CLINICAL ASPECTS OF LEUKEMIAS (1)
|
DISEASE |
AGE/SEX |
DISTRIB |
CAUSE |
SYMPTOMS |
ADENOP |
TREATMENT |
PROGNOSIS |
|
IM |
Any; 15-30 Kids are subclinical M = F |
Neg in trop And blacks |
EBV From saliva or blood transfusion |
Flu, fever, sore throat, tired Onset 3-4 weeks |
Cervical |
|
heal 6-12 wks or more Contagious 16 months |
|
CMV |
|
|
Bld transfusn |
|
|
|
|
|
PRV |
|
|
|
Red skin |
|
Donate blood |
Can à AML or Myeloid metaplasia |
|
Myelofibrosis |
|
|
|
|
|
|
Can à AML |
|
Myeloid Metaplasia |
Median age = 60 |
|
|
Onset 2 yrs; Fatigue, ↓wt Night sweats, kidney stones |
|
|
20%à AML
|
|
Aplastic anemia |
|
|
SC, HIM, Imm supp: Radiation, Bensol/Benz Vir: hepatitis |
Bleeding, Infections |
|
BMT, chemo |
Can à AML |
|
Leukemia (in general) |
M > F |
60% acute: = immature cells |
Genetic, virus, triggers: imm, age, chemicals |
Acute: Rapid onset and progression. Relentless cell division ↑uric acid |
|
|
|
|
ALL (Pre B) |
4 years 65% of kids leuk |
< Asian/Blk |
same |
Fatigue, fever, bleeding (nose, gums, cerebral, petic, bruises), freq infect |
yes |
Aggressive Chemo combo Intrathecal inj |
Kid w 10 year remission, best prognosis. Adults w/Ig relapse = bad |
|
ALL (Pre T) |
Kids Adults <50 |
< Asian/Blk |
same |
same |
yes |
same |
Not as good as B cell Kids>Adults |
|
AML |
Teens-30 Most comm. Adult leuk |
|
same |
same |
|
Aggressive Chemo combo
|
More severe in older adults |
|
APL |
|
Not very common |
same |
same |
|
same |
Poor (grans releaseà DIC), but good Tx available |
|
AMoL “Shilling’s” |
|
|
same |
Same, plus Skin/liver Tumors, gum bleeding |
|
Same; BMT |
Not good |
|
AMMoL “Neigle’s” |
|
|
Same; CFU-GM Confusion |
Same, especially Intracerebral bleeding |
|
Same; BMT |
Not good |
LABORATORY FINDINGS IN LEUKEMIAS
|
DISEASE |
Diagnostic |
RBCs |
WBCs |
Platelets |
Bone Marrow |
Organo megaly |
OTHER |
|
IM |
Lg #s atypical lymphocytes; monospot + Anti-EBV |
Anemia (rare) |
Downey II |
↓(rare) |
|
Hepato (10%) Spleno (50%) |
HAb + Post-Perfusion Syndrome |
|
CMV |
Atypical lymphs; |
|
|
|
|
|
Hab neg Post-Perfusion Syndrome |
|
PRV |
Pancytosis |
Increased |
Increased |
Increased |
|
|
|
|
Myelofibrosis |
|
|
|
|
Fibrosis |
|
Dry tap |
|
Myeloid Metaplasia |
|
UnresponAnemia, Immature, Abn morph |
Increased 10-20,000 |
↓ Maybe giant platelets; Bleed/bruise |
Hyperplasia |
Hepato Spleno
|
Dry tap
|
|
Aplastic anemia |
Pancytopenia |
Decreased |
Decreased Esp ↓PMNs |
↓ (Purpura) |
Hypoplasia |
|
Fetal Hgb Tissue culture (SC neg, HIM +) |
|
ALL (Pre B) more common |
Sm lymphblasts No Auer rods Scant cytoplsm No nucleoli |
Decreased |
Decreased PMNs Elevated WBC (2/3 cases)
|
↓ |
Lymphblast take over |
Hepato Spleno kidney |
CNS infiltrate Mu Chain Stain + CALLA (CD 10)* (later stage) TdT + Sudan neg, MOP neg |
|
ALL (Pre T) |
same |
same |
same |
↓ |
Same |
Same
|
Same But no CALLA or mu chain |
|
AML |
Lg Myeloblasts Auer rods Much cytoplsm 1-2 nucleoli |
same |
15-20,000 some higher or lower (few: 100,000) |
|
Myeloblasts take over |
None Except testicles |
Sudan + Myeloperoxidase + TdT neg PAS neg |
