Leukemia
Initial definition: Highly increased number of WBC
Why WBC :
Bone marrow increased production
Increased dismission into circulation
Reduced apoptosis
Types of leukemia
ACUTE
Myeloid
Lymphoid
CHRONIC
Myelogenous
Limphocytic
Leukemia: pathogenesis
The disease is clonal, i.e.,originates from a
single abnormal cell
Which gene:
Oncogene activation
Oncosuppressor gene inactivation
Type of mutations:
Single base mutation
Deletions, frameshift
Duplications
Translocations (hybrid genes)
Examples of hybrid genes
Age peaks:
ALL 3 14 years
AML 55 75 years
Acute leukemias: events
Stomatitis
Severe infections
Acute leukemias: diagnosis
Full blood count:
WBC usually , Hb , platelet
Differential: presence of blast cells
Bone marrow aspirate
Blast substitution
Additional studies:
Cytogenetics
Molecular biology tests
LDH and Uric acid often elevated
Acute leukemias: classifications
FAB: ALL 3 types (L1, L2, L3)
AML 8 types (M0 to M7)
IMMUNOLOGICAL
ALL: B or T
CYTOGENETIC
MOLECULAR
ALL subtypes
L1: small cells, childhood
L2: mixed small and large cells, adults
L3: large cells, Burkitts-like
M0 undifferentiated
M1 initial myeloid differentiation
M2 overt myeloid phenotype
M3 promyelocytic
M4 myelomonocytic
M5 monoblastic/monocytic
M6 erythroleukemia
M7 megakaryocytic
Acute leukemias: flow cytometry
Very helpful in clarifying unusual subtypes
Can be used to detect what remains after
an effective treatment (minimal residual
disease)
Myeloid antigens: CD13, CD33, CD14,
MPO, Glycophorin, etc.
Lymphoid antigens: CD2, CD3, CD7, CD10,
CD19, TdT, SmIg, etc
ALL : treatment strategy
RBC transfusion
Platelet transfusion
Antibiotics
Antifungi
Antiviral
Protected ward