone marrow biopsy, in which tissue is taken from bone marrow in your hip to see whether there are leukemia cells in your bone marrow and to figure out what type of leukemia you may have
• chest X-ray
• PET scan to stage the leukemia, which means finding out how much the cancer has spread and progressed
• chest CT scan
• cytogenetics, which looks at chromosomes in blood or bone marrow samples and can indicate the type of leukemia you have
• spinal tap, which checks the spinal fluid for leukemia cells

Some of these tests can also help a doctor, often a hematologist or an oncologist, determine the stage of leukemia. Different types of leukemia are staged in different ways:

• ALL doesn’t have stages like other types of cancer, but a doctor takes into account your type ALL (B cell or T cell) when determining treatment options.
• AML is classified in subtypes rather than symptoms using the World Health Organization (WHO) classification system and the International Consensus Classification (ICC).

• In the United States, CLL is usually staged using the Rai system, which includes stages 0–4. The stages are based on the amount of lymphocytes in your blood and bone marrow, as well as spleen, lymph nodes, and liver involvement.
• CML has three stages: chronic, accelerated, and blast. These stages are based on:
  • symptoms
  • blood cell counts
  • the number of blast cells you have

What are the current treatment options for older adults with leukemia?

The type of treatment you receive is based on several factors, including your overall health, the type of leukemia, and your age.

Leukemia in older adults is often harder to treat than leukemia in younger people. This is because:

• older adults tend to have more comorbidities or coexisting conditions
• higher doses of chemotherapy may be harder for older adults to tolerate.
• the immune system can weaken with age
• genetic changes in blood-forming cells become more common with age

Some treatment possibilities include:

• Watch and wait: If you have a chronic type of leukemia and you feel fine, a doctor might suggest “watch and wait.” That means you don’t start treatment right away. Instead, you get regular check-ups and blood tests. Many people live comfortably with this approach for years.
• Chemotherapy: For some leukemias, chemotherapy may still be used. But for older adults or people with health issues, doctors will now often use less-intense regimens or combine chemotherapy with newer drugs. This can help control the disease while minimizing harsh side effects.
• Stem cell transplant: A stem cell transplant can sometimes offer the best chance to prevent leukemia from returning. However, as a transplant can be hard on the body, it’s generally reserved for people whose leukemia is aggressive or has returned after other treatments, and is not recommended for everyone.

How long can an older adult live with leukemia?

The outlook for older adults with leukemia depends on many factors, including:

• the leukemia stage at diagnosis
• your age
• the type of leukemia you have
• other health issues you may have

Acute leukemias

According to a 2019 study, for people ages 70 years and older, the median overall survival rate for ALL is 4 months. The survival rate for AML is 6–12 months.

Targeted therapies, such as immunotherapies, can increase the survival rates of people with acute leukemias. While some research suggests targeted therapies can increase survival rates to approximately 10 months after diagnosis, these therapies are new, so less is known about them.

Different types of drugs are approved for different types of leukemia. Because these drugs work on specific pathways in your body, they may be safer than other therapies. Your doctor may also recommend adding a medication to chemotherapy for better results.

Chronic leukemias

For chronic leukemias, treatment is usually used to control the spread of cancer and manage your symptoms.

Treatment is generally not expected to cure chronic leukemia, but you can live for many years with it. If your cancer goes into remission after treatment, a stem cell transplant can further increase your survival rate.

Here is a breakdown by age of the 5-year relative survival rates for people with CLL, according to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program:

• ages 50–64: nearly 94%
• ages 65–74: around 91%
• ages 75 and over: around 81%

The 5-year relative survival rate for CML is about 50% for people ages 65 and older.

These figures come from 2015–2021 data. They may not reflect current advancements in treatment that can improve someone’s outlook today.

Since these figures also come from large populations of people, they cannot predict your individual outlook.

Takeaway

Leukemia is more commonly diagnosed in older adults. A doctor will consider your overall health, type of leukemia, age, and other factors when forming a treatment plan.

While the median survival rate for acute leukemia can be daunting, new treatments are being tested that may improve survival rates.

People with chronic leukemia can live many years with this disease and successfully manage their symptoms.

Talk with a doctor about your treatment goals to find the best options for you.