Leukemias Overview: ALL, CML, AML, APML, CLL Acute leukemias > 20% blasts in the peripheral blood smear or on bone marrow leading to a more rapid onset of symptoms. Chronic leukemia < 20% blasts with a relatively chronic onset of symptoms. ALL (Acute Lymphoblastic Leukemia): • Lymphocytes - T or B lineage • Immature • Age: 10 • 75% usually under 6 years age • 75% of ALL is of B-cell lineage ALL Symptoms: • Malaise, bleeding, infections, bone pain • Bulky lymphadenopathy • Blast cells - Blood and Bone marrow • Mature B-cell ALL can present as extramedullary disease, including gastrointestinal or testicular involvement • T-cell ALL: mediastinal mass • Rapidly rising blast cells - Blood & BM • Bulky lymphadenopathy • Cytopenia -> BM involvement • 30%: CNS involvement CML (Chronic Myeloid Leukemia): • Neutrophils (myeloid)↑ • Mature • Age: 40-60 • + (9;22) Philadelphia - BCR-ABL • ↑ Tyrosine Kinase activity • ↓ LAP Score • CML -> AML: Blast crises • Blasts > 10% leukocytes Blast Phase: • Headaches, bone pain, fever, joint pain, bleeding, infections, and lymphadenopathy CML Findings: • Splenomegaly • ↑ Leukocyte count ↑ PLT • ↑ PBS: Granulocytic cells in all phases of maturation • (Peripheral eosinophilia, basophilia, and thrombocytosis) CML Symptoms: • Fatigue, weight loss, abdominal fullness (splenomegaly), night sweats, bleeding • Pruritis after hot bath/showers • Lymphadenopathy AML (Acute Myeloid Leukemia): • Neutrophils • Immature/Myeloblasts • Age: 50-60 • Auer Rods Significant ↓ PLT: Petechiae, bruising, bleeding, infection RARE - Lymphadenopathy/HSM Leukocyte Count: • ↑ Can develop leukostasis syndrome: CNS manifestations, hypoxia, CXR - infiltrates (anemia, thrombocytopenia, or functional neutropenia) • Bone pain, dyspnea, gingival hypertrophy • Leukemia cutis (violaceous, nontender cutaneous plaques) AML Dx: • ↑ Leukocyte count • ↓Hg & PLT • Peripheral smear: Blasts APML (Acute Promyelocytic Leukemia): • Poorly differentiated leukocytes + distinctive primary granules • t(15;17) translocation • Significant bleeding: Fibrinolysis & DIC • Tumor lysis syndrome: Develops in treated pts. Intracellular Urate, Potassium and Phosphorus CLL (Chronic Lymphocytic Leukemia): • Lymphocytes • Mature • Age: 60-80 Clonal Accumulation of Mature B Lymphocytes: • In the peripheral blood, bone marrow and secondary lymphoid organs When Cancer Cells are in the Lymph Nodes: • Small lymphocytic lymphoma (SLL) CLL Symptoms: • Lymphadenopathy • HSM • Fevers • Drenching night sweats/fatigue • Exaggerated response to mosquito bites CLL -> Invade Skin: Leukemia cutis Labs: • Lymphocytosis/Cytopenias • AIHA, ITP, Agranulocytosis • Hypogammaglobulinemia, smudge cells Richter's Transformation: • Complication of Chronic Lymphocytic Leukemia (CLL) and/or Small Lymphocytic Lymphoma (SLL) • Sudden transformation of the CLL/SLL into a significantly more aggressive form of large cell lymphoma #Leukemia #Hematology #Oncology #Diagnosis
