Hematology N: Acute Leukemias

leukemia

The development of ___________is currently believed to be a stepwise progression of mutations.

acute leukemias,

For most __________ causes directly related to the development of the malignancy are unknown.

M0

Acute myeloid leukemia minimally differentiated

M0

≥30% Blasts

M1

Acute myeloid leukemia, without maturation

M1

30% Blasts

<10% Granulocytic Cells

M2

Acute myeloid leukemia with maturation

M2

30% Blasts

10% Granulocytic cell

M3

Acute promyelocytic leukemia

M3

30% Blasts

10% Granulocytic cell

30%-50% Promyelocyte

M4

Acute myelomonocytic leukemia

M4

20%-80% Monocyte cells

M4eo

Acute myelomonocytic leukemia with eosinophilia

M5a

Acute monocytic leukemia, poorly differentiated

M5a

80% Monoblast

M5a

Shillings type of Leukemia

M5b

Acute monocytic leukemia, well differentiated

M5b

80% monocytes

M6

Acute erythroleukemia

M6

30% Blasts

50% Erythrocytic Precursor

M7

Acute megakaryocytic leukemia

M7

30% Blasts 50% Megalaryocyte

AML with t (8:21)

AML with inv (16) or t (16:16)

AML with 1 (9:11)

APL with t (15:17)

Acute myeloid leukemia with certain genetic abnormalities

Acute myeloid leukemia with certain genetic abnormalities

AML with t (8:21)

AML with inv (16) or t (16:16)

AML with 1 (9:11)

APL with t (15:17)

AML with minimal differentiation

AML without maturation

AML with maturation

Acute myelomonocytic leukemia

Acute monoblastic/monocytic leukemia

Acute erythroid leukemia

Acute megakaryoblastic leukemia

Acute basophilic leukemia

Acute myeloid leukemia, not otherwise specified

Acute myeloid leukemia, not otherwise specified

AML with minimal differentiation

AML without maturation

AML with maturation

Acute myelomonocytic leukemia

Acute monoblastic/monocytic leukemia

Acute erythroid leukemia

Acute megakaryoblastic leukemia

Acute basophilic leukemia

Acute undifferentiated leukemia

Mixed phenotype acute leukemia with t (9:22)

Mixed phenotype acute leukemia with t(v:11q23)

Mixed phenotype acute leukemia,B lymphocytes-myeloid cells

Mixed phenotype acute leukemia, T-myeloid

Acute Leukemias of Ambiguous lineage

Acute Leukemias of Ambiguous lineage

Acute undifferentiated leukemia

Mixed phenotype acute leukemia with t (9:22)

Mixed phenotype acute leukemia with t(v:11q23)

Mixed phenotype acute leukemia, B lymphocytes-myeloid cells

Mixed phenotype acute leukemia, T-myeloid

FAB M0

Synonymous with the WHO classification of AML not otherwise categorized.

FAB M0

Minimally differentiated, has no evidence of myeloid differentiation.

FAB M1

Most common type of leukemia among children younger than 18 months of age.

FAB M1

Typically occurs in middle-aged adults with median age of 46 years old.

FAB M1

The median survival time is 3.5 months.

FAB M1

Rapid or gradual onset that may resemble acute infection

FAB M1

Cellular infiltration of organs is less prominent

Rapid or gradual onset that may resemble acute infection

FAB M1 Clinical signs and symptoms:

Chloroma

Tumors formed which consist of myeloblast.

Chloroma

In these tumors the presence of large amount of myeloperoxidase (MPO) produces GREEN color.

Anemia

Thrombocytopenia

Leukocytosis (usually greater than 100 x 10/L)

The outstanding feature of the peripheral blood film is the predominance of MYELOBLAST.

Auer rods is positive

Fab M1 Laboratory data:

Fab M1

Anemia

Thrombocytopenia

Leukocytosis (usually greater than 100 x 10/L)

The outstanding feature of the peripheral blood film is the predominance of MYELOBLAST.

Auer rods is positive

FAB M2

Typically occurs in middle-aged persons

FAB M2

The median age of occurrence is 48 years old

48 years old

FAB M2: The median age of occurrence is _________years old

FAB M2

Approximately 40% of the cases occur in individuals 60 years older.

FAB M2

Median survival time is 8.5 months.

Easy bruising

Epistaxis

Gingival bleeding

Hepatomegaly

Splenomegaly

Lymphadenopathy

FAB M2: Clinical signs and symptoms:

FAB M2:

Easy bruising

Epistaxis

Gingival bleeding

Hepatomegaly

Splenomegaly

Lymphadenopathy

Fab M3

Also known as acute promyelocytic leukemia

FAB M3

The median age of occurrence is 38 years old.

