Iran (IMNA) - According to Dr. Mehran Sharifi Esfahani, a specialist in adult hematology and oncology, understanding these differences is critical to improving patient outcomes. Blood cancers are broadly divided into two main categories: acute and chronic leukemias. Acute blood cancers are further classified based on the cell lineage involved, including acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Chronic blood cancers, by contrast, include chronic lymphocytic leukemia (CLL), which affects lymphoid white blood cells, and chronic myeloid leukemia (CML), which arises from the myeloid cell line.
Dr. Sharifi Esfahani explains that the clinical onset and diagnostic challenges of these cancers vary markedly. Acute leukemias typically develop explosively, with symptoms progressing so rapidly that it is unlikely for a patient to remain untreated for several months. Most individuals seek medical attention within two to three weeks of symptom onset, as the manifestations are severe and difficult to ignore.
Common features of acute blood cancers include a sharp decline in platelet counts and profound anemia. Patients may present with extensive bruising or spontaneous bleeding due to thrombocytopenia, while low hemoglobin levels can cause severe fatigue, weakness, and lethargy. In addition, the abnormal white blood cells seen in acute leukemia are often functionally ineffective, leaving patients vulnerable to fever and unusual or recurrent infections. These symptoms tend to worsen quickly, making acute leukemias relatively straightforward to recognize from a clinical standpoint.
Chronic blood cancers, however, pose a different challenge. Their more indolent nature means that diagnosis is often delayed, sometimes for years. This is particularly true of CLL, which may remain virtually asymptomatic until it reaches an advanced stage. In many cases, the disease is discovered incidentally during routine blood tests that reveal elevated white blood cell counts, prompting further investigation.
CML, on the other hand, is more likely to produce noticeable symptoms earlier in its course. Enlargement of the spleen is a hallmark of the disease and can lead to loss of appetite, abdominal distension, and digestive discomfort, driving patients to seek medical care sooner.
Advances in medical science have significantly transformed the diagnostic and therapeutic landscape of blood cancers. Traditionally, chemotherapy has been the cornerstone of treatment, working by disrupting the cell cycle and inhibiting rapid cell division. Because cancer cells proliferate more aggressively than normal cells, they are disproportionately affected. However, this approach also damages healthy tissues, contributing to many of the well-known side effects of chemotherapy.
In recent years, treatment has increasingly shifted toward targeted therapies and immunotherapy. These approaches require detailed laboratory and genetic analyses to identify specific receptors or molecular abnormalities within cancer cells. Once these targets are defined, therapies can be tailored to attack malignant cells with greater precision, sparing much of the surrounding healthy tissue. While the use of targeted treatments is currently limited, Dr. Sharifi Esfahani notes that they are expected to become far more widespread and may eventually supplant conventional chemotherapy in many settings.
Specialized diagnostic tests will play a central role in this transition, as future classifications of blood cancers are likely to rely heavily on cellular receptors and genetic characteristics rather than purely morphological criteria.
The quality of life of patients with blood cancers is influenced by a wide range of factors, including the type of leukemia, socioeconomic conditions, lifestyle, and psychological health. Depression and social stressors can significantly worsen a patient’s experience of illness, even when the biological features of the cancer are similar.
Acute blood cancers can severely disrupt quality of life in the short term due to aggressive disease progression and intensive treatments such as injectable chemotherapy, which often lead to hair loss, profound weakness, and physical exhaustion. Chronic blood cancers, by contrast, are generally milder and more manageable over time, with many patients achieving good disease control through oral medications and maintaining a relatively stable daily life.
As diagnostic tools become more sophisticated and therapies more precise, the future of blood cancer care points toward earlier detection, more individualized treatment, and, ultimately, a better balance between survival and quality of life for patients.
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