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1
Q

▪ Acute Lymphoblastic Leukemia

A

ACUTE LYMPHOCYTIC LEUKEMIA (ALL)

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2
Q

▪ uncontrolled growth of abnormal lymphoid cells in the

A

spleen, bone marrow, and lymph nodes

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3
Q

Proliferation of abnormal lymphoid lineage in the bm

A

ACUTE LYMPHOCYTIC LEUKEMIA (ALL)

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4
Q

▪ DEFECT:

A

DNA synthesis of lymphoblasts

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5
Q

• not defective but longer than normal tissues (?)

A

> 1hour

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6
Q

▪ ALL: primarily a disease of

A

childhood and adolescence

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7
Q

• accounting for [?] of childhood cancers and up to [?] of childhood leukemia (peak is at [?)

A

25%

75%

2 years of age

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8
Q

• most common:

A

children between 2-10 years old

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9
Q

uncontrolled growth of abnormal lymphoid cells in the bm = abnormal infiltration of cells in:

A

bm, spleen, liver, lymph nodes

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10
Q

▪ same with other acute leukemias (weight loss, night sweats/malaise) but

A

onset is more sudden

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11
Q

: due to proliferation of lymph. in the bm, other blood cells are not produced

A

▪ cytopenia

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12
Q

: enlargement of spleen and liver presses on the nerves (not common in AML)

A

▪ cranial nerve paralysis

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13
Q

▪ splenomegaly, hepatomegaly, and enlargement of the

A

superficial lymph nodes

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14
Q

▪ common causes of death:

A
  1. infection
  2. bleeding (spontaneous)
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15
Q

: lymph. produced are not stimulated by any microbes; no antigenic stimuli; nonreactive

A
  1. infection
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16
Q
  1. bleeding (spontaneous): due to [?]; leukemic cells infiltrates the: [?]
A

low platelet count (< 50 x 109 /L) or lower at (< 20 x 109 /L)

spleen and liver affecting Vit K dependent factors (↓: II, VII, IX, X)

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17
Q

▪ common causes of infections:

A

• S. aureus
• P. aeruginosa
• C. albicans
• H. influenza
• P. mirabilis

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18
Q

▪ WBC count:

A

• vary from low (< 5.0 x 109 /L) to high (> 100 x 109/L)

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19
Q

▪ predominant circulating cell:

A

leukemic lymphoid blast or lymphoblast

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20
Q

• except in conditions of [?] (has few or no circulating lymphoblasts)

A

aleukemic leukemia

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21
Q

▪ bone marrow:

A

• hypercellular (> 100 x 109/L WBC ct)
• heavily infiltrated with lymphoid cells
• presence of fibrosis (abnormal infiltration of lymphocytes in the bm causing bone pain)

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22
Q

B CELL ALL General criteria:

