Chronic leukemias

Features of chronic leukemias (4)

1. Cells appear more normal

2. Cells may have some function, but not really functional

3. More slowly dividing cells

   1. Can be asymptomatic for years

Name

Chronic myeloid leukemia

Name

Chronic lymphocytic leukemia

Chronic leukemia – general clinical presentation (2)(4)

1. Asymptomatic

2. Mild systemic symptoms

   1. Malaise weight loss, anorexia

   2. Fatigue (Anemia)

   3. Bleeding episodes (PLD reduction)

   4. Splenomegaly

Chronic lymphocytic leukemia – clinical presentation (2)(2)

1. *Chronic phase*

   1. Lymphadenopathy

2. *Transformation to a higher grade neoplasm*

   1. Richter syndrome

Richter syndrome

• Rapidly growing mass in a lymph node → resembles diffuse large B cell lymphoma

Chronic myeloid leukemia – clinical

presentation (2)(2)

1. *Accelerated phase*

   1. Impaired neutrophil differentiation with higher leukocyte counts (Think inverse diff)

2. Symptoms worsen = *Blast crisis*

   1. Resembles acute leukemia

Distinguishing feature of chronic myeloid leukemia

Philadelphia chromosome

Philadelphia chromosome Steps (3)

1. A piece of chromosome 9 and a piece of

   chromosome 22 break off and trade places

2. Forms the bcr-abl gene on chromosome 22

3. Produces a tyrosine kinase involved in cell transformation

BCR-ABL fusion protein (3)

1. Constitutively active tyrosine kinase

   1. Drives the proliferation of granulocytic and megakaryocytic progenitors and release of immature cells into blood

Target therapy to this

Chronic lymphocytic more often occurs in

Adults over 50

Chronic myeloid more often occurs in

Adults between 25 and 60