“Now we’ve got bad

blood?”
Acute VS Chronic
Myeloid Leukemia
Beatricia Alyssandra L. Luceno

1
Bad Blood?
Leukemia?
 “
Leukemias are characterized by
neoplastic proliferation of abnormal
WBCs. As these abnormal WBCs
accumulate, they interfere with the
normal production of other WBCs as
well as erythrocytes, and platelets.

3
MYELOGENOU LYMPHOCYTIC
S - Lymphocytes
- Granulocytes are affected
or monocytes
are affected
Leuke
mia
ACUTE Chronic
- Rapid - Progress slowly
progression

4
Pathology:
How does Acute Myeloid Chronic Myeloid
this Leukemia Leukemia
▹ No maturation at all ▹ Partially matured
happen?
Hematopoieti
c cells

MYELOID LYMPHOID

Erythrocytes Megakaryocyte B- cells T-cells

s
NK
Leukocytes Cells

Granulocyte
Monocytes s
Basophi
ls Neutrophils

Eosinophil
s

5
Incidence
and Acute Myeloid Chronic Myeloid
Etiology: Leukemia Leukemia
▹ Common in older populations ▹ Common in older populations
Who gets ▸ Median age is 67 ▸ Median age 55-65
affected ▸ 5-6% of normal ▸ 3% less than 20 y/o
individuals contain aged
by this? 70> contain
▹ ~15% of all leukemia
“premalignant” cells ▹ M>F
▹ 80% of all ADULT leukemias ▹ No familial associations,
etiologic agents, associations
▹ Most cases are idiopathic
exist with exposures to benzene
▸ (+) Genetic or other toxins, fertilizers,
predisposition, radiation, insecticides, or viruses.
chemical/other
occupational exposures, ▹ Not a frequent secondary
and drugs leukemia following therapy of
▸ (-) Viral etiology other cancers with alkylating
agents and/or radiation.
▹ Poorly understood etiology

6
Classificati
on:
How do we
divide
AML?

7
8
History:
Acute Myeloid Chronic Myeloid
What to
Leukemia Leukemia
ask? ▹ 90% are in the chronic or
▹ Non-specific symptoms indolent phase
▸ Usually asymptomatic
associated with anemia,
thrombocytopenia and ▹ Accelerated or Blastic phase
leukocytosis and leukopenia ▸ Unexplained fever, significant
weight loss, severe fatigue,
▹ Short course, diagnosis is often bone and joint pains, recurrent
made <3 months from symptom infections, bleeding and
onset thrombotic events

▹ FATIGUE, often the first ▹ Elicit the cardinal symptoms of

symptom elicited leukemia
▸ ▸ Most common is anemia or
Anorexia, and Weight
spleenomegaly
loss
▹ May present with hyperviscosity
▹ Bone pain, lymph- adenopathy,
events
nonspecific cough, headache, or ▸ Priapism, MI, venous
diaphoresis thrombosis, visual
distrubances, dyspnea,
▹ Myeloid Sarcoma
drowsiness…

9
Quick Tip!
HIS BLEED
▹ GENERAL EVALUATION FOR
PATIENTS WITH LEUKEMIA!
▸ Hepatosplenomegaly?
▸ Infection?
▸ Signs of anemia?
▸ Bleeding?
▸ Lymphadenopathy?
▸ Easy Bruising?
▸ Easy fatigability?
▸ Decreased weight?

10
 Physical
Examinati Acute Myeloid Chronic Myeloid
on: What Leukemia Leukemia
▹ Splenomegaly, hepatomegaly, ▹ Most common: Splenomegaly
to look lymphadenopathy, and “bone (20-10%)
for? pain” ▹ Hepatomegaly,
▹ APL Patients: DIC-associated Lymphadenopathy
hemorrhages ▹ Extramedullary disease (Skin and
▹ Retinal hemorrhages (~15%) subcutaneous) – usually a
▹ prognosticator of CML
WOF: Gingival infiltration; skin,
transformation
soft tissue, and meninges
▸ Confirmed with skin
biopsy showing blasts
▹ Symptoms of leukostasis
▹ High tumor burden complications
▹ High basophil count

11
12
Pancytope
A decrease in all peripheral blood

nia
lineages and is considered to be present
when all three cell lines are below the
normal reference range.

