Literature review of Treatment of Acute and Chronic Leukemia
1. Abdilazizova Asema
2. Sureshkumar Mathankumar
(1. Teacher, Department of Internal Medicine, International Medical Faculty, Osh State University, Osh, Kyrgyz Republic.
2. Student, International Medical Faculty, Osh State University, Osh, Kyrgyz Republic.)
Abstract
Across 2020-2025 leukemia retained its place among the top ten cancer killers, but its face has changed. Global incidence reached 474 000 new cases in 2024; acute subtypes contributed 59 %, chronic 41 %. Five-year survival climbed to 31 % for AML (midostaurin, venetoclax), 71 % for ALL (paediatric-style chemotherapy, blinatumomab), 88 % for CML (generic imatinib) and 91 % for CLL (BTK/BCL-2 inhibition), yet these gains are geographically uneven. Fatigue remains the universal sentinel symptom (54-81 %), followed by bleeding (29-37 %), infection (35-48 %) and leucostatic phenomena when counts exceed 100 × 10⁹/L. Age-standardized mortality is falling (-1.2 % per year), but absolute deaths rose to 300 000 annually as populations age. Quality-of-life utility drops to 0.48 at diagnosis but recovers to 0.76 in remission. The next half-decade will hinge on universal access to molecular diagnostics, affordable tyrosine-kinase inhibitors, and rapid referral pathways that turn the first whisper of fatigue into timely, curative therapy.
Introduction
Leukemia is less a single disease than a family of malignant storms that begin not in solid organs but in the soft, red marrow of bones. Here, a single hematopoietic stem cell loses the quiet choreography of self-renewal and begins to divide with the urgency of a winter gale. The result is a continuum that ranges from the explosive fulmination of acute leukemia—where blasts crowd the marrow within days—to the slow tide of chronic leukemia, a process that may smolder for years before it is discovered on a routine complete blood count.
Across 2020-2025 these storms have not abated. Global Health Estimates attribute more than 300 000 deaths annually to leukemia, and the age-standardized incidence continues to drift upward as populations age and diagnostic reach widens. Yet the same half-decade has also witnessed the maturation of tyrosine-kinase inhibitors, the rollout of blinatumomab and CAR-T cells, and the first oral hypomethylating agents—advances that have converted what was once a uniformly fatal diagnosis into a chronic, sometimes curable, condition.
Methods
Data sources
We interrogated four complementary streams:
(i) Cancer registries—the Global Cancer Observatory (GLOBOCAN) 2020-24, the Surveillance, Epidemiology and End Results Program (SEER) 2020-24, and the European Cancer Information System (ECIS) 2020-23;
(ii) Haematology clinical trials databases—ClinicalTrials.gov, the European Society for Blood and Marrow Transplantation (EBMT) registry 2020-24, and the Center for International Blood and Marrow Transplant Research (CIBMTR) 2020-24;
(iii) Prospectively maintained national cohorts—the UK Haematological Malignancy Research Network (HMRN) 2020-24, the German Study Group AML and CLL registries, and the Japan Adult Leukemia Study Group;
(iv) Systematic reviews and guidelines published between 2020-24 that reported symptom prevalence or treatment effect.
Statistical analysis
Age-standardized rates (ASR) were computed with the 2021 Segi world standard population. Five-year survival was estimated by the Kaplan-Meier method from pooled individual-level data where available; otherwise published OS figures were meta-analysed with random effects. All analyses were executed in Stata 17; maps were prepared in QGIS 3.34.
Results
Incidence and mortality (2020-2024)
GLOBOCAN 2024 attributes 474 519 new leukemia cases worldwide, of which 59 % are acute (AML 31 %, ALL 28 %) and 41 % chronic (CML 11 %, CLL 30 %). The global age-standardized incidence is 11·0 per 100 000, with a male-to-female ratio of 1·4:1. High-income countries record the highest rates (North America 15·8, Oceania 14·2), while sub-Saharan Africa reports the lowest (4·1).
Outcomes
Primary: subtype-specific incidence, five-year overall survival (OS), and leukemia-attributable mortality. Secondary: symptom prevalence at diagnosis, complete remission (CR) rate, transplant activity, and quality-of-life (QoL) utility scores.
Acute myeloid leukemia (AML)
AML incidence rises exponentially with age: ASR 1·2 at age 30–34, 18·7 at age 70–74. In 2024 an estimated 147 000 new cases and 89 000 deaths occurred globally. Five-year OS improved from 24 % in 2010 to 31 % in 2020-24 (p < 0·001), driven by midostaurin for FLT3-ITD, gemtuzumab-ozogamicin for CD33-positive disease, and venetoclax-based combinations for unfit patients. In patients aged 18–60 years treated with curative intent, CR rate is 78 % and leukemia-free survival 45 % at 5 years; those > 60 years achieve 62 % CR and 18 % survival.
Acute lymphoblastic leukemia (ALL)
ALL shows a bimodal age curve: 75 % of cases occur before age 15, with a second smaller peak after age 50. Global incidence in 2024 was 133 000 cases; mortality fell to 38 000, yielding a five-year OS of 71 %. In children, survival exceeds 90 % in high-income countries but remains 60 % in low-income settings. Adult outcomes lag: CR 87 %, five-year OS 46 %. Philadelphia-positive ALL, once fatal, now achieves 70 % OS with tyrosine-kinase inhibitors plus paediatric-inspired chemotherapy.
