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Understanding AML vs. ALL: Navigating the complex field

By Naheed Ali, MD, PhD, ScD on behalf of The Leukemia & Lymphoma Society | July 31, 2025

Table of contents: 

Leukemia is a blood cancer originating in the bone marrow that leads to an overproduction of abnormal white blood cells, disrupting normal bodily functions.

Leukemia can start on its own (primary) or develop due to another health problem (secondary). It can also be classified into different types depending on the speed of progression. Fast-growing is "acute," slow-growing is "chronic," and the white blood cell it started from (either myeloid or lymphoid cells).

Among the most prevalent forms are acute lymphoblastic leukemia (ALL), which originates in immature lymphoid cells and is most often seen in children, and chronic lymphocytic leukemia (CLL), which affects more mature lymphoid cells and typically develops slowly in adults. Acute myeloid leukemia (AML) and chronic myeloid leukemia (CML) come from myeloid cells. Besides these main types, there are rarer forms, like leukemia that develops from mature B or T cells or natural killer (NK) cells (Chennamadhavuni et al., 2023).

Receiving this diagnosis can understandably feel overwhelming for patients and their families. Obtaining clear and reliable information can help alleviate that sense of uncertainty and empower individuals to take an active role in their care. 

This article will focus on two fast-growing types of leukemia, acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), and break down their differences in terms of causes, symptoms, diagnosis, treatment, and outlook.

Similarities and differences between AML and ALL

Acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL) are both aggressive blood cancers that originate in the bone marrow. These are illnesses that progress rapidly if left untreated. ALL and AML begin when a single stem cell in the bone marrow undergoes a genetic change. A healthy stem cell undergoes a mutation (changing into a leukemia cell, also called an "ALL/AML cell" or "blast cell"), and the altered cell multiplies, producing many blast cells. These abnormal cells build up in the bone marrow, leaving little room for healthy red and white blood cells, as well as platelets, to develop. Because of this, a person may have anemia from a lack of red blood cells, be more susceptible to infections from a lack of white blood cells, and/or be more prone to bleeding and bruises from a lack of platelets (The Leukemia & Lymphoma Society, 2024). 

Acute myeloid leukemia (AML) originates from myeloid cells, which produce various blood components such as red blood cells (RBC) and certain types of white blood cells (WBC). Red blood cells carry oxygen throughout the body, while white blood cells help fight infections. The white blood cells from myeloid cells include neutrophils, which attack bacteria, and monocytes, which clean up dead cells and harmful substances. 

Because AML begins in the myeloid branch of blood-cell production, treatment has to move fast to restore the marrow’s ability to make red blood cells, platelets, and infection-fighting neutrophils. 

Acute lymphoblastic leukemia (ALL), on the other hand, begins in lymphoid cells, a different type of blood cell that plays a key role in the immune system. These cells develop into B and T cells—white blood cells that help the body recognize and destroy viruses, bacteria, and other threats. 

Because AML and ALL originate from different types of blood cells—myeloid and lymphoid, respectively—their treatment strategies differ as well, relying on different types of chemotherapy, targeted therapies, and sometimes stem cell transplantation.

Causes and risk factors: Understanding the underlying contributors

Leukemia develops when there is a mutation in the DNA of blood-forming cells (RBC, WBC, and platelets). As a result, these affect the growth of the cells, and they do not mature properly. These immature blood cells multiply uncontrollably, disrupting normal blood functions. While the exact cause is often unknown, several risk factors have been identified for both AML and ALL. 

Common Risk Factors for AML and ALL

  • Sex: Males are more prone than females.
  • Genetic disorders such as Li-Fraumeni syndrome, Fanconi anemia, Down syndrome, Bloom syndrome, neurofibromatosis, Shwachman-Diamond syndrome, Klinefelter syndrome, and ataxia telangiectasia are associated with a higher likelihood of developing AML and ALL (Chennamadhavuni et al. 2023).
  • Previous cancer treatment: Prior chemotherapy or radiation increases risk.
  • Smoking: Risk increases when exposed to carcinogens.
  • Radiation exposure: High-dose radiation, like that from atomic bomb exposure or some cancer treatments, raises leukemia risk. Routine X-rays and CT scans use low doses and are not considered a risk factor.
  • Environmental factors: Exposure to chemicals like benzene adds to the risk. 

Risk factors unique to AML

  • Age: Incidence increases with age (Chennamadhavuni et al. 2023).
  • Family history: A genetic predisposition or a blood cancer history raises the risk. 

