Acute Leukemias

in order to call something leukemia how many blasts should there be

~20%

Leukemias (All and Aml) only affect what cell type

blasts

M0

myeloblastic with minimal maturation

What flow markers are seen in M0

CD33/34+, CD13

in order to differentiate M0 from M1you need to order

immunophenotyping

• No auer rods seen

• <3% blasts MPO/SBB +

• 5% AML

• Affects adults

• CD13, 34, 33+

• poor prognosis

M0- AML

M1

Myeloid Leukemia w/o maturation

WBC: L, NL, H

Low Hgb/Hct

Few aurer rods

10% of the AML

M1 diff/CBC

M1 BM

• hyper cellular marrow

• Blasts >90% of WBC

• Later grans <10%

• Decreased Megs ad nrbc

• CD13, 33, 34+

M1 Stains that are +

• MPO

• SSB

• SpEst

M2

Myeloid with maturation

• WBC H

• Low Hgb/HCt

• Low Plt

• Auer rods seen most of the time

• Dysplasia frequent

• 30-45% of the AML

• HIGH BLASTS

M2 CBC/diff

M2 BM

• Hypercellular

• Blasts>20%

• Blasts <90% of WBC

• Later gans >10%

• Monocytes<20%

M2 + stains

• MPO

• SBB

• spest

Cyto genetics of M2 needed to seperate from M3, what does M2 have

• t(8:22) sometimes (indicated better prognosis)

• CD13, CD33

• CD34±

• CD19 and CD3-

M3 is

HYPER GRANULAR acute proglanulocytic Leukemia

M3 CBC/diff

• WBC low

• Bundles of Auer rods seen

• Nucleus is kidney shaped or bilobed

• 70% of M3 are hyper granular

M3m

Microgranular promyeloctic

• WBC: high

• Blasts resemble monos with ilobed irregular nucleus

• dust like granular

• auer rods possible

• MArrow is hyper granular

M3m CBC/diff/BM

ALL M3 have + stains

• MPO

• SBB

• Spest

What is diagnostic in M3

t(15:17)

What other tests do you run for M3

• DIC complications

• genetics

• MPO

• FISH for PML/RARa

• CD13, CD33+/CD34- (flow)

M4

Acute Myeloonocytic Leukemia or Naegeli type

M4 CBC/diff

• WBC: H

• H-H: LOW

• PLt: LOW

• auer rods may be present

• immature grans

• increase in : monos, prosmonos, blasts/hybrids

• 15-25% AML

• CD13, CD33, CD14, CD64+

M4 BM

• Later grans >20% but <80% of WBC

• Monocytic line > 20% but <80% of WBC

• Often marrow monos are lower than blood amount

M4 + stains

• PAS

• SBB

• SPEST

• Nsest

M4 eo

• EOS increased in marrow and blood >5% but <30%

• Inversion or translocation of long arm Ch. 16

M5a

Acute Monocytic Leukemia or Schillings type

M5a CBC/diff

• WBC varies

• Younger ages

• 5-8% of AML

• Monoblasts >80%
   round or oval nucleus/occ
  fold
   lots of cytoplasm
   few granules
   pseudopods poss.
   Rare Auer rod seen

M5a BM

• Differ from M5b in that the majority of monocytic cells are monoblasts (>80%)

• <20% granulocytes

• Appearance of the abnormal cells varies from case to case
  - CD13, CD33, CD36 pos

M5b CBC and diff

• Mature monos more numerous in blood than marrow

• Majority of monocytic cells are promonocytes <20% granulocytes

• CD13, CD33, CD36 pos

• 3-6% of AML

• Promonocytes:
   fine chromatin;
  cerebriform shape
   cytoplasm more gray
   few fine granules

• Mature monos often
  have extreme folding
  and irregularity

M5a and b are + for what stains

• PAS

• SBB

• NSEST

• Non-sp becomes neg. when NaF added

What genetic abnormality is likely with M5a and b

11q23(MLL)

WBC can be elevated otherwise blood is panocytopenic

• Glycophorin A pos. on flow

• multinucleation

• RBC show macrocytic anemia, HJ bodies, baso stipling, ringed sideroblasts, and ansiopoik

M6 Erythroleukemia

What stains will be + in M6

• PAS

• MPO/SBB

• NSE and resistant to NaF

WBC low

Plt varies but atypical and bizarre

• >50% of blasts are megakaryoblasts

• Adults and children

• 3-5% of AML

• Poor prognosis, particular in
  infant with t(1;22).

• May be associated with marrow
  fibrosis

• If dry tap, >50% megakaryocytic
  cells of any stage

• Flow for CD41+

M7 - Acute Megakaryocytic Leukemia

What stains are positive for M7

• NSEst weak

Any leukemia with two phenotypic markers for B and T cells is considered

Biphenotypic

WBC increased half the time, normal or decreased the other half

>65% lymphoblasts

• Small size (up to 2x lymph size)
   High N/C ratio - scant cytoplasm
   Nucleus is round with occ. cleft or indent
   Homogenous chromatin
   Inconspicuous nucleoli
   Fairly uniform population
   Cytoplasm may have vacuoles

L1

• 

  WBC increased half the time, normal or decreased the other half

  >65% lymphoblasts

• Mixture of blast sizes - majority > 2x lymph
  size

• Mod to large amount of cytoplasm

• Nuclear indentation and clefting very common (stretched appearance)

• Heterogeneous chromatin distribution

• Larger, visible nucleoli

L2

WBC increased half the time, normal or decreased the other half

>65% lymphoblasts

• Large size blasts

• Moderate N/C ratio

• Nucleus is oval or round

• Semi-coarse chromatin

• One or more prominent nucleoli

• Cytoplasm is medium to intensely blue with prominent vacuoles

L3 or Burkitts lymphoma

What stains are + in ALL

• Tdt most of the time

• PAS sometimes

what is the prfered method of diagnosis for ALL

immunophenotyping to determine B cell, Tcell, or hybrid