Acute and Chronic Leukemias
ALL AML CLL CML
General - most common leukemia Myeloid problem - most common adult Myeloid
in children (4 – 7 years) leukemia
characteristics problem (that
lymphocyte problem - over 95% B cell cases can lead to ALL
(either B or T cell)! - men to women 2:1 or AML)!
- median age 60 – 65
years
Lymphocyte problem
Signs/ - anemia, Same as ALL - 40% asymptomatic - B symptoms+
Symptoms thrombocytopenia, - Lymphadenopathy, fatigue, gout,
neutropenia hepatomegaly, splenomegaly,
- night sweats, fever, splenomegaly bone pain
weight loss (B - B symptoms + infections
symptoms) - bone pain
- bone pain
CBC - increased WBC Same as ALL (but - WBC elevated - WBC elevated,
- decreased Hgb + differential shows - lack of antibodies (due platelets may or
platelets increased myeloid to lack of functional B may not be
lineage cells) cells) elevated
Smear - Blasts: No cytoplasm, - Blasts: Large - mature-looking - all stages of
big mauve nucleus, mauve nucleus with lymphocytes, smudge granulocytic
prominent nucleoli cytoplasm + Auer cells (blasts) maturation from
rods, cytoplasmic blast cells to
granules neutrophils
(basophils seen)
- overall left shift
Flow - pre-B cell: CD19, CD22, CD13, CD33, CD5, CD19, CD20,
cytometry CD10 Myeloperoxidase CD23, light chain
- T cell: CD7, CD3 restriction
*similar to ALL
Bone marrow - over 20% lymphoid - over 20% Most cells end up in - hypercellular
biopsy blasts myeloblasts periphery – usually not bone marrow
needed with granulocytic
predominance
Histochemical Periodic acid-schiff stain, Myeloperoxidase, * similar to ALL *flow cytometry
staining Tdt sudan Black stain, indicative of
combined esterase increased myeloid
stain (granulocytes progenitors
stain red,
monocytes stain
black)
Treatment Induction therapy Supportive - Gleevec or other
(+CNS prophylaxis), therapy chemotherapy/treatment tyrosine kinase
consolidation, Chemotherapy: ONLY if symptomatic inhibitors
maintenance therapies induction + (cytopenia, infections,
tyrosine kinase inhibitor consolidation etc.) *same as ALL
(if Phil+) Bone marrow
bone marrow transplant transplant if eligible
if needed
Prognosis Children: > 80% 75% achieve - 8 years if enlarged - due to Gleevec,
complete remission and remission with lymph nodes, 6 years if no need for bone
finish 2 – 3 years, over induction therapy, enlarged liver/spleen, 2.5 marrow transplant
70% survival less than 30% cured years if anemia or (fairly good
Adults: 65- 85% thrombocytopenia prognosis)
complete remission, less - IgVH mutations
than 40% survival (very associated with better
poor prognosis for Phil+) results
Cytogenetics T(9;22) – poor prognostic - Favourable: 17p, 11q, 12q trisomy and T(9;22) – Phil+
t(8;21), t(15;17), 13q deletions
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