Acute Leukemias

Question 1

Leukemia definition?

Answer 1

A hematological malignancy characterised by accumulation of immature cells or blasts in the bone marrow and eventually in the blood.

Question 2

Classification of Leukemias?

Answer 2

Leukemias are generally classified into 2;
Acute and Chronic Leukemias.
Each however is subclassified based on the lineage of blasts cells into Myeloid and Lymphoid Lineages. ie
Acute Myloid Leukemia and Acute Lymphoid Leukemia
Chronic Myeloid Leukemia and Chronic Lymphoblastic Leukemia

Question 3

Acute Leukemias

Answer 3

Aggresive disease in which immature progenitor cells/ balst cells accumulate in the bone marrow.

Question 4

What is the diagnostic feature of acute Leukemia?

Answer 4

Presence of >30% of Blast cells in the bone marrow or blood at clinical presentation.

Question 5

Epidemiology of Acute Leukemias?

Answer 5

Account for 50-60% of all leukemias with the myeloid types more common than the lymphoid types.

Question 6

What is Acute Myeloid Leukemia?

Answer 6

Accumulation of immature myeloid blasts in the bone marrow due to oncogenic mutations that impede differentiation.

Question 7

Age Distribution of AML?

Answer 7

Occurs at all ages but peaks at around ages 60 to 65

Question 8

How are myeloblasts differentiated from Lymphoblasts?

Answer 8

1. Presence of Auer Rods, which are purple crystalline cytoplasmic inclusions
2. Coarse cytoplasmic granules when they show some maturation into promyelocytes
3. Cytochemical or Immunological markers

Question 9

What is the FAB classification?

Answer 9

A system of AML classification which divides AMLs based on the degree of diffenrentiation and also the lineage of leukemic blasts.

Question 10

How many types of AMLs are present according to FAB.

Answer 10

Classifies AML from M0 to M7

Question 11

WHO subdivides AML into how many types?

Answer 11

4

Question 12

Make a statement on M0

Answer 12

M0 is the first type ofAML in the FAB classification.
Characterised by Myeloperoxidase negative blasts which are immature.
Myeloid antigens detected by Flow cytometry
5% of AmLs

Question 13

what are the charecteristics of M1

Answer 13

Contains still immature blasts of which >3% are myeloperoxidase positive.
accounts for 15% of all AmLs

Question 14

What are the Features of M2.

Answer 14

M2 cells show granulocytic maturation and hence abnormal cytoplasmic granules are present. Auer rods can also be seen .
t(8;21)(q22;22), t(6;9)

Question 15

Features of M3?

Answer 15

Acute Promyeloctyic Leukemias . APLs.
Numerous Auer rods which often form bundles called faggots.
May have prominent granules / inconspicous in the micronodular type.
There is an increased incidence of DIC

Question 16

Features of FAB M4?

Answer 16

Acute myelomonocytic leukemia. Usually due to inversion on chromosome 16.(p13q22) or a deletion.
A variant M4Eo is characterised by presence of Eosinophilic precursors with abnormal basophilic granules. Due to inversion on chr16 or a translocation. t(16;16)

Question 17

Features and subclasses of M5?

Answer 17

M5 aka Acute monoblastic leukemia. subclassified into M5a and M5b
M5a is characterised by presence of non esterace positive monoblasts and promonoblasts.
M5b is characterised by presence of mature monocytes, and is commonly due to del(11q), t(9;11) , t(11;19)

Question 18

What are the characteristics of M6?

Answer 18

M6 is characterised by presence of erythroid precursors mixed with myeloid blasts. Also subckassified into M6a and M6b.
M6a -erythroid/myeloid subtype.ddfined by >50% of erythroid precursors mixed with >20% myeloid blasts
M6b- Pure erythroid subtype. Defined by >80% of erythroid precursors without myeloblasts. Rare

Question 19

Features of M7?

Answer 19

Acute Megakaryoblastic leukemia due to t(1;22). Xterized by blasts of megakaryocyte lineage. Detected with antibodies against megakaryocyte specific markers such as GpIIb/IIIa or vWF.
Most common AML in Down syndrome and associated with Marrow fibrosis

Question 20

Describe the clinical presentation of a patient with AML?

Answer 20

》Weakness
》Shortness of breath
》Bleeding disorders
》easy fatigueability
》Weightloss and loss of appetite
》Fever

Question 21

What are the Routine investigations to be carried out?

Answer 21

1. FBC

2. Bone Marrow Aspirate

Question 22

How is AML managed?

Answer 22

1.Chemotherapy
2.Radiation Therapy
3.Stem cell therapy.
4.Targeted therapy.
Note:Goal of treatment is to achieve complete remission

Question 23

Prognosis?

Answer 23

60% achieve complete remission with chemo but only about 15 to 30% remain free after 5 years
AMLs with t(8;21)ie M2 and inv
(16), M4, have good prognosis with conventional chemo