Leukemia

Dr. Isbandiyah SpPD

Bag. Ilmu Penyakit Dalam
UMM
Malang
 What Is Leukemia?
Cancer of the white blood cells
Acute or Chronic
Affects ability to produce normal
blood cells
Bone marrow makes abnormally
large number of immature white
blood cells called blasts
 Classification of leukemias

Acute Chronic

Myeloid Acute Myeloid Chronic Myeloid Leukemia

Leukemia (AML) (CML)
origin

Lymphoid Acute Lymphoblastic Chronic Lymphocytic Leukemia

Leukemia (ALL) (CLL)
origin
 Hematopoiesis
PLURIPOTENT MIXED COMMITTED RECOGNIZABLE MATURE
STEM CELL PROGENITOR PROGENITOR BONE MARROW BLOOD
CELL CELL PRECURSOR CELL CELL

BFU-E/CFU-E pronormoblast red cell

myeloblast neutrophil
CFU-GM
monoblast monocyte
CFU-Eos eosinophil
myeloid CFU-Baso basophil
progenitor
cell CFU-Meg megakaryocyte platelet
pluripotent
stem cell pre-T lymphoblast T-cell

pre-B lymphoblast B-cell

lymphoid & plasma cell
progenitor
cell
 Myeloid maturation
myeloblast promyelocyte myelocyte metamyelocyte band neutrophil

MATURATION
Adapted and modified from U Va website
 Acute Leukemia
accumulation of blasts in the marrow
How to distinguish AML vs CML
from looking at peripheral
blood
Myeloid cell CML AML normal
blasts
promyelocytes
myelocytes
metamyelocytes
bands
neutrophils
 Classification of acute
leukemias
ALL AML
mainly children mainly adults
M>F M>F
curable in 70% of
children curable in minority
curable in minority of adults
of adults
 Clinical manifestations
symptoms due to:
marrow failure
tissue infiltration
leukostasis
constitutional symptoms

usually short duration of symptoms

 Marrow failure
neutropenia: infections, sepsis
anemia: fatigue, pallor
thrombocytopenia: bleeding
Infiltration of tissues/organs
enlargement of liver, spleen, lymph
nodes
gum hypertrophy
bone pain
other organs: CNS, skin, testis, any
organ
Gum hypertrophy
 Leukostasis
accumulation of blasts in
microcirculation with impaired
perfusion
lungs: hypoxemia, pulmonary
infiltrates
CNS: stroke
only seen with WBC >> 50 x 109/L
 Causes of acute leukemias
idiopathic (most)
underlying hematologic disorders
chemicals, drugs
radiation
viruses
hereditary/genetic conditions
 Constitutional symptoms
fever and sweats common
weight loss less common
 Laboratory features
WBC usually elevated, but can be
normal or low
blasts in peripheral blood
normocytic anemia
thrombocytopenia
 Bone marrow in acute
leukemia
necessary for diagnosis
useful for determining type
useful for prognosis
Acute leukemias are defined by the
presence of > 20% blasts in bone
marrow (% of nucleated marrow
cells)
Distinguishing AML from ALL
light microscopy
AML: Auer rods, cytoplasmic granules
ALL: no Auer rods or granules.
special stains (cytochemistry)
flow cytometry
AML
ALL
Auer rods in AML
 Treatment of acute
leukemias
Choice of Rx is influenced by:
type (AML vs ALL)
age
curative vs palliative intent

Chemotherapy
Immunotherapy
Radiation
Bone marrow transplant
Principles of treatment
combination chemotherapy
first goal is complete remission
further Rx to prevent relapse
supportive medical care
transfusions, antibiotics, nutrition
psychosocial support
patient and family
 Chemotherapy for acute
leukemias
Phases of ALL treatment
induction
consolidation post-remission therapy
Maintenance

AML treatment
induction
consolidation (post-remission therapy)
 Prognosis

Adult AML
Age CR DFS
< 60 75% ~ 30%
> 60 50% 5-15%

Adult ALL

similar to or worse than AML