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Acute Leukemia

Acute Leukemia. Kristine Krafts, M.D. Hematologic Malignancies. Leukemia Malignancy of hematopoietic cells Starts in bone marrow , can spread to blood, nodes Myeloid or lymphoid Acute or chronic Lymphoma Malignancy of hematopoietic cells

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Acute Leukemia

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  1. Acute Leukemia Kristine Krafts, M.D.

  2. Hematologic Malignancies Leukemia • Malignancy of hematopoietic cells • Starts in bone marrow, can spread to blood, nodes • Myeloid or lymphoid • Acute or chronic Lymphoma • Malignancy of hematopoietic cells • Starts in lymph nodes, can spread to blood, marrow • Lymphoid only • Hodgkin or non-Hodgkin

  3. Leukemias Hematologic Malignancies • Acute leukemias • Chronic leukemias Lymphomas • Hodgkin lymphoma • Non-Hodgkin lymphoma Plasma cell disorders • Multiple myeloma

  4. How is a diagnosis made? • Clinical setting • Morphology • Immunophenotyping • Molecular studies • Cytogenetics

  5. Bone marrow biopsy needle

  6. Bone marrow biopsy: cellularity

  7. Normal bone marrow biopsy

  8. Normal bone marrow biopsy

  9. Bone marrow aspiration needle

  10. Bone marrow aspiration

  11. Normal bone marrow aspirate

  12. Normal bone marrow aspirate

  13. Immunophenotyping

  14. Normal chromosomes Chromosomes in CML

  15. Cytogenetics

  16. Molecular Studies cut paste amplify

  17. Leukemias Hematologic Malignancies • Acute leukemias • Chronic leukemias Lymphomas • Hodgkin lymphoma • Non-Hodgkin lymphoma Plasma cell disorders • Multiple myeloma

  18. Leukemias Hematologic Malignancies • Acute leukemias • Chronic leukemias

  19. Acute vs. chronic leukemia Acute leukemia • Sudden onset • Can occur in either adults or children • Rapidly fatal without treatment • Composed of immature cells (blasts) Chronic leukemia • Slow onset • Occurs only in adults • Longer course • Composed of mature cells

  20. Acute myeloid leukemia Acute lymphoblastic leukemia

  21. Chronic lymphocytic leukemia Chronic myeloid leukemia

  22. Leukemias Hematologic Malignancies • Acute leukemias

  23. Pathophysiology of Acute Leukemia • Definition: malignant proliferation of immature myeloid or lymphoid cells in the bone marrow • Cause • Clonal expansion • Maturation failure • Badness • Crowd out normal cells • Inhibit normal cell function • Infiltrate other organs

  24. Acute leukemia: bone marrow biopsy

  25. Clinical Findings in Acute Leukemia • Sudden onset (days) • Symptoms of bone marrow failure • Fatigue • Infections • Bleeding • Bone pain (expanding marrow) • Organ infiltration (liver, spleen, brain)

  26. Acute Myeloid Leukemia • Malignant proliferation of myeloid blasts in blood, bone marrow • 20% cutoff for diagnosis • Many subtypes • Bad prognosis Things you must know

  27. 20% need at least blasts

  28. Auer rods

  29. AML-M3 Acute promyelocytic leukemia

  30. Faggot cell

  31. Acute monoblastic leukemia

  32. Acute monoblastic leukemia

  33. Acute monoblastic leukemia: brain involvement

  34. Acute monoblastic leukemia: gum involvement

  35. Treatment Chemo Bone marrow transplant Prognosis Dismal Some chromosomal abnormalities confer different prognosis If therapy-related, worse prognosis Treatment and Prognosis of AML

  36. Myelodysplastic Syndrome • Dysmyelopoiesis ± increased blasts • May evolve into AML • Older patients, usually • Macrocytic anemia • Treatment depends on age, aggressiveness

  37. Dyserythropoiesis (dysmyelopoiesis in red cells)

  38. Dysgranulopoiesis (dysmyelopoiesis in neutrophils)

  39. Acute Lymphoblastic Leukemia Things You Must Know • Malignant proliferation of lymphoid blasts in blood, bone marrow • Classified by immunophenotype (B vs. T) • More common in children • Prognosis often good!

  40. ALL

  41. ALL

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