Leukemia: AML, ALL, CML, CLL

Question 1

Leukemia

• pathophysiology
• types
• presentation
• diagnosis
• management

Answer 1

Malignant neoplastic proliferation of hematopoetic blood cells => accumulate in BM that prevent maturation of normal cells

ALL - most common in children
AML
CLL - most common in adults
CML -

BM failure - anemia, thrombocytopenia, neutropenia
-fatigue, SOB
-bruising, easy bleeding
-frequent infections
Neoplastic infiltration in primary and secondary lymphoid organs
-BM - bone pain
-thymus - mass, airway compression
-hepatosplenolymphadenopathy

Blood count, smear
BM smear
Immunophenotyping

Chemo, BM transplant, RT

Question 2

ALL

• pathophysiology
• risk factors
• presentation
• diagnosis
• management

Answer 2

Immature lymphoblasts (B or T) accumulate in BM => physical suppression of normal blasts

MOST COMMON IN CHILDREN
-Downs

Abrupt onset
-BM failure + neoplastic infiltration

Blood count, smear - high WCC, lymphoblasts
BM smear - lymphoblast domination

Chemo, radiotherapy

Question 3

AML

• pathophysiology
• risk factors
• presentation
• diagnosis
• management

Answer 3

Immature myeloblasts (neutrophil, eosinophil, basophil, monocytes, megakaryocyte precursors) accumulate in BM => physical suppression of normal blasts

Adults, children with Downs
RT, CT
MPD

Abrupt onset

• BM failure + neoplastic infiltration
• gum swelling

Blood count, smear - high WCC, anemia
BM smear - high myeloblasts

Chemo, BM transplant

Question 4

CLL

• pathophysiology
• risk factors
• presentation
• diagnosis
• management

Answer 4

Mature B cells accumulate in BM => physical suppression of other cells

MOST COMMON IN ADULTS => lymphoma

Late onset
-BM failure + neoplastic infiltration

Blood count, smear - high lymphocytes, smudge cells
LN biopsy - lymphocytic infiltration
Immunophenotyping

Chemo, immuno, BM transplant, RT

Question 5

CML

• pathophysiology
• risk factors
• presentation
• diagnosis
• management

Answer 5

Mature granulocytes accumulate in BM => physical suppression of other cells

Adults
Radiation/benzene exposuree
PHILADELPHIA CHROMOSOME (9,22)

Chronic asymptomatic phase - BM failure
Accelerated symptomatic phase - neoplastic infiltration, worsening BM failure
Blast crisis - increased blasts in blood/BM

Blood count, smear - high granulocytes
BM biopsy - hypercellularity of myeloid line
Immunophenotyping - Philadelphia

Tyrosine kinase inh
BM transplant