Leukemias Flashcards
Leukemia
Cancer of the WBC's Acute or chronic cell growth Affects ability to produce normal cells BM makes large amounts of immature cells "crowd out" anemia, bleeding, infxn
Which blood-forming tissues does leukemia affect?
Bone Marrow
Lymph
Spleen
Myelogenous Leukemia
Characterized by proliferation of myeloid tissue (as of bone marrow and spleen)
Abnormal increase in the number of granulocytes, myelocytes and myeloblasts in circulating blood
Lymphocytic leukemias
Characterized by immature lymphocytes and their progenitors that originate in the BM, but infiltrate the spleen, lymph, CNS and other tissues.
AML
Primarily affects older people
Acute Myeloid Leukemia
Suppresses normal blood cell production
ALM risk factors
Age (over 60) Benzene exposure Radiation Tobacco (20% linkage) Genetic disorders (Down syndrome) Past chemo/meds/cancers
AML stats
12,000 new cases each year
50% mortality
65 yo 5 yr survival = 4%
20 - 30% experience remission and cure
AML Symptoms
Fatigue, SOB, Fever, Weight loss
Easy bruising, bleeding, recurrent infxns
Symptoms usually present for 3 or more months before dx is made.
AML signs
FUO > 3 wks Multiple bruises GI, gingival bleed Splenomegaly Sternal tenderness
AML lab findings
Anemia (normochromic, normocytic)
Leukocytosis (around 150,000)
Thrombocytopenia <100,000
AML morphology
> 20% myeloblasts in blood/marrow
Auer rods (cytoplasmic granules)
Hypercellular bone marrow
AML tx
Chemotherapy (induction, intensification, maintainence)
Bone marrow transplant
Transfusions (for platelets <8)
Empirical Abx for fever
Allopurinol for increased uric acid levels
ALL
Acute Lymphoid Leukemia
Clonal proliferation and accumulation of blast cells in blood, marrow and other organs.
Originates in B or T cell progenitor
20% of acute leukemias
ALL stats
3,000 new cases per year in children
Mostly affects children (peak 4 yrs)
May be B, T cell or null (neither)
ALL Symptoms
Fever, fatigue, SOB, weight loss/fatigue
Bleeding, bruising, petechiae
Bone Pain
ALL signs
Fever Splenomegaly, hepatomegaly Lymphadenopathy Multiple bruises, petichiae Unexplained infxns CN palsies, HA, N/V, papilledema
ALL lab findings
Anemia (normochromic, normocytic)
WBC < 5000, or > 25,000
Thrombocytopenia
Blast cells
in ALL, is B or T cell lineage more common?
B cell lineage (85%)
ALL morphology
L1: Small round blasts, clumped chromatin
L2: Pleomorphic larger blasts, clefted nuclei, fine chromatin
L3: Large blasts, nucleoli, vacuolated cytoplasm
Chromosome philadelphia
If positive, indicated VERY high-risk ALL
High-risk ALL
Over 35 yrs old
>30 G/L in B-ALL
>100 G/L in T-ALL
NO remission after 4 weeks of induction therapy
ALL Tx
Antineoplastic treatment CNS preventative tx supportive care Tx of complications Chemotherapy (methotrexate) Stem cell transplant
ALL prognosis
Children: complete remission (CR) 95 - 99%
Children: leukemia-free survival (LFS) 80%
Adults: CR 80 - 85%
Adults LFS: 30 - 40%
CML
Chronic Myeloid Leukemia
Proliferative disorder of hematopoetic stem cells
Has Ph (Philadelphia) chromosome and Bcr-Abl tyrosine kinase
Bcr-Abl Tyrosine Kinase
A single molecular abnormality that causes transformation of a hematopoetic progenitor into a malignant clone.
3 phases of CML
Chronic phase
Accelerated phase
Blast crisis
CML stats
1-2 cases per 100,000 ppl
More common in women
Median age is 50 yrs
Philadelphia chromosome present in _____ of cases.
95%
CML S/S
40% asymptomatic Splenomegaly (increased abd girth) Anemic features Abnormal platelet fxn Gout, visual disturbances Chronic infxn - fever
CML lab findings
Anemia (normochromic, normocytic)
Leukocytosis (20,000)
Basophilia
Thrombocytopenia
CML morphology
Hypercellular (reduced fat spaces) Myeloid erythroid ratio 10:1 to 30:1. Myelocyte predominant cell, blasts <10% Megakaryocytes increased and dysplastic Increased reticulin fibrosis
CML chronic phase
85%
lasts 3-5 years
Treatment w/ alpha interferon
CML accelerated phase
difficult to control lasts 6 - 9 months Symptoms related to hypermetabolism Blasts > 15% in blood Thrombocytopenia Basophils >20%
CML blastic phase
Resembles acute leukemia
Diagnosis requires >30% blasts in marrow
Survival is around 3 months
CML tx
Prolong chronic phase Alpha interferon, chemo Hydration Eradicate malignant clone Allogenic transplantation
CML prognosis
Median survival: 3.5 yrs
Interferon and Chemo: 6 yrs
Transplant: 5+ yrs
CLL
Chronic lymphoid leukemia
4 - 7 cases per 100,000 ppl
30% of all leukemia cases
Most common lymphoid lukemia
CLL stats
Median age is 70 years
only 10% of pts are <50 yrs old
More males than females
80% due to B lymphocytes
CLL Symptoms
25% are asymptomatic at time of dx
fever, night sweats, fatigue, SOB, pallor
Easy bruising, bleeding, weight loss, infxns
CLL signs
Fever spleno/hepatomegaly Lymphadenopathy Multiple bruises Easy bleeding Leukemia cutis
CLL lab findings
Lymphocytes > 20,000 microL, which is usually 75 - 98% lymphocytes
HCT and platelets are normal
Smudge cells, soccer balls **
B cell specific differentiation antigens
CLL Rai classifications, survival rates
0: Lymphocytosis >5 G/L (>10 yrs)
I: Lymphocytosis + Lymphadenopathy (>8 yrs)
II: “ + splenomegaly (6 yrs)
III: “ + anemia < 2 yrs)
CLL Tx
Alkylating agents Nucleoside analogs Monoclonal antibodies Bone marrow transplant Tx of symptoms (abx, steroids, blood)
Hairy Cell Leukemia
2% of all adult leukemias
Usually in males >40
Chronic disease of B cell proliferation
Hairy Cell S/S
Splenomegaly Pancytopenia Infxn Vasculitis Decreased WBC and platelets Hairy Cells
Hairy Cell Tx
Chemo
Alpha-interferon
Good prognosis
