Hematology: Intro to Leukemias

new growth, tumor (benign or malignant)

neoplasm

malignant disease characterized by unregulated proliferation of one of the cell lines in the bone marrow

leukemia

leukemia secluded to the bone marrow; lacks typical S/S of leukemia

aleukemic leukemia

tumor in lymphoid tissue (nodes, spleen, etc); can turn into leukemia

lymphoma

How can leukemia arise from bone marrow damage?

Chronic bone marrow dysfunction: aplastic anemia, PNH

Ionizing radiation causes DNA mutations

exposure to chemicals and drugs damages bone marrow

What are some examples of leukemia arising from impaired immune function?

AIDS, immunosuppressive drugs can lead to leukemia

What viruses can lead to leukemia?

HTLV-1 and HIV

What are the two ways leukemia can be classified?

cell type: myeloid or lymphoid

cell maturity: immature (acute) or mature (chronic)

Why is it challenging to diagnose acute leukemias?

there are no S/S when the cancer is secluded to the bone marrow; S/S occur when the cancer leaks into the peripheral blood

Which age group is more commonly associated with acute leukemic conditions? Chronic?

acute: children

chronic: adults (16 and older)

What does AML/AGL stand for? What is the predominant cell involved?

acute myeloblastic/granulocytic leukemia

blasts

What does APL stand for? What is the predominant cell involved?

acute promyelocytic leukemia

promyelocytes

What does AMML stand for? What is the predominant cell involved?

acute myelomonocytic leukemia (Naegeli type)

myelocytes and monocytes

What does AMoL stand for? What is the predominant cell involved?

acute monocytic leukemia (Schilling's type)

monocytes

What does AEL stand for? What is the predominant cell involved?

erythroleukemia or DiGugliemo's

red cells

What does ALL stand for? What is the predominant cell involved?

acute lymphoblastic or lymphocytic leukemia

blasts and lymphs

What does AUL stand for? What is the predominant cell involved?

acute undifferentiated leukemia or stem cell leukemia

stem cell precursors

What does AMegkL stand for? What is the predominant cell involved?

acute megakaryoblastic leukemia

platelets

lymphadenopathy and splenomegaly are ___________ in acute and ___________ in chronic leukemias

mild in acute, present in chronic

With any leukemia, what is the goal of treatment?

eradicate the leukemia

supportive care

What are the four treatment types and their role?

1) chemotherapy: kills the cells, stops them from replicating

2) bone marrow (stem cell) transplants: give pt good cells

3) radiotherapy: localized tissue involvement

4) immunotherapy: stimulates the patient's immune system to help patient's own immune system mount an immune response against malignant cells (currently experimental and unproven)

What are the 3 types of chemotherapy?

1) antimetabolites: kills rapidly dividing cells

2) alkylating agents: kills resting and proliferating cells

3) antibiotics: interferes with cell replication

acute vs. chronic leukemias

age

acute affects all ages, chronic affects adults

acute vs. chronic leukemias

clinical onset

acute is sudden, chronic is insidious

acute vs. chronic leukemias

course (time)

acute is less than 6 months

chronic is 2-6 years

acute vs. chronic leukemias

leuk. cells

acute has immature cells, chronic has mature cells

acute vs. chronic leukemias

anemia

acute has prominent anemia, chronic has mild anemia

acute vs. chronic leukemias

plt count

acute has a low plt count, chronic is variable

acute vs. chronic leukemias

WBC count

acute is variable, chronic is increased WBC

What is a myeloproliferative disorder?

abnormal clonal proliferation of 1 or more hematopoietic cell lines

How are chronic leukemias generally discovered?

patients come in for another reason and get testing, CBCs

Where do B-cells and T-cell mature?

T-cells mature in the thymus

B-cells mature in the bone marrow

After chemotherapy, which cell is the first to return?

T-cells

Which leukemia is most common in children?

ALL (a cute little kid)

Which leukemia is most commonly associated with chromosomal abnormalities?

CML

Which leukemia presents with smudge cells?

CML

Immunotherapy involves which cells?

lymphocytes, because those are what make antibodies and respond to infection

(chronic/acute) can turn into (chronic/acute)

Chronic can turn into acute

Acute is end-stage. Cannot return to chronic