Leukemia Flashcards
Chronic lymphocytic leukemia
Chronic lymphocytic leukemia (chronic lymphoid leukemia, CLL) is a monoclonal disorder characterized by a progressive accumulation of functionally incompetent lymphocytes. CLL is the most common form of leukemia found in adults in Western countries
Clinical signs:Localized or generalized lymphadenopathy Splenomegaly (30-40% of cases) Hepatomegaly (20% of cases) -Petechiae •Pallor
Rai Staging
This system divides CLL into 5 stages based on the results of blood tests and a physical exam:
Rai stage 0:Lymphocytosis; no enlargement of the lymph nodes, spleen, or liver; red blood cell and platelet counts are near normal.
Rai stage I:Lymphocytosis; enlarged lymph nodes; spleen and liver are not enlarged; red blood cell and platelet counts are near normal.
Rai stage II:Lymphocytosis; enlarged spleen (and maybe an enlarged liver); lymph nodes may or may not be enlarged; red blood cell and platelet counts are near normal.
Rai stage III:Lymphocytosis; lymph nodes, spleen, or liver may or may not be enlarged; red blood cell counts are low (anemia); platelet counts are near normal.
Rai stage IV:Lymphocytosis; enlarged lymph nodes, spleen, or liver; red blood cell counts may be low or near normal; platelet counts are low (thrombocytopenia).
Doctors separate the Rai stages into low-, intermediate-, and high-risk groups when determining treatment options.
Stage 0 is low risk.
Stages I and II are intermediate risk.
Stages III and IV are high risk.
Binet stages
A- few areas of lymphoid tissue enlargement with normal CBC
B- 3 or 4 of lymphoid tissue enlargement with normal CBC
C- more than 4 lymphoid tissue enlargement with anemia and thrombocytopenia
Diagnostic criteria
Criteria and treatment
1) A peripheral blood lymphocyte count of greater than 5 G/L, with less than 55% of the cells being atypical
2) The cell should have the presence of Bcell-specific differentiation antigens (CD19, CD20, and CD24) and be CD5(+)
3) A bone marrow aspirates showing greater than 30% lymphocytes
Treatment
-Alkylating agents (chlorambucil, cyclophosphamid
-Nucleoside analogs (cladribine, fludarabine)
-Biological response modifiers,eg erythropoietins, interferons, interleukins, colony-stimulating factors, granulocyte and macrophage colony-stimulating factors, stem-cell growth factors, monoclonal antibodies, tumor-necrosis-factor inhibitors, and vaccines.
-Monoclonal antibodies
Bone marrow transplantation
And systemic complications requiring therapy:
antibiotics
immunoglobulin
steroids
•blood products
Chronic myelogenous leukemia
Chronic myelogenous leukemia (CML), also known as chronic myeloid leukemia, is a myeloproliferative disorder characterized by increased proliferation of the granulocytic cell line without the loss of their capacity to differentiate. Consequently, the peripheral blood cell profile shows an increased number of granulocytes and their immature precursors, including occasional blast cells. CMLaccounts for 20% of all leukemias affecting adults
Phases
Chronic stable phase
Blasts < 10% in peripheral blood and bone marrow
Accelerated phase
Blasts comprising 10-19% of white blood cells (WBCs) in peripheral blood and/or nucleated bone marrow cells
Peripheral blood myeloblasts and promyelocytes combined ≥30%
Peripheral blood basophils ≥20%
Persistent thrombocytopenia (< 100 × 109/L) unrelated to therapy or persistent thrombocytosis (> 1000 × 109/L) unresponsive to therapy
Increasing WBC counts and spleen size unresponsive to therapy
Additional clonal cytogenetic abnormalities in Philadelphia chromosome–positivecells
Blast crisis
Blasts ≥ 20% of peripheral blood WBCs or nucleated bone marrow cells
Extramedullary blast proliferation
Large foci or clusters of blasts on bone marrow biopsy
Treatment
Pharmacotherapy-
Old Standard: hydroxyurea (no possible cytogenic response) or interferon alpha + cytarabine
New Standard: tyrosine kinase inhibitors
•Imatinib, dasatanib, nilotonib
Stem Cell Transplant
Using bone marrow from a donor to “resupply” the patient
