Lymphoma vs Leukemia: Key Similarities and Crucial Differences

Lymphoma and leukemia are both blood cancers that originate from lymphocytes (white blood cells in the immune system). They may have similar symptoms, such as fevers, night sweats, and weight loss. There are even some general crossovers in terms of treatment. However, these are two distinct types of cancer.

“Leukemia presents in the blood with elevated or low white blood cell counts and disruption of the normal blood cell development and function with typically low hemoglobin and platelets,” said Sara Taveras Alam, MD, an oncologist with UTHealth Houston. “Lymphoma often presents as painless enlarged lymph nodes or masses of lymphoid tissue.”

Andrew Evens, DO, MBA, MSc, of Rutgers Cancer Institute ,and the SAB chair-elect for the Lymphoma Research Foundation explained that treatments for lymphoma and leukemia also vary. “Do we use chemotherapy sometimes for both? Yes. But the future is more targeted treatment – not just chemo that just kills everything growing fast in the body, but something to get inside and target the blood cancer that way.”

Can you have lymphoma and leukemia at the same time? Most patients either deal with one or the other of these two blood cancers. However, after going through treatment for one blood cancer, you may be more likely to develop another type of cancer down the road, which is called secondary cancer.

Lymphoma and leukemia often present with similar symptoms. “Both diseases can cause constitutional symptoms such as fever, night sweats, and weight loss,” said Dr. Taveras.

Symptoms of lymphoma include:

• Skin rash or itching

• Abdominal pain or swelling

• Painless enlarged lymph nodes

• High fevers

• Night sweats

• Weight loss

Dr. Evens added that symptoms can vary based on what type of lymphoma you have. “Just with non-Hodgkin lymphoma, there are more than 80-90 different types,” he said. Indolent lymphomas grow slowly; patients may be asymptomatic for several years before needing treatment. High grade lymphomas, however, are more aggressive, presenting with “B symptoms” like night sweats, fevers, and weight loss, which indicate a faster-growing cancer.

For leukemias, symptoms often include:

• Bone pain

• Fatigue

• Bleeding

• Fever

• Night sweats

• Weight loss

Similar to indolent lymphomas, chronic leukemias move slowly. Acute leukemias can take over the bone marrow more quickly, affecting blood counts and causing infections, fatigue, and bleeding.

Is lymphoma a blood cancer? The answer is yes. When it comes to lymphoma, the two primary types are Hodgkin’s lymphoma and non-Hodgkin’s lymphoma, Dr. Taveras said.

“Hodgkin lymphomas can be subtyped as classic Hodgkin lymphoma or nodular lymphocyte-predominant Hodgkin lymphoma,” Dr. Taveras said. “Non-Hodgkin lymphomas can be B-cell or T-cell lymphomas and can also be classified as aggressive or indolent.” Currently, there are close to 100 different subclassifications of lymphoma.

There are four main types of leukemias:

• Acute myeloid leukemia (AML)

• Acute lymphoblastic leukemia (ALL)

• Chronic myeloid leukemia (CML)

• Chronic lymphocytic leukemia (CLL)

These large groups are further subdivided based on their chromosomal or molecular characteristics.

The genetic risk factors behind lymphoma and leukemia aren’t clear. “For many of the lymphomas and leukemias, ‘We don’t know’ is the honest answer,” Dr. Evens said. “We need to continue to do that research and find more genetic links.”

However, experts have identified factors that make someone more likely to be diagnosed with one of these cancers. Risk factors for lymphoma include:

• Genetic predisposition in patients with a family history of lymphoma

• Certain chemicals, such as pesticides and herbicides

• Certain viral infections, like HIV, Epstein-Barr (EBV), and human T-cell lymphotropic virus (HTLV)

For leukemia, risk factors include:

• Exposure to high levels of radiation

• Chemicals like benzene (an industrial chemical found in petroleum products)

• Certain chemotherapies given for other cancers

“Down syndrome is associated with a higher risk of developing acute leukemias specifically,” Dr. Taveras said. “AML and chronic leukemias are more common in older patients, and ALL is most common in children.”

“Usually, a lymphoma diagnosis is made by a biopsy,” said Dr. Evens. In some cases, an initial needle biopsy is enough. However, “You need enough evidence from the crime scene to make the diagnosis,” Dr. Evens explained. If pathologists need more information, sometimes doctors will remove the entire lymph node (called an excisional lymph node biopsy).

Doctors diagnose leukemia based on blood tests and a bone marrow biopsy. They’ll analyze a patient’s complete blood count (CBC), looking for abnormal white blood cells. A bone marrow biopsy removes a small amount of marrow cells and a small piece of bone filled with marrow. This allows doctors to look for changes in the cells that indicate blood cancer.

Treatments for leukemia and lymphoma vary based on factors such as the patient’s age and fitness level; targetable or prognostic mutations; and, in the case of lymphomas, the stage of the disease.

“Surgery and radiation have a role in the management of early-stage lymphoma,” said Dr. Taveras. “Chemotherapy, immunotherapy, and targeted therapy are our main options for the management of advanced lymphoma.”

Stem cell transplants can play a role in treating both leukemia and lymphoma. These transplants help achieve a higher likelihood of a cure or a longer duration of remission. For leukemia patients, chemotherapy and targeted therapy acting on specific mutations or proteins present in the cancer cells are key.

“We define what’s the best effective, most tolerated treatment for patients no matter what the subtype,” Dr. Evens said. “It’s an exciting time in blood cancers as more and more of the science comes out. There are many more treatments on the way in a very personalized and targeted fashion.”