Leukemias

What is Leukemia?

malignant disorder characterized by uncontrolled proliferation of leukocytes

-causes overcrowding of bone marrow & inability to produce normal hematopoietic cells

Which 2 cell lines are predominant in leukemias?

-myeloid (AML & CML)

-lymphoid (ALL & CLL)

What is the difference between acute & chronic leukemias?

-what is the rate of onset for each?

Acute: presence of undifferentiated or immature cells (blast cells)

-rapid onset with short survival

Chronic: predominantly mature cells that do not function correctly

-slow progression

Which leukemia is most common in children?

-what is the peak age range?

Which is most common in adults?

Children: ALL

-age 2-5

Adults: AML

True or False: Benzene are benzene containing compounds such as kerosene & carbon tetrachloride cannot cause AML.

False

Which 2 viruses have been associated with developing leukemia?

-what kind of leukemia can each cause?

1. Human T-cell Lymphotropic virus type I (HTLV-I)

-causative agent of adult T-cell leukemia

2. Epstein-Barr Virus

-associated with endemic African form of Burkitt's leukemia/lymphoma

What are 3 clinical manifestations of acute leukemia at diagnosis?

-anemia (pallor, fatigue)

-thrombocytopenia (petechiae, bruising)

-infection (esp. in AML, bacterial)

In Acute Lymphoblastic Leukemia (ALL), bone marrow biopsies demonstrate > _____% blasts.

-What # of blasts indicates a poor prognosis?

20

50,000 = poor prognosis

What test is diagnostic for Acute Lymphoblastic Leukemia (ALL)?

Terminal deoxynucleotidyl transferase

What 3 organs/sites are commonly infiltrated in Acute Lymphoblastic Leukemia (ALL)?

-CNS

-testicles

-kidneys

What physical finding on the skin may be present in Acute Myelogenous Leukemia (AML)?

-what does it look like?

Leukemia cutis

-looks like scabs on the skin

True or False: CNS involvement is present in ALL, but not AML.

True

What 3 organs/sites are commonly infiltrated in Acute Myelogenous Leukemia (AML)?

-eyes

-GI

-pulmonary

Auer rods are pathognomonic for...

-explain what they look like

-what does the absence of auer rods in this type of leukemia indicate?

Acute myelogenous leukemia (AML)

-look like cigar shaped rods in cells

-absence of auer rods in AML = even poorer prognosis

What tests should be done to diagnose Acute Myelogenous Leukemia (AML)? (3)

-explain what is seen in each

-CBC: elevated WBC count

-Peripheral smear: Auer rods

-Bone marrow biopsy & aspiration: hypercellularity > 20% blasts & cytogenetics

Explain the poor prognosis factors for ALL and AML for the following:

-Age

-WBC count > ____________

ALL:

-Age: <2 or >14

-WBC count: > 50,000

AML:

-age >60

-WBC count: > 100,000

What is the goal of leukemia treatment?

complete remission (CR)

-check by getting peripheral smears

Acute Promyelocytic Leukemia (APL/M3) is a subtype of which type of leukemia?

-what age of patients does it typically affect?

-what disorder is it associated with?

-what is it's prognosis?

-what is present on the peripheral smear? (2)

subtype of AML

-usually affects younger patients

-associated with DIC

-best prognosis of the AMLs

-lots of granules (very dark & dotty)

-Ruloux's formation

Chronic lymphocytic leukemia (CLL) is a clonal malignancy of mature ____ lymphocytes.

-which is more common, CLL or CML?

-what gender is predominantly affected?

B

-CLL much more common than CML

-affects males in a 2:1 ratio

As age ______________, incidence of Chronic lymphocytic leukemia (CLL) _______________.

increases

increases

What is the main criteria for diagnosis of Chronic Lymphocytic Leukemia (CLL)?

-give specific #

-how long must this # be maintained

absolute lymphocytosis

- > 5,000,000/ mm (5 x 10^6) mature lymphocytes

-sustained over 4 week period

True or False: Chronic Lymphocytic Leukemia (CLL) patients are often symptomatic.

False

-CLL patients often asymptomatic

-but can present with fatigue, night sweats, fever, infections

What is seen on a Chronic Lymphocytic Leukemia (CLL) peripheral smear?

smudge cell

-pathognomonic

What is the treatment for low risk Chronic Lymphocytic Leukemia (CLL) patients?

observation

Autoimmune hemolytic anemia is associated with which leukemia?

-what test do we use to monitor this?

Chronic Lymphocytic Leukemia (CLL)

-Coomb's test (+ = hemolysis)

What drug is used to treat Chronic Lymphocytic Leukemia (CLL)?

Tyrosine kinase inhibitor: Ibrutinib

-doesn't "cure" CLL, stops progression in its tracks

-created at OSU

Which kind of leukemia involves a Philadelphia gene mutation?

-explain the mutations

Chronic myelogenous leukemia (CML)

-translocation between chromosome 9 & 22

Patients usually present in which phase of Chronic myelogenous Leukemia (CML)?

chronic phase

What is a common physical exam finding Chronic myelogenous Leukemia (CML)?

EXTREME splenomegaly (causes abdominal fullness)

-splenectomy may be necessary

What WBC range is common for patients with Chronic myelogenous Leukemia (CML)?

100,000-150,000

Besides an extremely elevated WBC count, what are 3 other cell counts that may be increased on a Chronic myelogenous Leukemia (CML) patient's CBC?

increased...

-basophils

-eosinophils

-platelets

True or False: Chronic myelogenous Leukemia (CML) symptoms persist even once the disease is controlled.

False

-becomes asymptomatic once controlled

What is the only curative treatment for Chronic myelogenous Leukemia (CML)?

Bone marrow transplant

-can use tyrosine kinase inhibitors (Imatinib), but not as effective as in CLL