FAB M3

Median survival time is 16 months.

FAB M3

MOST AGGRESSIVE of acute leukemia with a severe bleeding tendency and a fatal course, if untreated, of only weeks.

FAB M3

Anemia

Thrombocytopenia

Leukopenia is seen frequently

PROMYELOCYTE predominate the bone marrow.

Increased incidence for disseminated intravascular coagulation (DIC)

Anemia

Thrombocytopenia

Leukopenia is seen frequently

PROMYELOCYTE predominate the bone marrow.

Increased incidence for disseminated intravascular coagulation (DIC)

FAB M3 Laboratory data:

FAB M4

Acute myelomonocytic leukemia

FAB M4

Also known as Naegeli-type monocytic leukemia.

FAB M4

Uncommon among children and young adults.

FAB M4

Highest frequency is in adults older than 50.

FAB M4

Average survival time is approximately 8 months

FAB M4

Anemia

Thrombocytopenia

Total leukocyte count rarely exceeds 100 x 10/L

Proliferation of granulocytes and monocytes are present.

Early myeloid predominate

20% of the cells are monocytes

Auer rods may be present.

Anemia

Thrombocytopenia

Total leukocyte count rarely exceeds 100 x 10/L

Proliferation of granulocytes and monocytes are present.

Early myeloid predominate

20% of the cells are monocytes

Auer rods may be present.

FAB M4 Laboratory data:

FAB M5

Pure monocytic leukemia.

M5a M5b

Pure monocytic leukemia. Two forms:

FAB M5a

Most common in young adults (median age is 16 years old)

FAB M5a

Synonymous with acute monoblastic leukemia.

FAB M5a

Cells are poorly differentiated

FAB M5b

Peak occurrence characteristically during the middle age (median age, 49)

FAB M5b

Synonymous with acute monocytic leukemia.

FAB M5b

Cells are well differentiated

FAB M5

Onset is dramatic with headaches and fevers.

Fatigue, weight loss, bleeding.

GINGIVAL HYPERPLASIA.

Onset is dramatic with headaches and fevers.

Fatigue, weight loss, bleeding.

GINGIVAL HYPERPLASIA.

FAB M5

FAB M5

Anemia

Thrombocytopenia

Total leukocyte count ranges from 15 to 100 x 10⁹/L

Monocytes and promonocytes constitutes 25 to 75% of nucleated cells.

Blast frequently have a muddy or smoggy gray-blue cytoplasm containing tiny granules, and pseudopods are common.

Anemia

Thrombocytopenia

Total leukocyte count ranges from 15 to 100 x 10/L

Monocytes and promonocytes constitutes 25 to 75% of nucleated cells.

Blast frequently have a muddy or smoggy gray-blue cytoplasm containing tiny granules, and pseudopods are common.

FAB M5

FAB M6

Acute erythroid leukemia.

FAB M6

Also known as erythemic myelosis or Di Guglielmo.

Di Guglielmo.

FAB M6: Also known as erythemic myelosis or

FAB M6

Proliferation of both immature granulocytic and erythrocytic cell types.

FAB M6

More than half of the patients is 50 years old and above.

FAB M7

Acute megakaryoblastic leukemia

FAB M7

50% or more of the blast are of megakaryocytic lineage.

Eosinophilic leukemia

Death usually occurs within 1 year.

Eosinophilic leukemia

On peripheral blood smears, more than 60% of the WBC are eosinophils.

Basophilic leukemia

Also known as mast cell leukemia

Basophilic leukemia

Rarest form of leukemia

Basophilic leukemia

Peripheral blood smear shows >50% basophils

Acute Lymphoblastic Leukemia (ALL)

Most common cancer in children, representing 23% of cancer diagnosis among children younger than 15 years of age

FAB L1

FAB L2

FAB L3

ALL is divided into

FAB L1

children

FAB L2

Older children and adults

FAB L3

Patients with leukemia secondary to Burkitt lymphoma

L1

Size of Blasts: Small

L2

Size of Blasts: Large, heterogeneous

L3

Size of Blasts: Large

L1

Nuclear Shape: Indistinct

L2

Nuclear Shape: Indented, prominent

L3

Nuclear Shape: Regular oval to round

L1

Nucleoli: Scant

L2

Nucleoli: Large, abundant

L3

Nucleoli: Prominent, basophilic

L1

Cytoplasm: Invisible

L2

Cytoplasm: Moderately clefted