Leukemia Flashcards
leukemia etiology
idiopathic
drugs/chemicals
radiation
inadequate tumor suppressor gene
forms of leukemia
acute: 50%, aggressive, sudden onset, AML/ANLL- adults, ALL-kids
chronic: less aggressive, insidious onset, more mature cells, adults
acute leukemia clincal presentation
fatigue
pallor
petechiae/bleeding
fever
bonepain
neurologic abnormalities
acute leukemia laboratory presentation
n/n anemia
decreased Plt
variable wbc- dependant on stage of disease
diff: blasts (monotonous), leukemic hiatus, auer rods
bm: hypercellular, incre M:E, 1 cell line predomiinates
increas uric acid and LD
classification of AML
FAB: M0, M1, M2, M3, M4, M5, M6, M7
classification of ALL
FAB: L1, L2, L3
M0 leukemia- myeloblastic w/o differentiation
adults
>90% blasts
positive: MPO/SSB, SPECIFIC ESTERASE
negative; non specific esterase
CD34 markers
M1 leukemia- myeloblastic w/o differentiation
adults
>90% blasts
=/+ auer rods
postive: MPO/SBB, specific esterase, PAS
negative; non specific esterase
M2 leukemia- myeloblastic w/ differentiation
adults
30-89% blasts
10% promyelocytes and myelocytes
+/= auer rods
positive: MPO/SBB, specific esterase, PAS
negative: non specific esterase
M3 leukemia-
promyelocytic
adults
>30% blasts
increas. promyelocytes
auer rods
assoc. w/ DIC
hyer/micro granular variants
15/17 chromo. translocation
rx: trans-retinoic acid
positive: MPO/SBB (+++), PAS, specific esterase
negative: non speicific esterase
M4 leukemia-
myelomonocytic
adults
>30% blasts
increas. monocytes
positive: MPO/SBB, PAS, specific esterase
negative: non specific esterase
M4e variant: eosinophilic variant, inversion of chromo 16, specific esterase is + in these but = in normal eos, better prognosis than M4
M5 leukema-
monocytic
adults
>30% blast
>80% monocytes
blasts, promonocytes, monocytes
positive: MPO/SBB, PAS, specific esterase, non specific esterase (+++)
M5a: monoblasts predominate
M5b: promonocytes predominate (gums/skin, tissue infiltrates)
M6 leukemia-
erythroleukemia
Digugliemo’s syndrome
>30% blasts
>50% RBC precursors
least common leukemia
can evolve from M1/M2
PAS + (VERY)
M7 leukemia-
megakaryoblastic
>30% megakaryoblasts
increas. fibrin & reticulum in marrow
dry tap
rare
Down’s synd.
Plt blebbing
positive: PAS, acid phosphatase
negative: MPO/SBB, specific esterase
classified w/ immunophenotyping
immunophenotyping
cell markers and indicators
flow cytometry
id cell types
cluster of differentiation
CD13 & CD33- Myelocytic and monocytic cells
L1 ALL
small homogenous cells
fine chromatin
no nucleoli
scant cyto
most common in kids
best prognosis
L2 ALL
large cells
fine chromatin
irr. nuclei w/ clefts
nucleoli
abundant cyto
adult
most common ALL
classification of ALL
based on immunophenotyping and cell markers
common acute lymphocytic leukemia antigen (CALLA)
t cell vs. b cell
immature lymphs- tdt +
T cell: CD- 1,2,3,4,5,6,7; positive- acid phosphataste
B cell: CD- 10,19,22; slg positive
REAL classification of leukemia
revised European American lymphoid neoplasm
based on morph, immunophenotyping, genetics, clinical appearance
3 groups: B cell, T/NK cell, Hodgkin’s Disease
Chromosomal anaysis for leukemia
philidelphia chromo 9:22 translocation- CML
15:17 translocation- M3
8:21 translocation- AML
9:14 translocation- M4
WHO classification of Leukemia
based on cell lineage
determined by morph, immunophenotype, genetic features, clinical apperance
~6 groups: ALL, AML, therapy related, not otherwise specified, myeloid syndrome, Down’s syndrome, hematopoetic, lymphopoietic, histocytic/dendritic
>20% blasts defines leukemia
albumin smears
helps w/ increased smudge cells
buffy coat smears
low # wbc or low #abnormal cells
Leukemia therapy
goal: eliminate abnormal clone
chemo
radiation
bm transplant
supportive care
leukemia therapy side effects
kills all fast growing cells
hair, skin, GI
bm suppression: infec., anemia, bleeding
increased cell turnover
increased uric acid (kidney failure)
leukemia prognosis
ALL: 80% survival kids, poorer for adults
AML: 55-65% survival
chronic leukemia: generally longer survivals