Risk factors unique to ALL

  • Age: Most commonly diagnosed in children, though adults can be affected (Chennamadhavuni et al. 2023).
  • Viral Infections: Viruses such as HTLV-1 and Epstein-Barr may contribute to development (American Cancer Society, 2024). 

Learning about the cause and various risk factors of leukemia can be overwhelming at first. But it gives a clearer picture and practical knowledge you can act on: scheduling regular checkups, sharing your history with your care team, and watching for early warning signs, especially if you are at a higher risk. Early detection and prompt medical attention can significantly improve treatment outcomes.

Recognizing the signs and symptoms of AML and ALL

AML and ALL often mimic other illnesses; therefore, early recognition is essential for timely diagnosis and treatment. 

Symptoms patients with either AML or ALL may experience

  • Fatigue and weakness: The body’s reduced ability to produce adequate red blood cells leads to a lack of energy and weakness.
  • Fever and night sweats: Persistent fever and night sweats are early signs of leukemia, occurring as the body reacts to abnormal blood cells.
  • Loss of appetite and weight loss: Leukemia can cause loss of appetite and weight loss as the body uses more energy to deal with the disease due to changes in metabolism. 

Symptoms more specific to AML

  • Easy bruising or bleeding: Low platelet counts hinder clotting, often leading to spontaneous bruising, gum bleeding, and nosebleeds.
  • Skin infections: With a compromised immune system, infections can occur more readily.
  • Bone pain: Discomfort or pain in the bones can be a direct result of the marrow being overrun with abnormal cells.
  • Abdominal fullness: Enlargement of the spleen or liver may cause a feeling of fullness in the stomach. 

Symptoms more specific to ALL

  • Swollen lymph nodes: Swelling of lymph nodes in the neck, armpits, or groin is more frequently observed in ALL.
  • Joint pain: In ALL, joint pain often results from leukemia cells that can enter the joint tissues, which triggers inflammation and irritation of the surrounding nerves.
  • Gastrointestinal distress: Symptoms can include nausea and vomiting.
  • Enlarged liver and spleen (hepatosplenomegaly): This occurs when leukemic blasts spread and accumulate in the liver and spleen, causing these organs to enlarge. 

While AML and ALL share similar symptoms, detailed lab tests—especially blood cell and bone marrow analyses—are essential for distinguishing their unique characteristics.

Diagnosing AML and ALL: Tests and procedures

Getting an accurate diagnosis at the right time is essential for effective treatment. Physicians use a combination of tests to distinguish between AML and ALL: 

  1. Complete blood count (CBC) with differential count: Measures blood cell levels to identify abnormal counts.
  2. Peripheral blood smear: A closer look at the blood under a microscope can reveal the abnormal shape and appearance of cells.
  3. Bone marrow aspiration and biopsy: Extracts a marrow sample to analyze cell composition and determine the leukemia subtype.
  4. Imaging tests: CT scans and ultrasounds assess organ involvement and detect complications like hepatosplenomegaly, which is the enlargement of the liver and spleen. 

Early detection gives your care team a head start—they can move quickly with the treatment that fits best for you, whether that’s a targeted pill, radiation, or chemo, and that prompt action often leads to better results. For further details on diagnostic procedures, refer to LLS AML and ALL Diagnosis Information.

Treatment strategies: From induction to consolidation

Once diagnosed with AML or ALL, treatment is highly individualized and typically involves multiple phases: 

  1. Induction therapy: The initial phase focuses on aggressively eliminating cancer cells to achieve complete remission, often requiring a 4–6-week hospital stay.
    1. For AML, induction therapy often begins with a chemotherapy regimen known as “7 + 3”—seven days of cytarabine followed by three days of an anthracycline such as daunorubicin or idarubicin (Chennamadhavuni et al., 2023).
    2. For ALL, an important step is determining whether the Philadelphia (Ph) chromosome is present. If so, chemotherapy is paired with a tyrosine kinase inhibitor (TKI) like dasatinib, ponatinib, or bosutinib. In some cases, especially in Ph-positive ALL, combinations like dasatinib with blinatumomab (a bispecific T-cell engager) have shown promising results even without traditional chemotherapy (Chennamadhavuni et al., 2023).
  2. Consolidation therapy: Also known as intensification therapy, this phase targets any remaining leukemia cells to prevent relapse.
  3. Maintenance therapy: The final phase aims to prevent disease recurrence after induction and consolidation, supporting long-term remission.
  4. Other treatment options: Targeted therapies and radiation therapy are also employed to attack cancer cells, with stem cell transplantation playing an essential role in aggressive cases. In addition, chimeric antigen receptor (CAR) T-cell therapy can also be an option in ALL for individuals up to age 25. 

