Leukemia: AML vs. ALL

Medically Reviewed by Arefa Cassoobhoy, MD, MPH on September 25, 2023
Written by Alyson Powell Key
4 min read

Leukemia is a type of cancer that attacks cells in the bone marrow that make blood. Acute leukemia is a type of the disease that grows quickly. In these cases, bone marrow cells don’t mature the way they should. There are two main types of acute leukemia:

  • Acute lymphocytic leukemia (ALL) starts in cells that become lymphocytes -- white blood cells that are an important part of your immune system. About 80% of childhood leukemia cases are this type.
  • Acute myelocytic leukemia (AML) begins in early myeloid cells These are cells that become white blood cells (other than lymphocytes), red blood cells, or platelet-making cells. It’s the most common type of leukemia in older people.

Mixed phenotype acute leukemia is when these two forms of leukemia combine.

The general symptoms of AML and ALL look very much alike. Conditions other than cancer can sometimes cause similar symptoms, too. The symptoms include:

Low numbers of normal white, red, and platelet blood cells seen in both ALL and AML can cause specific symptoms. A lack of red blood cells (aka anemia) can lead to:

  • Feeling tired
  • Feeling weak
  • Dizziness or lightheadedness
  • Pale skin
  • Having a hard time catching your breath

If you have too few normal white blood cells, you may get infections and fevers over and over. A high white blood cell count is possible with leukemia, but these cells don’t protect against infection like normal white blood cells do.

Platelets are tiny blood cells that help your body stop bleeding. Low platelet counts can lead to:

If you have signs of AML or ALL, your doctor will order blood tests and a bone marrow test. Blood tests show your white blood cell, red blood cell, and platelet counts, and whether you have too many or few of these cells.

A bone marrow test confirms a leukemia diagnosis. During this test, your doctor will use a needle to take a bone marrow sample from your hipbone or breastbone to check for leukemia cells.

If doctors find that you have ALL or AML, they could also test your leukemia cells to look for certain genes and chromosome changes. This will help guide your treatment and let you know your chances of getting better.

Symptoms of AML may require more tests, like a spinal tap (lumbar puncture). Your doctor will insert a needle into your spinal canal and remove spinal cord fluid to test for leukemia cells.

In general, there are two stages of treatment for both AML and ALL:

  • Induction therapy kills most of the leukemia cells in your blood and bone marrow and lets your body make normal cells again.
  • Consolidation therapy (post-remission therapy) destroys leukemia cells left behind in parts of your body like the brain and spinal cord.

If you have ALL or certain types of AML, you may also get maintenance therapy to keep leukemia cells from growing back. Doctors give these treatments at lower doses over a long period of time. They may also give you shots of chemotherapy drugs into your spinal cord to kill any cells in your nervous system.

Treatment for ALL can take 2-3 years. Treatment plans for AML depends on your age, overall health, and other causes.

During these stages, therapy methods include:

  • Chemotherapy. Doctors use drugs to kill cancer cells. With ALL or AML, you’ll probably stay in the hospital while you get this.
  • Targeted therapy. These drugs target specific flaws in cancer cells that help them grow.
  • Bone marrow transplant. Doctors replace unhealthy bone marrow with leukemia-free stem cells. This will regrow healthy bone marrow.
  • Clinical trials. This is research to test a new cancer treatment or a new way to use a current one.
  • Radiation therapy. This treatment uses high-powered beams to kill cancer cells.
  • CAR T-cell therapy. This is a type of gene therapy that's sometimes used to treat ALL in children and young adults.

The major problem that happens with AML and ALL is a weakened immune system. This makes it hard for your body to fight infections. It’s due to a lack of healthy white blood cells. It's a temporary side effect of some leukemia treatments.

You’ll also bruise and bleed more easily because of low platelet levels. Serious bleeding (hemorrhaging) can happen inside your skull, lungs, and stomach. Call 911 right away if you think you’re hemorrhaging.

Many leukemia treatments cause infertility, meaning you’re not able to have a baby. This is often temporary but can sometimes be lasting. Your chance of infertility goes up if you’ve had high doses of chemotherapy or radiation.

You're more likely to get better if you have a lower white blood cell count when you get your diagnosis.

About 98% of children with ALL go into remission a few weeks after they start chemotherapy. If you're younger than 50, you're better able to handle the treatment. There's also less of a chance that you'll have changes in your chromosomes that can't be treated.

Your chances for getting better depend on your age and whether doctors find a specific gene or chromosome changes in the leukemia cells. If you're over 60, you may find it hard to manage intense treatment. You may also have chromosome changes that make you less likely to get better.