November 5, 2022

Types of blood and bone marrow cancers

by

Learn about the different types of blood cancer: leukemia, lymphoma, myeloma and additional hematological cancers.

Blood cancers are malignancies that arise out of the cells that form blood. The three main categories of blood cancers include leukemia, lymphoma and myeloma. But each of these cancers have subtypes, as well. Plus, some related bone marrow cancers don’t fall under the three main types of blood cancer.

Dr. Bhagirathbhai Dholaria, an expert in hematologic oncology at the Vanderbilt Stem Cell Transplant and Cellular Therapy Clinic, explained the types and subtypes of the various forms of hematological malignancy.

Leukemia

Most leukemia will present as circulating tumor cells in the peripheral blood. Leukemia falls into two categories: acute and chronic. “Acute leukemias, as the name suggests,” Dholaria said, “are fast-growing, very aggressive and lethal without treatment in a short period of time.” Chronic forms usually have a slower progression but can be lethal if untreated in many cases.

Acute leukemia has two main types: acute lymphoblastic leukemia and acute myeloid leukemia. Acute lymphoblastic leukemia is commonly seen in children and young adults, though a subset occurs in adults in their 60s or 70s. Acute myeloid leukemia generally shows up in older adults. Both diseases require immediate treatment in the form of chemotherapy and immunotherapy and sometimes advanced blood cancer treatments like chimeric antigen receptor T-cell therapy (CAR T-cell therapy) or donor stem cell transplant. “We have come a long way,” Dholaria said, “and we cure the majority of acute lymphoblastic leukemia, especially in children.” Acute myeloid leukemia tends to behave more aggressively, however. “We cure around roughly half of patients in the long term,” Dholaria added.

Chronic leukemia has two main subtypes: chronic lymphocytic leukemia and chronic myelogenous leukemia. Chronic lymphocytic leukemia is a slow-growing type of blood cancer typically diagnosed in patients in their 70s or 80s. Chronic myelogenous leukemia behaves more aggressively. Both forms of chronic leukemia are often treated with oral medications. “Most patients live close to a normal life if they respond to this targeted therapy,” Dholaria said.

Lymphoma

Lymphomas are tumors arising from the lymph nodes or immune cells. Lymphomas often present as an enlarged lymph node, which may be accompanied by other symptoms such as night sweats, fever, loss of appetite and weight loss. Lymphomas fall into two groups: indolent lymphoma and aggressive lymphoma.

Indolent lymphoma is slow-growing. “Most indolent lymphomas can be observed if the patient is not symptomatic,” Dholaria explained. “When it grows to a certain point and starts causing symptoms, then we tend to treat, usually with a combination of chemotherapy and immunotherapy.”

Aggressive lymphoma is fast-growing. “We have made significant advances in the treatment of aggressive lymphoma,” Dholaria said, “especially aggressive B-cell lymphomas, such as Hodgkin lymphoma and diffuse large B-cell lymphoma, where we cure more than half of the patients with upfront chemotherapy and immunotherapy combinations.”

Multiple myeloma

Multiple myeloma is a type of blood cancer arising from a type of immune cell called a plasma cell in the bone marrow cavity. It produces tumors within bones.

Multiple myeloma is one of the most common types of blood cancer, and it typically affects people in their late 60s to mid-70s. “Multiple myeloma can present with bone tumors causing bone fractures,” Dholaria said, “and it also affects kidney function and can cause anemia and bleeding problems.” Multiple myeloma is treated with combinations of targeted therapy — sometimes chemotherapy followed by autologous stem cell transplant. “Many patients with multiple myeloma have an excellent prognosis,” he added, “and they can have their cancer in remission for many, many years.”

Other types of blood cancers

Some blood cancers do not fall under the three main categories, but they are considered bone marrow cancers that lead to bone marrow failure. The largest group is myelodysplastic syndrome (MDS), in which the hematopoietic stem cell mutates and fails to make mature healthy red cell platelets and white blood cell counts. “It is a disease of old age,” Dholaria explained, “and sometimes individuals who have received chemotherapy for another type of cancer may develop MDS decades after the chemotherapy exposure.” In some cases, this cancer can be observed. But in other instances, it can turn into a form of leukemia.

Vanderbilt-Ingram Cancer Center leads the Southeast in using immunotherapy and cellular therapy for treating cancer, performing more stem cell transplants than almost anyplace else in the nation.

Learn More