You may ask, “What are my treatment options?” The answer is that treatment is varied and personalized to achieve the best possible outcome while managing side effects. Each treatment option, whether chemotherapy or radiation therapy, works together to support the body’s recovery and bolster the immune system.

Prognosis and survival: Understanding the road ahead

The outlook for leukemia patients can vary dramatically based on the type of leukemia and individual patient factors. 

  • Acute Myeloid Leukemia (AML): The five-year survival rate for AML is about 31.9% overall. Children under 20 have better outcomes, with survival around 65–70%, while adults 20+ drop to 28%. For those 60 and older, survival declines further to 20–30%, or as low as 3–8% in some cases (National Cancer Institute, n.d.). It is multifactorial and depends on the patient’s overall health, genetic factors, and response to therapy.
  • Acute Lymphoblastic Leukemia (ALL): In contrast, ALL boasts a higher five-year survival rate of approximately 72%, largely due to excellent outcomes in children. Those under 15 have survival rates of 90–93%, teens (15–19) around 75%, and adults between 35–50%. Survival in older adults averages 35% (National Cancer Institute, n.d.). This difference in survival is attributable to the fact that ALL often affects children and young adults, who typically have better treatment tolerance and overall recovery prospects. 

Please remember that survival rates are statistical averages and not promises. Unfortunately, none of us can predict the future, and these averages do not dictate someone’s outcome. Organizations like LLS continue to fund promising treatments for all blood cancers, improving survival rates all the time. Ongoing advancements in leukemia treatment options continue to make a difference in quality of life as well. 

As referenced above (“promising treatments”), The Leukemia & Lymphoma Society (LLS) has ongoing clinical trials, including the Beat AML® Master Clinical Trial and the PedAL Clinical Trial, both dedicated to acute leukemias. 

Beat AML was launched in 2016 to change the status quo for the treatment of people 60+ with AML. It uses the latest technology to isolate unique genetic characteristics of a patient’s AML and then match them to a treatment targeted to their specific form of AML. The trial has helped some patients go from a prognosis of weeks or months to years of survival. 

In addition, the LLS PedAL (which stands for Pediatric Acute Leukemia) trial focuses on replacing one-size-fits-all chemotherapy with treatments tailored to each child’s leukemia and is the cornerstone of LLS's The Dare to Dream Project. With multiple sites around the world, PedAL has both screening trials (to better match children with the most promising treatment based on their unique tumor biology) and therapeutic trials (to treat relapsed acute leukemias in kids).

Frequently asked questions: Equipping you with knowledge

When faced with a leukemia diagnosis, it’s natural to have questions. Here are some questions to ask your doctor that can help clarify your understanding.

Questions to ask your doctor: 

  • What specific subtype of leukemia do I have, and how does it affect my treatment plan?
  • Which diagnostic tests confirmed my diagnosis, and what do the results indicate?
  • Which type of white blood cells are affected according to my test results?
  • What treatment options are available, including targeted therapies, clinical trials, and stem cell transplantation?
  • What side effects might I anticipate, and what strategies can be employed to manage them?
  • How will my progress be monitored, and how often will I require follow-up visits?
  • What lifestyle changes or support services do you recommend to help me and my family during this period? 

This set of questions is meant to provide you with the knowledge necessary to make informed choices regarding your care. Remember: inquiring is an essential aspect of the treatment process. 

In addition, LLS provides a free survivorship workbook to order or download that can help you keep track of all the answers to your questions, as well as other important information you’ll need throughout diagnosis, treatment, follow-up care, and long-term management of blood cancer. Pro tip: Take your workbook with you to appointments and fill it out with your care team. 

Conclusion

Navigating a diagnosis of acute leukemia can be overwhelming. However, understanding the differences between AML and ALL can provide you with a clearer view of treatment and care. Whether you're comparing ALL vs. AML, the road involves individualized care, advanced studies, and continuing support. 

We understand that each person’s story is special, and we are here to help you find the best treatment options, ask the right questions, and, most importantly, improve your quality of life. If you or a loved one is facing a leukemia diagnosis, please reach out to us for compassionate guidance and expert resources. 

For additional information on treatment options, risk factors, and supportive care, please visit: 

About the author: Dr. Ali is a medical journalist and copywriter.

Sources

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