Summary of Leukemias

This is a brief summary of four leukemias:  CML, CLL, AML, ALL.

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ADDITIONAL TAGS
Leukemia
CML
CLL
AML
ALL
Chronic
Myelogenous
Leukemia
Chronic
Lymphocytic
Leukemia
Acute
Myeloid
Leukemia
Acute
Lymphoblastic
Leukemia

Chronic Myelogenous Leukemia
Neoplasm of progenitor stem cell → considered myeloproliferative
Malignant cells can still differentiate → morphological heterogeneity
Clinical:  ambiguous symptoms (fever, sweats, weight loss) or asymptomatic; occurs in adults (median 66); hepatosplenomegaly; high WBC (neutro/baso/eosinophils), low RBC, high plts
Characteristic translocation t(9;22) forming the Philadelphia chromosome
New BCR-ABL fusion protein codes for an oncogenic tyrosine kinase
Diagnose with FISH for t(9:22) or PCR for BCR-ABL transcript
Chronic phase → accelerated phase → blast phase (AML, ALL)
Treat with imatinib (tyrosine kinase inhibitor), cure with allogeneic stem cell transplant
CML
CLL
AML
ALL

Chronic Myelogenous Leukemia
CML
CLL
AML
ALL
Peripheral blood (MGG stain): marked leucocytosis with granulocyte left shift

Chronic Myelogenous Leukemia
CML
CLL
AML
ALL
Peripheral blood (MGG stain): marked leucocytosis with granulocyte left shift

Chronic Lymphocytic Leukemia
Malignancy of mature (but naive) B cells; which are differentiated → morphological homogeneity, clonal
Clinical:  ambiguous symptoms (fever, sweats, weight loss); occurs in adults (median 72); hepatosplenomegaly; lymphadenopathy; high WBC (neutro/baso/eosinophils), low RBC, low plts; hypogammaglobulinemia → frequent infections (respiratory by encapsulated bacteria)
Autoimmune hemolytic anemia; immune thrombocytopenia (2%)
Spherocytes, smudge cells
Flow cytometry:  CD19+, CD20+, CD23+, CD5+, Zap-70, CD38+, gamma OR lambda but not both
CD10- (unlike follicular, burkitt, ALL); CyclinD1- (unlike mantle cell)
Rai:  stage 0 is leukocytosis only; stages I, II, III, IV has lymphadenopathy, splenomegaly, anemia, thrombocytopenia, respectively (I,II,III,IV=L,S,A,T)
Not curable, but good long-term prognosis
CML
CLL
AML
ALL
zap70 is the itams associated with TCR, usually on T-cells but its on CLL B cells… CD38 is white blood cells in general

Chronic Lymphocytic Leukemia
CML
CLL
AML
ALL
Peripheral blood (MGG stain): marked leucocytosis with granulocyte left shift

Chronic Lymphocytic Leukemia
CML
CLL
AML
ALL

Acute Myeloid Leukemia
Malignancy of immature myeloid progenitor; proliferation of granulocyte blast cells; cannot differentiate → morphological homogeneity, clonal
Smear:  large blasts; 20% blasts; Auer rods (crystallization of mpo, DIC)
Clinical:  high WBCs, low RBCs, low neutrophil, low plts
Arise from t(15;17) → Acute Promyelocytic Leukemia (APL)
Disrupts RAR, which inhibits maturation, because retinoic acid (RA) is a differentiator → treat with ATRA, good prognosis
Arise from FLT3 mutation (de novo), which makes tyrosine kinase → bad
Other bad prognoses → deletion of chr 5 or 7, old age, AML from previous MDS or treatment (chemo/rad)
Curable:  treat with 7+3 chemo → 7 d cytarabine and 3 d anthracycline; potential for allogeneic stem cell transplant
CML
CLL
AML
ALL

Acute Myeloid Leukemia
CML
CLL
AML
ALL
Peripheral blood (MGG stain): marked leucocytosis with granulocyte left shift

Acute Myeloid Leukemia
CML
CLL
AML
ALL

Acute Lymphoblastic Leukemia
Malignancy of immature lymphoid progenitor; proliferation of B or T blast cells; cannot differentiate → morphological homogeneity, clonal
Clinical:  low RBCs, low neutrophil, low plts, hepatosplenomegaly
Tumor lysis syndrome:  high K, high uric acid, high LDH, high PO43-, low Ca → renal failure
Lymph node, mediastinal mass
Most common cancer in children (peak incidence ages 2 to 5)
Risk factors:  chemo/rad, down’s, NF, Bloom synd, ataxia telangiectasia
B cell ALL is more common, expresses CD10+, TdT+, CD19+, CD20+
Good prognosis if:  hyperdiploid, age 1-10, t(12;21),
Bad prognoses if:  hypodiploid, high WBC, t(9;22), abn(11q23)
T cell ALL is less common, represents as thymic mass in teenagers
CML
CLL
AML
ALL
young - median age is 11


Acute Lymphoblastic Leukemia

CML
CLL
AML
ALL

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