Acute Leukemias Flashcards
Acute Leukemias
stem cell disorders characterized by malignant neoplastic proliferation & accumulation of immature & nonfunctional hematopoietic cells in the BM
Acute Leukemia General Characteristics
Abrupt onset & progresses rapidly
symptoms are related to the anemia, thrombocytopenia &/or neutropenia
BLASTS ARE ALMOST ALWAYS FOUND IN PB
2 categories
AML vs ALL
AML- affects the maturation of myeloid stem cells
ALL- affects the lymphoid progenitor
Acute Leukemia FAB criteria
morphological & cytochemical evaluation
>30% blasts
Acute Leukemia WHO criteria
morphology, cytogenetics, molecular genetics, & immunologic markers
>20% blasts
Acute Lymphoblastic Leukemias
malignant lymphocytes that do not mature & do not undergo apoptosis
Epidemiology of ALL
L1 - most common leukemia of children
L2 & L3 - seen in children & adults
ALL clinical Findings
normo, normo anemia thrombocytopenia bone pain usually neutropenia WBC - increased, normal, decreased LYMPHOBLASTS - no auer rods & scant cytoplasm
ALL BM findings
hypercellular
>20% lymphoblasts
ALL stain reactions
myeloperoxidase -
sudan black B -
chloroacetate esterase -
ALL L1 General Characteristics
most common ALL in children - peak age is 2-6
best prognosis
majority of ALL cases
ALL L1 Morphology
lymphoblasts predominantly small (2x mature lymph)
nuclear shape is regular
nucleoli are NOT prominent
cytoplasm is scant & only moderately basophilic
ALL L2 General Characteristics
most frequent ALL found in adults
large lymphoblasts
ALL L2 morphology
LARGE lymphoblasts
nuclear shape is irregular w/ indentations
nucleoli are large & prominent
cytoplasm size & color is variable
ALL L3 General Characteristics
rarest form of ALL
known as BURKITT’S lymphoma/leukemia
presents more often as a lymphoma
occurs in both children & adults
ALL L3 morphology
Large lymphoblasts nuclear shape is regular nucleoli is prominent cytoplasm is abundant & deeply basophilic VACUOLIZATION
WHO classification of ALL
- precursor B & precursor T cell neoplasms
2. Burkitt type (L3)
Precursor B-Cell Leukemia
B-Cell ALL or B-ALL
80-85% of ALL cases in children
70% of cases in adults
B-ALL characteristics
B lymphoblasts - TdT +, HLA-DR +, CD19+
B-ALL w/ CD10 + have best prognosis
cytogenetic abnormalities include : translocation, hypodiploidy, hyperdiploidy
Translocation
2 broken off chromosome pieces of chromosomes are exchanged
most common translocation in childhood B-ALL : t(12;21)
Hypodiploidy
# of chromosomes per cell that is less than 2n 30-39
Hyperdiploidy
of chromosomes per cell is more than 2n
B-ALL prognosis
usually good
children complete remission rate is 95%
adults - 60-85%
Precursor T-Cell Leukemia
T-ALL
15% of children ALL/ 25% of adults
high WBC
Lymphoblasts are more variable in size & cytoplasmic vacuoles may be present
T-ALL clinical findings
Lymphoblasts are TdT+, CD7+ , CD3+
cytogenetic - translocations
Acute Myeloid Leukemia General Characteristics
affects CFU-GEMM
affects neutrophils, platelets, RBCs, monocytes
common in infants & older adults
rapidly fatal if not treated
AML PB lab findings
WBC - increased, normal, decreased
anemia
thrombocytopenia
BLASTS- auer rods common
AML BM lab findings
hypercellular w/ decreased fat content
predominance of blasts - auer rods present
Acute Myeloblastic Leukemia (M0)
rare
myeloblasts w/o granules
myeloperoxidase & sudan black B - negative
Acute Myeloblastic Leukemia w/ Minimal Maturation (M1)
common (20%)
myeloblasts w/ or w/o scant granules, auer rods can be present
myeloperoxidase & sudan black b - POSITIVE
Acute Myeloblastic Leukemia w/ Maturation (M2)
most common (30%)
myeloblasts w/ granules, promyelocytes & few myelocytes
auer rods present
myeloperoxidase & sudan black b - POSITIVE
Acute Promyelocytic Leukemia (M3)
15% of AML
myeloblasts, promyelocytes w/ prominent granules
auer rods common
faggot cells- multiple Auer rods occurring in bundles
Acute Promyelocytic Leukemia (M3) Stain reactions
myeloperoxidase & sudan black b - POSITIVE
specific esterase - positive
nonspecific esterase - negative
Acute Myelomonocytic Leukemia (M4)
20% of AML
myeloblasts & promyelocytes >30% marrow cells
promonocytes & monoblasts >20%
auer rods may be present
Acute Myelomonocytic Leukemia (M4) Stain reactions
myeloperoxidase & sudan black b - POSITIVE
specific esterase - positive
nonspecific esterase - positive
Acute Myelomonocytic Leukemia w/ Eosinophilia (M4eo)
same as M4 w/ >5% abnormal eosinophils
Acute Monoblastic Leukemia w/o Differentiation (M5a)
5-15% of cases
large monoblasts w/ lacy nuclear chromatin & abundant cytoplasm
Specific esterase - negative
nonspecific esterase- positive
Acute Monoblastic Leukemia w/ Differentiation (M5b)
monoblasts, promonocytes, blood monocytosis
specific esterase - negative
nonspecific esterase - positive
Acute Erythroleukemia (M6)
rare
erythroid blast (pronormoblasts) & precursors >50%
PB: poikilocytosis & anisocytosis
Acute Erythroleukemia (M6) Stain reactions
myeloperoxidase & sudan black b - positive
specific esterase - positive
PAS - POSITIVE
Megakaryocytic Leukemia (M7)
rare
megakaryoblasts, possible cytoplasmic budding
myeloperoxidase & sudan black b negative
WHO AML classifications
- AML w/ characteristic/ recurrent genetic abnormalities
- AML w/ multilineage dysplasia
- AML & MDS; therapy related
- AML not otherwise categorized (all of FAB)
AML w/ characteristic genetic abnormalities
better prognosis
translocations: t(8;21), t(15;17)
inversions in chromosomes: inv(16)
11q23 abnormalities
AML w/ multilineage dysplasia
prior MDS or MPD that transforms into AML
most often in elderly patients & often worse prognosis
AML & MDS therapy related
prior chemo &/or radiation and subsequently develop AML or MDS
often carry a worse prognosis
AML not otherwise categorized
includes all of FAB classification
