3 - Leukemias Flashcards
What is leukemia?
Malignancy of hematopoietic progenitor cell -> uncontrollable proliferation and marrow replacement
Acute phase
Blasts > 20 percent
Chronic phase
Blasts < 20 percent
Effects of too many blasts
Bone marrow “replacement”
Solid organ infiltration
Coagulation activation
Etiologies of AML
Radiation Prior chemo Marrow toxic drugs Benzene Pre-existing d/o’s
Clinical approach to leukemia
Myeloid or lymphoid?
Myeloid - myeloproliferative d/o’s
Lymphoid - lymphomas
Acute or chronic?
Median age of AML
60 yrs
Peak age of ALL
3 to 7 yrs
80% of adult acute leukemia is which type?
AML
80% of acute leukemias of childhood are which type?
ALL
BLUF for ages in acute leukemia
Myelogenous - adults
Lymphoblatic - kids
Sxs of acute leukemias
Fatigue Anorexia Weight loss Fever SOB Bleeding
Which acute leukemia associated with DIC?
Acute promyelocytic leukemia
Infection risks in acute leukemia?
Due to decreased neutrophils
PE for acute leukemias
Pallor Petechiae Bone / joint pain Gingival hypertrophy due to leukemic infiltration Hepatosplenomegaly Lymphadenopathy (ALL)
Sxs of hyper-leukocytosis (WBC >100K)
Impaired circulation
HA
Confusion
Dyspnea
Urgent txt - leukapheresis and chemo
Definitive dx of acute leukemia>
Bone marrow bx
Labs for acute leukemias
CBC - pancytopenia
Variable WBC’s
Anemia, typically severe
Decreased platelets
Smear for ALL
Lymphoblasts
Smear for AML
Myeloblasts
Auer rod (eosinophilic, rod-shaped granule) - think:
AML
W/u for acute leukemias
Bone marrow bx ASAP (distinguish ALL vs AML)
AML = relative emergency
REFER to HEME-ONC
CNS involvement common in which acute leukemia?
ALL
Perform LP
First step in txt of acute leukemia?
Induction chemo with goal of complete remission
What does remission look like?
Normal peripheral blood, normal bone marrow (decreased blast to no blast), normal clinical status (disappearance of all signs and sxs)
Induction
Implies induction of remission - very aggressive chemotherapy in order destroy visible leukemic cells but doesn’t always lead to cure
Post-remission therapy
Under control, now cure it
Standard chemo, stem cell transplant
CNS prophylaxis?
Done with ALL - intrathecal chemo with or without cranial irradiation
Prognosis for acute leukemia?
Cure rate
• Under 60 years: post-remission chemo leads to cure of
35-40% of patients • Under 60 years and allogeneic bone marrow transplant:
curative 50-60% of patients • Cure rates for older patients approx 10-15%
Median age of CML?
55 yrs
Features of CML
Philadelphia chromosome
Bcr/abl
Fatigue / splenomegaly / bone pain
+++WBC in chronic phase
May progress to accelerated or blast phase
Imatinib = 1st line txt
CLL
Chronic lymphocytic leukemia
Replication of a malignant clone of mature B
cell leading to progressive accumulation of
immune- incompetent lymphocyte
• Inadequate antibody production from abnormal B cells
MC leukemia in adults in western countries>
CLL
MC’ly found in older guys (70 yrs)
Sxs of CLL
Painless swollen cervical lymph nodes that wax and wane
Fatigue
Some asymptomatic
CBC - absolute lymphocytosis
MC finding in CLL
Lymphadenopathy
Usually cervical, supraclavicular, axillary
Firm, round, freely mobile, nontender
Hallmark of CLL
Isolated lymphocytosis (absolute count >5k)
Smudge cells, think:
CLL
Txt for CLL
If early, asymptomatic - observe
If advanced (progressive fatigue, anemia, thrombocytopenia, symptomatic lymphadenopathy, repeat infections) - treat -> chemo, rituximab, bone marrow transplant (tailored to patient)
Richter’s transformation?
75 y/o dude with CLL, suddenly loses weight night sweats,
aggressive diffuse large b-cell non-Hodgkin lymphoma
5-8 month median survival
Why couldn’t Chloe comb her hair?
She had leukemia
