Chronic lymphocytic leukaemia (CLL) and acute myeloid leukaemia (AML) are both blood cancers, but they affect different blood cells and follow different treatment approaches.

With CLL, treatment may not be needed straight away. AML, on the other hand, usually needs treatment soon after diagnosis. Test results also provide important information about the type of leukaemia and help doctors decide which treatments are suitable.

Understanding these differences can make a treatment plan easier to follow, particularly when medicines are being considered.

Key Takeaways

  • CLL and AML affect different blood-cell lineages and have different treatment approaches.
  • Some people with CLL can be monitored without starting treatment immediately.
  • AML generally requires treatment soon after diagnosis because it can progress quickly.
  • Blood, bone marrow and molecular tests can provide information that helps guide treatment.

CLL and AML: What Makes Their Treatment Different?

CLL develops in lymphocytes, a type of white blood cell involved in the immune system. The abnormal cells usually accumulate gradually, and the disease may remain stable for some time.

AML develops from immature cells in the myeloid lineage, which normally produces several types of blood cells. The abnormal cells can build up quickly in the bone marrow and interfere with the production of healthy cells.

 CLLAMLWhen treatment may beginSome people can be monitored until the disease becomes active or causes symptomsTreatment is generally started soon after diagnosisCommon treatment approachesTargeted medicines and other therapiesChemotherapy, targeted medicines, lower-intensity regimens or stem cell transplantRole of venetoclaxUsed in certain treatment regimens, sometimes with other targeted or antibody-based medicinesUsed with other medicines in certain patients with newly diagnosed AMLMonitoringMay include regular follow-up before treatment is neededClose monitoring is usually needed during treatment

Why the Diagnosis Matters

A leukaemia diagnosis is only the starting point. Doctors need to establish the specific type and look for features that could affect treatment.

For CLL, blood tests can identify abnormal lymphocytes. Additional testing may look for genetic or molecular changes that provide more information about the disease.

AML is usually assessed using blood and bone marrow samples. Tests can identify the type of AML and detect chromosome or molecular changes that may affect the treatment plan.

The results help doctors choose a treatment that fits the particular cancer rather than treating every leukaemia in the same way.

Treatment Approaches for CLL and AML

With CLL, treatment may not be needed immediately. If the disease is not causing symptoms or showing signs of becoming more active, doctors may recommend watchful waiting, with regular check-ups and blood tests. Treatment can begin when the disease becomes more active or starts causing problems.

Treatment options may include:

  • Targeted medicines
  • Antibody-based medicines
  • Other therapies suited to the disease

AML usually requires treatment soon after diagnosis. Depending on the person's circumstances, treatment may include:

  • Intensive chemotherapy, often given as induction followed by consolidation.
  • Lower-intensity treatment when intensive chemotherapy is not suitable
  • Targeted medicines
  • Stem cell transplant for some people after initial treatment.

Venetoclax is used to treat some people with CLL and AML. It works by blocking BCL-2, a protein that helps cancer cells survive. The medicines used alongside it can differ between the two cancers. Venclexta 100mg is a brand of venetoclax used to treat CLL and certain cases of AML. Although venetoclax is used for both cancers, the treatment combination and dosing schedule are different.

What Else Influences Treatment Choices?

Leukaemia type is not the only consideration. Doctors may also look at:

  • Genetic and molecular features of the cancer
  • Previous treatment and how the disease responded
  • Age
  • Other health conditions
  • Overall fitness and ability to tolerate intensive treatment
  • Whether a stem cell transplant is appropriate

These considerations can affect which treatment is offered and how intensive it needs to be. Two people with the same type of leukaemia may therefore have different treatment plans.

What Treatment May Look Like

Treatment can affect everyday life in different ways.

Someone with CLL may spend a period of time having regular blood tests and appointments without taking cancer medicines. Once treatment begins, follow-up continues to check how the disease is responding.

AML treatment is often more intensive, particularly at the beginning. Blood counts can fall during treatment, increasing the risk of infection, anaemia or bleeding. Regular testing and supportive care are an important part of this stage of treatment.

Treatment plans can also change over time as the disease responds or new information becomes available. Keeping up with appointments and telling the healthcare team about new symptoms can help them manage these changes.

Disclaimer: This article is for general educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Treatment decisions for CLL or AML should be made with a qualified healthcare professional based on the individual's medical history and test results.