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Acute Leukemia

Acute Leukemia

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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. Myeloid Hematologic Malignancies Lymphoid • Acute myeloid leukemia • Chronic myeloid leukemia • Acute lymphoblastic leukemia • Chronic lymphocytic leukemia • Hodgkin lymphoma • Non-Hodgkin lymphoma • Multiple myeloma

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

  6. Bone marrow biopsy needle

  7. Bone marrow biopsy: cellularity

  8. Normal bone marrow biopsy

  9. Normal bone marrow biopsy

  10. Bone marrow aspiration needle

  11. Bone marrow aspiration

  12. Normal bone marrow aspirate

  13. Normal bone marrow aspirate

  14. Acute leukemias

  15. Chronic leukemias

  16. Non-Hodgkin lymphoma

  17. Hodgkin lymphoma

  18. Myeloma

  19. Morphology Regular stain (Wright-Giemsa) Cytochemical stain (Non-specific esterase)

  20. Immunophenotyping

  21. Normal chromosomes Chromosomes in CML

  22. Cytogenetics

  23. Molecular Studies cut paste amplify

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

  25. Leukemias Hematologic Malignancies • Acute leukemias • Chronic leukemias

  26. 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

  27. Acute ALL AML Chronic CLL CML Lymphoid Myeloid

  28. Acute ALL AML Chronic CLL CML

  29. Acute myeloid leukemia Acute lymphoblastic leukemia

  30. Chronic lymphocytic leukemia Chronic myeloid leukemia

  31. ALL AML CLL CML Lymphoid Myeloid

  32. Leukemias Hematologic Malignancies • Acute leukemias

  33. 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

  34. Acute myeloid leukemia Acute lymphoblastic leukemia

  35. Acute leukemia: bone marrow biopsy

  36. 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)

  37. Laboratory Findings in Acute Leukemia • Blasts/immature cells in blood • Leukocytosis • Anemia • Thrombocytopenia

  38. Leukemias Hematologic Malignancies • Acute leukemias • acute myeloid leukemia • acute lymphoblastic leukemia

  39. Leukemias Hematologic Malignancies • Acute leukemias • acute myeloid leukemia

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

  41. Acute Myeloid Leukemia M0 - acute myeloblastic leukemia, minimally differentiated M1 - acute myeloblastic leukemia without maturation M2 - acute myeloblastic leukemia with maturation M3 - acute promyelocyticleukemia M4 - acute myelomonocytic leukemia M5 - acute monocyticleukemia M6 - acute erythroblasticleukemia M7 - acute megakaryoblasticleukemia