|
APL |
promyelocytes |
|
|
|
Promyelos |
|
|
|
AMoL |
monoblasts |
|
No Auer rods |
|
Monocytes |
|
Sudan neg MOP neg |
|
AMMoL |
Mono/myelo |
anemia; blasts, multi-nuc |
15-20,000 Auer rods (maybe) |
↓ |
Myelos and Monocytes |
Hepato Spleno Kidney
|
Hgb decreased Slight + Sudan and MOP Muramidase/lysosyme released in plasma/urine |
* CALLA (CD10) detected with Mab immunotyping
CLINICAL ASPECTS OF LEUKEMIAS (2)
|
DISEASE |
AGE/SEX |
DISTRIB |
CAUSE |
SYMPTOMS |
ADENOP |
TREATMENT |
PROGNOSIS |
|
Aleukemic leukemia |
|
|
|
|
|
Leukemia phoresis |
|
|
CML |
Middle age 25-60yrs M>F
|
Not very common |
Radiation, Benzene, chemicals, Idiopathic |
Onset 2 yrs: Fatigue, clots, anorexia, abd fullness, night sweats, kidney stones |
yes |
Gleevec = good Irradiate spleen |
Longer, more predictable course than acute. Responsive to therapy Blast crisis = bad |
|
CLL |
50-70 M >> F |
< Asian/Blk most common chronic |
Idiopathic Maybe familial |
Slow onset Fatigue, anorexia
|
yes |
Chemotherapy: stabilizes for years, but no cure. |
Best Px of chronic leuks Abnorm immune à ↑cancer; Late stage = anemia, clots, ↓ PMNs, die from 2° infections |
|
HAIRY CELL
|
Same |
Uncommon
<2% of leukemias |
Retrovirus HTLV-2 |
Same as CLL |
yes |
αINF = good More responsive than CLL, can live years before going downhill |
Good, but eventually die from bacterial or fungal infections. |
|
Hodgkin’s Lymphoma |
20-50 |
|
|
Tumors anywhere in lymph system. |
Yes Starts in cervical |
Chemo, radiation = good results |
Untreated à anemia à death |
|
Multiple Myeloma |
50-60 M = F
|
|
|
Fractures
|
Yes |
Chemo, radiation, plasmaphoresis |
Can live for a few years, but high proteins in blood à ischemia everywhere. |
|
Burkett’s Lymphoma |
|
African kids |
EBV |
|
|
|
|
LABORATORY FINDINGS IN LEUKEMIAS
|
DISEASE |
Diagnostic |
RBCs |
WBCs |
Platelets |
Bone Marrow |
Organo megaly |
OTHER |
|
Aleukemic |
Smoldering leukemia |
anemia |
Decreased; Few leuk cells PMNs disfunct |
↓ |
Packed with Blasts |
|
|
|
CML |
Many cells, all stages of mat Ph’ chromo |
Modest normocyt |
50-500,000 ↑lymphs + monos ↑eos, ↑baso (later) |
↑↑↑ and large |
Hypercell |
Spleno megaly |
LAP <13 ↑uric acid |
|
CLL |
Smudge cells = fragile |
Slight à progresses to worse 5-10% = hemolytic |
Many small abnorm lymphocytes, clefts; ↓PMNs ↓all Ig
|
Normal or slight ↓ |
Same |
Liver and spleen |
Surface Ig identify them as mature B lymphocytes
TRAP neg |
|
HAIRY CELL |
Hairy shaped B lymphocytes
|
Same |
Same |
Same |
Same |
Same |
Looks like CLL
Resistance to tartrate (acid phosphatase) = TRAP + |
|
Hodgkin’s Lymphoma |
Biopsy lumps Reed Sternberg cells |
|
|
|
|
|
|
|
Multiple Myeloma |
Plasma cells in blood; Bence Jones proteins in urine |
↑↑ ESR Rouleaux stacking |
|
|
Filled up with plasma cells and one type of Ig = monoclonal gammopathy |
|
Excess Kappa (light chain) Atypical lymphocyte = Lg plasma cell 1) Protein electrophoresis 2) Immunoelectrophoresis 3) Immunofixation, (all to id Ig)
|
|
Burkett’s Lymphoma |
|
|
|
|
|
|
Chr translocation: 8 à 2, 14, 22 Oncogene c-myc à enhances growth |