A

> 25% lymphoblast in BM is identified as Blineage lymphocytes

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23
Q

: equivalent to L1 and L2

A

▪ B-ALL & B-LBL

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24
Q

B CELL ALL morphology not mentioned by FAB

A

• lymphoblast with pseudopod projections often seen

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25
▪ criteria: > 25% lymphoblasts in BM
A) Precursor B-lymphoblastic Leukemia (B-ALL)
26
▪ present in childhood (poor prognosis in adults) B ALL B LBL T ALL T LBL
A) Precursor B-lymphoblastic Leukemia (B-ALL)
27
▪ criteria: > 25% lymphoblasts in BM extranodal sites (lymph nodes and spleen; mass lession)
B) B-lymphoblastic Lymphoma (B-LBL)
28
▪ involvement of lymph nodes which exhibits more mass lesions (less leukemic process)
B) B-lymphoblastic Lymphoma (B-LBL)
29
▪ rare B ALL or B LBL
B) B-lymphoblastic Lymphoma (B-LBL)
30
T CELL ALL general criteria:
> 25% lymphoblast in BM identified as B-lineage lymphocytes
31
▪ present in children (15-20%) and adults (25%)
A) Precursor T-lymphoblastic Leukemia (T-ALL)
32
▪ more mitotic blast cell
A) Precursor T-lymphoblastic Leukemia (T-ALL)
33
▪ frequently found in males in all ages, predominantly in adults
B) T-lymphoblastic Lymphoma (B-LBL)
34
BASIS OF FAB
▪ cytologic features ▪ degree of heterogeneity in distribution among the leukemic cell population (age)
35
▪ cytologic features:
cell size, chromatin, nuclear shape, nucleoli, degree of basophilia in the cytoplasm, and presence of cytoplasmic vacuolation
36
▪ Cell size: small
L1
37
▪ Cell size: homogenous
L1 L3
38
▪ Cell size: large
L2 L3
39
▪ Cell size: heterogenous
L2
40
NON-B
L1 L2
41
BURKITT TYPE
L3
42
▪ Nucleus: regular
L1 L3
43
▪ Nucleus: occasional clefting
L1
44
▪ Nucleus: irregular
L2
45
▪ Nucleus: common clefting or indentation
L2
46
▪ Nucleus: oval to round
L3
47
▪ Nucleus: no clefting
L3
48
▪ Nucleoli: rare
L1
49
▪ Nucleoli: not visible or small
L1
50
▪ Nucleoli: inconspicuous
L1
51
▪ Nucleoli: present (often large)
L2
52
▪ Nucleoli: 1-3 (vesicular)
L3
53
Chromatin : homogenous
L1
54
▪ Chromatin : variable
L2
55
▪ Chromatin : finely stippled
L3
56
▪ Amount: scanty
L1
57
▪ Amount: moderately abundant
L2 L3
58
▪ Amount: moderately abundant
L2 L3
59
Vacuolation: variable
L1 L2
60
▪ Vacuolation: often prominent
L3
61
▪ Basophilia: moderate
L1
62
▪ Basophilia: variable
L2
63
▪ Basophilia: intense
L3
64
▪ Incidence: 15 y/o and below
L1
65
▪ Incidence: older than 15 y/o (adult)
L2
66
▪ Incidence: rare
L3
67
▪ most common (more treatment available)
L1
68
▪ best prognosis
L1
69
▪ L3 cytogenic abnormality:
t(8;2;14;22)
70
▪ worst prognosis
L3
71
▪ “Burkitt’s lymphoma”
L3
72
A translocation between [?] appears to mark a type of ALL that can evolve into a myeloid (AML) or monocytic diseases
ch4 and ch11
73
Neutrophil primary granules
Myeloperoxidase (MPO)
74
Phospholipids
Sudan Black B (SBB)
75
Cellular enzyme
Specific Esterase Non-specific Esterase
76
Intranuclear enzyme
Terminal Deoxyribonucleotidyl Transferase (TdT)
77
Glycogen
Periodic Acid Schiff (PAS)
78
Myeloblasts are strongly positive
Myeloperoxidase (MPO) Sudan Black B (SBB) Specific Esterase
79
Differentiates ALL (-) from ANLL (+)
Myeloperoxidase (MPO) Sudan Black B (SBB)
80
Monoblasts are strongly positive (M4, M5)
Non-specific Esterase
81
Lymphoblasts are positive
Terminal Deoxyribonucleotidyl Transferase (TdT) PAS
82
Differentiates ALL (+) from ANLL (-)
Terminal Deoxyribonucleotidyl Transferase (TdT)
83
Important in identifying blastic transformation of CML
Terminal Deoxyribonucleotidyl Transferase (TdT)
84
(+) M6 (Erythroleukemia)
Periodic Acid Schiff (PAS)
85
Differentiates L1 (4+) from L2 (1-2+) of ALL
Periodic Acid Schiff (PAS)
86
Periodic Acid Schiff (PAS) ▪ L1: ▪ L2:
chunky granules (block-like) in staining (very reactive) minimal granular appearance
87
(+) AML-M7 (+) ALL L1-L3
Acid Phosphatase
88
Early (pro/pre-pre) B-ALL
CD34, CD19, cytoplasmic CD22, TdT
89
Intermediate (common)
BALL CD34, CD19, CD10, cytoplasmic CD22, TdT
90
Pre-B ALL
CD34, CD19, cytoplasmic CD22, cytoplasmic m, TdT (variable)
91
T-ALL
CD2, CD3, CD4, CD5, CD7, CD8, TdT
92
Immunologic markers
93
: detects B lymphocytes
Surface immunoglobulin (SIg)
94
: detects T lymphocytes
Sheep erythrocyte receptor
95
: +70% of ALL patients
CALLA (common acute lymphoblastic antigen)
96
NOT present on normal peripheral lymphocytes
CALLA (common acute lymphoblastic antigen)
97
NOT specific for leukemia (also present on normal BM cells that are positive for TdT and HLA-DR antigen)
CALLA (common acute lymphoblastic antigen)
98
normal in blast cells/bm; abnormal in the circ
CALLA (common acute lymphoblastic antigen)
99
▪ present on the leukemia cells of 70% of ALL patients
CALLA
100
▪ not present on normal peripheral lymphocytes
MONOCLONAL COMMON ACUTE LYMPHOBLASTIC LEUKEMIA ANTIGEN (CALLA)
101
NOT specific for leukemia because it is also present on normal BM cells that are positive for TdT and HLA-DR antigen
MONOCLONAL COMMON ACUTE LYMPHOBLASTIC LEUKEMIA ANTIGEN (CALLA)
102
CLASSIFICATION BASED ON IMMUNOLOGIC + CYTOCHEMICAL PROPERTIES
103
▪ absence of T antigens, SIg, and CALLA
Null/Unclassified ALL
104
▪ presence of CALLA, HLA-DR, and TdT
Common ALL (cALL)
105
▪ highest remission rate even after chemotherapy
Common ALL (cALL)
106
• due the appearance of a tumor chromosome identical to Ph1 chromosome (presence makes poor prognosis)
Common ALL (cALL)
107
▪ T-cell antigen and sheep erythrocyte receptor
T ALL
108
▪ usually occurs in males
T ALL
109
▪ CNS involvement
T ALL
110
▪ poorer prognosis
T ALL
111
▪ T-cell antigen without sheep erythrocyte receptor
Pre-T ALL
112
▪ presence of cytoplasmic immunoglobulin (CIg)
Pre-B ALL
113
▪ absence of SIg
Pre-B ALL
114
▪ presence of CIg, SIg, and B cell antigen
B ALL
115
▪ corresponds to FAB L3 classification
B ALL
116
: present in all ALL types except B ALL
TdT

Hematology 2 Lec (29 decks)

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