15 - Acute Leukemias Flashcards
1
Q
Definition of Acute Leukemia
A
- Clinical Definition: A life-threatening event caused by the accumulation of immature white bloods cells in the bone marrow requiring immediate therapeutic intervention.
- Pathologic Definition: Maturation arrest at the level ofhematopoietic precursor cells (myeloblasts or lymphoblasts) defined by the presence of at least 20% blasts in the bone marrow.
2
Q
Clinical Presentation of
Acute Leukemia
A
- Symptoms result from displacement of normal hematopoietic elements in the bone marrow
– Displacement of myelopoietic cells => infections
– Displacement of megakaryopoiesis => bleeding
– Displacement of erythropoiesis => anemia
3
Q
How to diagnose Acute Leukemia?
A
- Morphology (bone marrow, peripheral blood)
- Immunophenotyping (mainly flow cytometry)
- Cytogenetics
- FISH
- Molecular Studies (Next Generation Sequencing, PCR etc.)
4
Q
Comparison between Acute Leukemia
and Myeloproliferative Disease and Myelodysplasia
A
- Blasts in bone marrow
and peripheral blood - Effective abnormal
hematopoiesis,
hypercellular marrow and
peripheral leukocytosis - Ineffective abnormal
hematopoiesis,
hypercellular marrow,
peripheral cytopenia(s)
5
Q
Two Major Types of Acute Leukemia
A
- Acute Lymphoid Leukemia (ALL)
- Acute Myeloid Leukemia (AML)
6
Q
Myeloid and lymphoid
maturation and differentiation
A
7
Q
Acute Lymphoblastic Leukemia/Lymphoma of B-Cell Type
A
- Most common cancer in children (peaks at age 3)
- Childhood ALL is a therapeutic success story (95% go into full remission, 85% permanently cured)
- CNS involvement more common in ALL than in AML
- 90% have structural and numerical chromosomal changes
- Presents as leukemia and not as tumor
- Positive for TdT, CD19, CD10, CD22 etc. Negative for surface Ig by definition
8
Q
Acute Lymphoblastic Leukemia of B-Cell Type
A
9
Q
Acute Lymphoblastic Leukemia/Lymphoma of T-Cell Type
A
- Can arise from bone marrow or thymus
- Most common in adolescent males
- Aggressive malignancy
- Thymic masses common
- Presents as leukemia and/or tumor
- Positive for TdT
10
Q
Normal peripheral blood
A
11
Q
Acute Lymphoblastic Leukemia/Lymphoma of T-Cell Type
A
12
Q
classification of acute lymphoblastic leukemias
A
13
Q
Acute Myeloid Leukemia
A
- As in ALL, symptoms are caused by
displacement of normal bone marrow cells. - Tumor formation is possible
(myeloid/monocytic sarcoma, extramedullary
myeloid tumor), e.g. leukemia cutis, gingiva
involvement - CNS involvement less common than in ALL
- Tumor cells positive for myeloperoxidase
- Some AMLs may have Auer Rods
14
Q
acute myeloid leukemia with definining genetic abnormalities and differentiation
A
15
Q
Acute Myeloid Leukemia M1
A