Acute leukemia Flashcards by Mavis Mawuena

What is acute leukemia

A heterogenous group of malignant disorders that is characterised by uncontrotrolled clonal and accumulation of blast cells in the bone marrow and body tissues

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Acute leukemias are classified as

ALL and AML

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A cute lymphoid leukemia mainly occurs in

Children and is curable in 70% of them

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ALL gender distribution

Found in more males than females

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All in adults

Found less in adults and only curable in minority of them

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Acute myeloid leukemia is found mainly in

Adults and is curable in minority of them

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AML gender distribution

M>F

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Causes of acute leukemia

Idiopathic
Underlying hematologic disorders
Chemicals, drugs
Ionizing radiation
Viruses i.e HTLV 1, EBV,HIV
Heredetary genetic conditions like fanconis anemia, down syndrome, ataxia telangectasia

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Pathophysiology of acute leukemia

Blast cells are arrested in the early phase from maturation and also begin to proliferate rapidly due to an abnormal expression of genes often as a result of chromosomal translocations.

Blast cells overtake the bone marrow leading to decreased production of other cells causing anemia, thrombocytopenia and neutropenia

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invasion of vital organs in AL

varies according to subtype

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Hyperluekocytosis in AL

This occurs due to the uncontrolled increase in the number of blast cells which prevents the increase in other cells lines.

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Effects of hyperleukocytosis

increase in blood viscosity
predisposes one to microthrombi or acute bleeding
Can cause decreased organ perfusion

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IN AL there can be hidden site relapse in

testes

meninges

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Metabolic manifestations of AL

Hyponatremia due to vasopressin released by myeloblast

Hypokalemia due to lysozyme released by myeloblast

Hyperurecimea - due to lysis of leukemic blast cells

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Hypokalemia die to lysozyme release usually seen in

AML M5

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Symptoms of AL

Marrow failure
leukostasis
tissue infiltration
constitutional symptoms like fever, weight loss
DIC

Lasts for a short duration

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Signs of AL

Gum hypertrophy
Lymph adenopathy
Hepatosplenomegaly
petechiae
Confusion

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Types of blasts in acute lymphocytic leukemia

L1 -85%
l2-14%
L3-1% (Burkitts lymphoma)

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L1 blast

small homogenous blasts,
single inconspicuous nucleolus
Regular nuclear outline

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L2 blasts

Larger sized blasts

More pleomorphic

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L3 burkitt cell type

Basophilic and vacuolated cytoplasm

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M3 acute promyelocytic leukemia features

Hypergranular;promyelocytes

Auer rods/faggot cells seen

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classical M3 FEATURES

Hypergranular, 80% leucopeanic (low WBC)

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Variant M3 features

hypogranular

leokocytosis

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GRanules in M3 contain

Thromboplastin like Procoagulants leading to massive DIC

Diagnostic feature of M3

t(15;17)

M4- acute myelomonocytic leukemia features

Monocytes | promonocytes

M4 is involved with the part of the body

CNS

Variant M4

M4 with eosinophilia

Variant M4 prognosis

good

AML M5 divided into

M5a - acute monoblastic leukemia | M5b - acute monocytic leukemia

AML associated with

Infiltration into gums and skin

Variant M4 associated with

Deletions and inversions on chromosome 16q

Symptoms of AML M5

Weakness bleeding diffuse erythematous skin rash

50% or more of nucleated marrow cells are

erythroid precursors and cause M6 erythroleukemia

30 % or more of non erythrod cells are

myeloblasts

Acute megarkaryoblastic leukemia M7 associated with

fibrosis of bone marrow

M7 blasts have

cytoplasmic blebs and pseudopod formation

Precursor B cells for ALL

t(9,22) t(11q23) t(1,19) t(12,21)

Precursor T cell ALL

Burkitt-cell leukemia

Diagnosis and classification of aml requires

``` morphological assessment immunophenotyping cytogenic analysis molecular analysis clinical assessment ```

AML definition

A type of cancer of the bone marrow with more than 20 percent blast cells

WHO classification of AML

AML with genetic abnormalities AML with multilineage dysplasia AML therapy related AML not otherwise categorised

What distinguishes AML from ALL

in light microscopy, AML has auer rods, cytoplasmic granules. ALL doesnt have them Flow cytometry for immunophenotyping Special stains

Blast size comparison

small in ALL large in AML

Cytoplasm comparison

Scanty in ALL Moderate in AML

Chromatin material

Dense in ALL, Fine lacy in AML

Nucleoli comparison

Indistinct in ALL, prominent in Aml

AUer rods comparison

Found in AML, not founD IN ALL

cytochemical staining with peroxidase

negative in ALL, positive with AML

Periodic acid schiff stain

Positive ALL, negative AML

Acid phospahtase test is

POsitive in all

What is immunophenotyping

Identification of antigens present on blast cells to identify if leukemia is lymphoid or myeloid Also differentiates T-ALL and B-ALL To identify the subtype of leukemia i.e AML-M7 has a specific marker of CD-61

Common antigens in AML

CD 13,33,117

Common antigens in ALL

``` B-ALL T-ALL CD-10 CD-19 CD-22 CD-3 CD-7 ```

Cytogenics and molecular studies will

Detect abnormalities in leukemic clone And provide prognostic value

Cytogenics and molecular studies will

Detect abnormalities in leukemic clone And provide prognostic value

A biochemical screening that shows leucocytosis will cause

renal impairment | hyperuriceamia

chest radiography that shows mediastinal mass

present in 70% of T-ALL patients

ALL bone lesions seen in

childhood

Diagnostic feature of AML with maturation M2

t(8,21)

Diagnostic feature of ALL,CML

t(9,22)

Diagnostic feature of B-ALL

t(8,14)

Phases of ALL treatment

induction intensification CNS prophylaxis maintenance last 3 are post remission therapy

Phases of ALL treatment

Induction | consolidation-- post remission therapy

Principles of treatment in AL

1. combination chemotherapy ; complete remission and prevent future relapse 2. supportive care ; transfusion, antibiotics, nutrition 3. Psychosocial support

Age as a poor prognostic factor

in ALL if your'e less than 1 and in aml if youre greater than 60

total white blood cell count poor prognosis

if greater than 50*10^9/L

CNS and poor prognosis

if present in both AML and ALL though rare in AML

Sex and poor prognosis

In male who have ALL | IN both male and females who have AML

Poor prognostic factors cytogenic

for ALL T(9,22) | IN AML monosomy 5,7

Acute leukemia Flashcards

(71 cards)