Chapter 17

Chapter 17
Introduction to Leukemia and the Acute Leukimas

Classification of Leukemia

• Cell morphology review

• Immunological markers and cytochemical staining

• Flow cymmentary to determine blast immunephenotype
  

​AML with minimal differentiation	​AML without maturation	​	​
​FAB M0 No definitive myeloid differentiation Primitive leukemic blasts	​AML M1 Predominately poorly differentiated myeloblast	​	​

​Leukemia

Myleoid: encompasses granulocytic, monocytic, megakaryocytic, and erythrocytic leukemia

• Acute myeloid leukemia

• Chronic myeloid leukemia

​Lymphoid: encompasses B cell or T cell leukemia

• Acute lymphoblastic leukemia

• Chronic lymphocytic leukemia

Myeloid Leukemia

​T-ALL	​B-ALL	​Burkitt
​Adoloscent males Clonal blast TdT and T cell antigen	​Antigen independent Stages indicated by stages of TdT, surface markers, and immunoglobulin Disease of children Neutropenia, anemia, thrombocytopenia, and variable WBC Fever, pain, weightloss	​Deeply basophilic cytoplasm Vacolulated

​Acute lymphoblastic leukemia

​Features	​Acute Leukemia	​Chronic Leukemia
​Age	​All ages, usually children	​Adults
​Clinical onset	​Sudden	​Insidious
​Course (untreated)	​less than 6 months	​2-6 year
​Leukemic cells	​Immature; many blasts	​Mature
​Anemia	​Mild to severe	​Mild
​Thrombocytopenia	​Mild to severe	​Mild
​WBC	​Variable	​Increased
​Organomegaly	​Mild	​Prominent

​Acute vs Chronic Leukemia

Match

Match Leukemia with description

• Myeloid Leukemia

• Lymphoid Leukemia

• Chronic Myeloid Leukemia

• Acute Lymphoblastic Leukemia

• Acute Myeloid Leukemia

Granulocytic monocytic, megakaryocytic

B cell and T cell origin

Chronic Myeloid Leukemia is a slow-growing cancer that affects the blood and bone marrow.

Acute Lymphoblastic Leukemia is a fast-growing type of leukemia that affects the lymphoid cells.

Acute Myeloid Leukemia is a rapidly progressing disease that requires immediate treatment.

• Granulocytic monocytic, megakaryocytic

• B cell and T cell origin

• Chronic Myeloid Leukemia is a slow-growing cancer that affects the blood and bone marrow.

• Acute Lymphoblastic Leukemia is a fast-growing type of leukemia that affects the lymphoid cells.

• Acute Myeloid Leukemia is a rapidly progressing disease that requires immediate treatment.

Categorize

Options (14)

Blast cells

Rapid progression

Slow progression

Frequent infections

Long-term treatment

Anemia

Weight loss

Enlarged lymph nodes

Enlarged spleen and liver

Anemia: Mild to severe

Anemia: mild

Increased WBC

Mature Cells; less blast

Younger children predominant

Organize these options into the right categories

Acute Leukemia

Chronic Leukemia

Both

​Acute Leukemia

​Factor	​AML	​ALL
​Age	​Common in adults, rare in children	​Common in children, rare in adults
​Blood	​Anemia, neutropenia, thrombocytosis, myeloblast, and promyelocytes	​Anemia, neutropenia, thrombocytosis, lymphoblasts, and prolymphocytes
​Morphology	​Medium to large blasts, more cytoplasm than lymphoblasts, cytoplasmic granules, Auer rods; fine nuclear chromatin and distinct nucleoli	​Small or medium blasts scare cytoplasm, no granules, fine nuclear chromatin,n and indistinct nucleoli
​Cytochemistry	​Positive peroxidase and sudan black B	​Negative peroxidase and sudan black B
​Extramedullary and focal disease	​Common in spleen and liver, less common in lymph nodes and CNS	​Common in lymph nodes, spleen, and liver, CNS, and gonads.

​Feature	​AML	​ALL
​Blast Nuclei	​Usually larger, finely dispersed chromatin, and variable nucleoli	​Variable size small to medium, fine to more mature chromatin, and may or may not have nucleoli
​Cytoplasm	​Moderately abundant, fine small granules are often present, and may see Auer rods	​Usually scant, coarse granules may be present
​Background marrow	​dysplastic may be present	​dysplastic usually not present

Categorize

Options (14)

Translocation in young patients with maturation

FISH and RT-PCR for reliable testing

Auer rods, myeloblasts with abundant basophilic cytoplams and azurophilic granules.

Eosinophils precursors increases normally

Inversion of chromosome 16 and t(16;16) (p13.1;q22)

abnormal eosinophils appear immature

Purple violet granules; large

Granulocytic and monocytic differentiation

hypergranular or microgranular

Giant granules, obscuring the nucleus

Auer rods, stack or bundles

inversion of long arm of chromosomes 3 results

Myeloblasts may show myelomonocytic or mekaryocytic morph.

Dysplastic morp features may be seen in blood and bone marow

Organize these options into the right categories

AML with recurrent genetic abnormalities

AML with t(8;21) (q22;q22.1)

AML with inv (16) (p13.1;q22) or t (1

Acute Promyelocytic Leukemia

AML inv(3) (q21.3;q26.2)

Categorize

Options (8)

Infants and children under 3 without down syndrome

Hepatosplenomegaly, anemia, thrombocytopenia

Bone marrow show dysplastic megakaryoytes

No evidence of organomegaly and peripheral basophilia

Not from CML origin

monocytic differentiation is common

exon 12 of NPM1

Immature myelocytes or monocytic differentiation in immunophenotype

Organize these options into the right categories

AML (megakaryoblastic) with t(1;22) (p13

AML with BCR-ABL1

AML with mutated NPM1

​AML with myelodysplasia-related changes	​Therapy-related myeloid neoplasms
​ ​ ​More than 20% of cells are blasts More than 50% of cells are in at least two lines (pretreatment specimen) Severe pancytopenia AML arising in preexisting MDS or MDS/MPN qualifies for diagnoses Aberrant antigen expression heterogeneous disease Loss of chromosome 5q and 7q	​ ​ ​Alkylating agent/radiation-deletion or translocation of 5q and 7q, multilineage in peripheral blood or bone marrow, basophilia, and bone marrow showing reticulum fibrosis Topoisomerase II inhibitor-translocation of 11q23

​AML with minimal differentiation	​AML without maturation	​AML with maturation	​Acute Myelomonocytic Leukemia
​FAB M0 No definitive myeloid	​AML M1 Without maturation Composed of pre-dominantly poorly differentiated myeloblasts	​FAB M2 Infiltrate more than 20% blasts and evidence of maturation More than 10% of cells at different stages of granulocytic maturation	FAB ​M4 Neutrophilic and monocytic differentiation More than 20% blasts More than 20% precursors of neutrophils and monocytes of the bone marrow cellularity

​Acute monoblastic and monocytic Leukemia	​Pure Erythroid Leukemia	​Acute Megakaryoblastic Leukemia
​FAB M5a (majority monoblasts) and M5b (promonocytes/monocytes dominance) Predomiincaof monocytic lineage cells More than 80% of leukemic cells	​FAB M6 abnormal proliferation of immature erythroid precursors More than 80% of immature erythroid 30% proerythroblasts	​FAB M7 Neoplastic proliferation of megakaryoblasts and atypical megakaryocytes More than 20% blast Acute Leukemia 50% or more are blasts of megakaryocytic

​Lymphoblastic Leukemia and Lymphoma