Acute leukemia Flashcards
What is acute leukemia
A heterogenous group of malignant disorders that is characterised by uncontrotrolled clonal and accumulation of blast cells in the bone marrow and body tissues
Acute leukemias are classified as
ALL and AML
A cute lymphoid leukemia mainly occurs in
Children and is curable in 70% of them
ALL gender distribution
Found in more males than females
All in adults
Found less in adults and only curable in minority of them
Acute myeloid leukemia is found mainly in
Adults and is curable in minority of them
AML gender distribution
M>F
Causes of acute leukemia
Idiopathic Underlying hematologic disorders Chemicals, drugs Ionizing radiation Viruses i.e HTLV 1, EBV,HIV Heredetary genetic conditions like fanconis anemia, down syndrome, ataxia telangectasia
Pathophysiology of acute leukemia
Blast cells are arrested in the early phase from maturation and also begin to proliferate rapidly due to an abnormal expression of genes often as a result of chromosomal translocations.
Blast cells overtake the bone marrow leading to decreased production of other cells causing anemia, thrombocytopenia and neutropenia
invasion of vital organs in AL
varies according to subtype
Hyperluekocytosis in AL
This occurs due to the uncontrolled increase in the number of blast cells which prevents the increase in other cells lines.
Effects of hyperleukocytosis
increase in blood viscosity
predisposes one to microthrombi or acute bleeding
Can cause decreased organ perfusion
IN AL there can be hidden site relapse in
testes
meninges
Metabolic manifestations of AL
Hyponatremia due to vasopressin released by myeloblast
Hypokalemia due to lysozyme released by myeloblast
Hyperurecimea - due to lysis of leukemic blast cells
Hypokalemia die to lysozyme release usually seen in
AML M5
Symptoms of AL
Marrow failure leukostasis tissue infiltration constitutional symptoms like fever, weight loss DIC
Lasts for a short duration
Signs of AL
Gum hypertrophy Lymph adenopathy Hepatosplenomegaly petechiae Confusion
Types of blasts in acute lymphocytic leukemia
L1 -85%
l2-14%
L3-1% (Burkitts lymphoma)
L1 blast
small homogenous blasts,
single inconspicuous nucleolus
Regular nuclear outline
L2 blasts
Larger sized blasts
More pleomorphic
L3 burkitt cell type
Basophilic and vacuolated cytoplasm
M3 acute promyelocytic leukemia features
Hypergranular;promyelocytes
Auer rods/faggot cells seen
classical M3 FEATURES
Hypergranular, 80% leucopeanic (low WBC)
Variant M3 features
hypogranular
leokocytosis
GRanules in M3 contain
Thromboplastin like Procoagulants leading to massive DIC
Diagnostic feature of M3
t(15;17)
M4- acute myelomonocytic leukemia features
Monocytes
promonocytes
M4 is involved with the part of the body
CNS
Variant M4
M4 with eosinophilia
Variant M4 prognosis
good
AML M5 divided into
M5a - acute monoblastic leukemia
M5b - acute monocytic leukemia
AML associated with
Infiltration into gums and skin
Variant M4 associated with
Deletions and inversions on chromosome 16q
Symptoms of AML M5
Weakness
bleeding
diffuse erythematous skin rash
50% or more of nucleated marrow cells are
erythroid precursors and cause M6 erythroleukemia
30 % or more of non erythrod cells are
myeloblasts
Acute megarkaryoblastic leukemia M7 associated with
fibrosis of bone marrow
M7 blasts have
cytoplasmic blebs and pseudopod formation
Precursor B cells for ALL
t(9,22)
t(11q23)
t(1,19)
t(12,21)
Precursor T cell ALL
Burkitt-cell leukemia
Diagnosis and classification of aml requires
morphological assessment immunophenotyping cytogenic analysis molecular analysis clinical assessment
AML definition
A type of cancer of the bone marrow with more than 20 percent blast cells
WHO classification of AML
AML with genetic abnormalities
AML with multilineage dysplasia
AML therapy related
AML not otherwise categorised
What distinguishes AML from ALL
in light microscopy, AML has auer rods, cytoplasmic granules. ALL doesnt have them
Flow cytometry for immunophenotyping
Special stains
Blast size comparison
small in ALL large in AML
Cytoplasm comparison
Scanty in ALL Moderate in AML
Chromatin material
Dense in ALL, Fine lacy in AML
Nucleoli comparison
Indistinct in ALL, prominent in Aml
AUer rods comparison
Found in AML, not founD IN ALL
cytochemical staining with peroxidase
negative in ALL, positive with AML
Periodic acid schiff stain
Positive ALL, negative AML
Acid phospahtase test is
POsitive in all
What is immunophenotyping
Identification of antigens present on blast cells to identify if leukemia is lymphoid or myeloid
Also differentiates T-ALL and B-ALL
To identify the subtype of leukemia i.e AML-M7 has a specific marker of CD-61
Common antigens in AML
CD 13,33,117
Common antigens in ALL
B-ALL T-ALL CD-10 CD-19 CD-22 CD-3 CD-7
Cytogenics and molecular studies will
Detect abnormalities in leukemic clone
And provide prognostic value
Cytogenics and molecular studies will
Detect abnormalities in leukemic clone
And provide prognostic value
A biochemical screening that shows leucocytosis will cause
renal impairment
hyperuriceamia
chest radiography that shows mediastinal mass
present in 70% of T-ALL patients
ALL bone lesions seen in
childhood
Diagnostic feature of AML with maturation M2
t(8,21)
Diagnostic feature of ALL,CML
t(9,22)
Diagnostic feature of B-ALL
t(8,14)
Phases of ALL treatment
induction
intensification
CNS prophylaxis
maintenance
last 3 are post remission therapy
Phases of ALL treatment
Induction
consolidation– post remission therapy
Principles of treatment in AL
- combination chemotherapy ; complete remission and prevent future relapse
- supportive care ; transfusion, antibiotics, nutrition
- Psychosocial support
Age as a poor prognostic factor
in ALL if your’e less than 1 and in aml if youre greater than 60
total white blood cell count poor prognosis
if greater than 50*10^9/L
CNS and poor prognosis
if present in both AML and ALL though rare in AML
Sex and poor prognosis
In male who have ALL
IN both male and females who have AML
Poor prognostic factors cytogenic
for ALL T(9,22)
IN AML monosomy 5,7