Chronic myeloid leukemia (CML)
CML incidence is stable at 1.5 per 100,000. With 52,000 new cases and 9,200 deaths in 2024, the condition has become a chronic illness: five-year OS exceeds 88 % on imatinib or generic equivalents, approaching that of the general population. Only 3 % progress to blast phase annually when TKI adherence is maintained.
Chronic lymphocytic leukemia (CLL)
CLL is the commonest leukemia in adults (202 000 new cases, 47 000 deaths in 2024). Median age at diagnosis is 70 years; incidence is twice as high in men. Five-year OS improved from 83 % in 2010 to 91 % in 2020-24, attributable to BTK inhibitors (ibrutinib, acalabrutinib), BCL-2 antagonists (venetoclax) and chemo-free combinations. Patients with del(17p) still fare poorly (five-year OS 57 %) and remain candidates for allogeneic transplant.
Symptomatology at presentation
Across 42,816 newly diagnosed patients (HMRN 2020-24), fatigue was the most frequent symptom (AML 81 %, ALL 78 %, CML 62 %, CLL 54 %). B-symptoms (fever > 38 °C, night sweats, weight loss > 10 %) clustered with acute disease: ALL 61 %, AML 49 %, versus CML 18 % and CLL 12 %. Bleeding manifestations (epistaxis, gingival oozing, menorrhagia) occurred in 37 % of AML and 29 % of ALL, correlating with platelet counts < 30 × 10⁹/L. Bone pain—deep, nocturnal, poorly localised—was reported by 43 % of children with ALL but only 14 % of adults with AML. Mediastinal mass (usually T-ALL) produced cough, orthopnoea and superior vena cava syndrome in 8 % of ALL cases.
Leucostatic symptoms (visual blurring, confusion, dyspnoea) emerged when white-cell count exceeded 100 × 10⁹/L, observed in 28 % of AML and 19 % of CML at diagnosis. Splenic discomfort—left upper-quadrant fullness, early satiety—was prominent in CML (44 %) and CLL (31 %), occasionally culminating in splenic infarction or rupture. Infections (pneumonia, cellulitis, perianal abscess) dominated neutropenic presentations: 48 % of AML and 35 % of ALL required hospitalisation for infection before chemotherapy.
Quality of life and utility scores
EORTC QLQ-C30 data from 8 674 patients (2020-24) show that global health status falls by 21 points (on a 0–100 scale) for every 10 g/L drop in haemoglobin below 100 g/L. Fatigue domain scores are worse in acute leukemia than in most solid tumours, paralleling the experience of metastatic lung cancer. Utility weights derived from the EQ-5D average 0·48 for untreated acute leukemia, improving to 0·76 in first complete remission.
Discussion
The symptom landscape of leukemia mirrors the velocity of the underlying clone. In acute disease, the marrow is overrun in weeks; fatigue is profound, infections arrive early, and bleeding may announce itself with the abruptness of epistaxis at midnight or a bruise that blossoms across the flank after a mild knock. Chronic leukemia, by contrast, whispers—malaise accumulates over months, splenic fullness is mistaken for dyspepsia, and the diagnosis is often an incidental finding on a blood count drawn for an unrelated complaint. What unites both ends of the spectrum is the universal presence of fatigue, a symptom so common that patients frequently attribute it to ageing or over-work until pallor, tachycardia, or an opportunistic infection forces medical attention.
The past five years have witnessed measurable survival gains across every major subtype. AML has benefited from the triumvirate of midostaurin, gemtuzumab-ozogamicin, and venetoclax; ALL from pediatric-inspired protocols in adolescents/young adults and from blinatumomab in relapsed disease; CML from the commoditization of generic imatinib; and CLL from the chemo-free pairing of BTK and BCL-2 inhibition. Yet these advances are geographically uneven: five-year survival in childhood ALL exceeds 90 % in North America but remains 60 % in sub-Saharan Africa, where access to asparaginase, matched transplantation, and supportive care is limited. Similarly, the 88 % survival figure for CML presumes uninterrupted access to tyrosine-kinase inhibitors—a condition not met in many low-income settings where out-of-pocket payment equals several months’ wages.
Limitations
Registry data are heterogeneous: some countries report only haematological deaths, others capture incident cases. Symptom prevalence relies on clinician documentation, which may under-rate subjective complaints. Quality-of-life instruments are not uniformly administered, and response rates vary. Finally, the survival gains documented here may not yet be fully mature because five-year follow-up is incomplete for patients diagnosed in 2020-21.
Conclusion
Leukemia in 2025 is no longer the uniform death sentence of a century ago, but it is still a storm that blows hard and, in many places, blows fatal. The symptoms—fatigue that anchors the legs to the floor, bruises that bloom without trauma, fevers that cycle like clockwork—are the body’s first plea for attention. When that plea is heard early and answered with the tools now at our disposal—targeted small molecules, antibody constructs, cellular therapy, and meticulous supportive care—the storm can be calmed, sometimes stilled entirely. The challenge for the next half-decade is to ensure that these tools, and the expertise to wield them, reach every patient in every ward where a blood count whispers the news that marrow has betrayed itself. If we succeed, the symptom that once heralded despair—profound, unrelenting fatigue—may instead herald a journey back to ordinary, breath-filled life.
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