13
 Pancytopenia

Confirm with Rule out effects of

CBC drugs or toxins

Initial work up Additional work up

If PBS shows Peripheral

Consumption Production
MACROCYTOSI Disorders Disorders
Destruction and
S Impaired Production

Autoimmune
Megalobastic
Aplastic Anemia Mediated Nutritional Non- Nutritional
Anemia
Pancytopenia

Splenic Bone Marrow

MDS
Sequestration Hypoplasia

Malignancy
14
Diagnostic
s: What to Acute Myeloid Chronic Myeloid
expect? Leukemia Leukemia
▹ Anemia; normocytic, ▹ Anemia; anisocytosis,
normochromic poikilocytosis
▹ Reduced reticulocyte count ▹ Leukocytosis ranging from 10–
▹ 500 × 109/L is common.
Reduced RBCs
▹ Basophils and/or eosinophils are
▹ Median presenting leukocyte
frequently increased.
count is ~15,000/μL
▹ Thrombocytosis is common,
▹ Platelet counts <100,000/μL
thrombocytopenia- rare, worse
(~75%)
prognosis
▹ PBS: Primary nonspecific
▹ PBS: left-shifted hematopoiesis;
granules; fine lacy chromatin,
neutrophils and bands,
with one or more nucleoli
myelocytes, metamyelocytes,
characteristic of an immature cell
promyelocytes, and blasts (≤5%)
▹ Auer Rods

15
Diagnostic
s: What to Acute Myeloid Chronic Myeloid
expect? Leukemia Leukemia
▹ Blasts in the bone marrow; 20% ▹ Bone marrow is hypercellular
blasts with marked myeloid
▹ hyperplasia and a high
Diagnosis is more on
myeloid-to-erythroid ratio of
cytogenetics, cytochemistry and
15–20:1
immunophenotyping
▹ Marrow blasts are usually <5%;
▹ (+) CD19 – APL (Auer Rods)
for the accelerated phase >15%
▹ Electrolyte disturbances
▹ Definitive Diagnosis:
(hyperuricemia, hyperkalemia,
Identification of t(9;22) through
hyperphosphatemia,
G-banding
hypocalcemia)
▸ FISH and PCR
▸ TUMOR LYSIS
SYNDROME ▹ Decreased leukocyte alkaline
phosphatase activity
▹ Increased LDH, uric acid and
B12

16
FIGURE 100-1 Morphology of acute myeloid
FIGURE 100-1 Morphology of acute myeloid
leukemia (AML) cells. A. Uniform population
leukemia (AML) cells. A. Uniform population
of primitive myeloblasts with immature
of primitive myeloblasts with immature
chromatin, nucleoli in some cells, and primary
chromatin, nucleoli in some cells, and primary
cytoplasmic granules. B. Leukemic myeloblast
cytoplasmic granules. B. Leukemic myeloblast
containing an Auer rod. C. Promyelocytic
containing an Auer rod. C. Promyelocytic
leukemia cells with prominent cytoplasmic
leukemia cells with prominent cytoplasmic
primary granules. D. Peroxidase stain shows
primary granules. D. Peroxidase stain shows
dark blue color characteristic of peroxidase in
dark blue color characteristic of peroxidase in
granules in AML.
granules in AML.

17
 ▹ Proliferation of
myeloid cells at
various stages of
maturation often seen
in cases of CML

18
Manageme
nt: What Acute Myeloid
do we do? Leukemia
▹ Divided into two phases
▸ Induction
▸ Consolidation (Post-
remission Management)
▹ Factors for treatment
▸ Age (<60)
▸ Overall Fitness
▸ Cytogenic or Molecular
Risk
▹ APL: All-trans retinoic acid
▹ Cytarabine
▹ Anthracyclines
▹ Supportive, Definitive

19
Manageme
nt: What Chronic Myeloid
do we do? Leukemia
▹ Tyrosine Kinase
Inhibitors
▸ Imatinib
▹ Supportive
▹ Definitive

20
Prognosis:
How does Acute Myeloid Chronic Myeloid
it end? Leukemia Leukemia
▹ Long-term survival is ▹ Previous median
infrequent; U.S. registry survival is 3-7 years
data report that only ▹ The current estimated
27% of patients survive 10- year survival rate is
5 years. 85%
▹ APL: Good Prognosis
▹ Poor prognosis: >60
years old, Increased
LDH, Karyotype
complexes

21
 “
Any questions?
Thank you!

22
 Reference
s: ▹ Agabegi, S. (2019). Leukemia. In Step-Up to Medicine (4th ed., pp. 360-364).
Where did Philadelphia, PA: Lippincott Williams & Wilkins.

this report ▹ Berliner, N. (2019, February 14). Approach to the adult with unexplained
pancytopenia. Retrieved April 19, 2019, from
come https://www.uptodate.com/contents/approach-to-the-adult-with-unexplained-
from? pancytopenia
▹ Clarke, C. J., & Holyoake, T. L. (2017). Preclinical approaches in chronic
myeloid leukemia: from cells to systems. Experimental Hematology, 47, 13-23.
doi:10.1016/j.exphem.2016.11.005
▹ Gnanaraj, J., Parnes, A., Francis, C. W., Go, R. S., Takemoto, C. M., &
Hashmi, S. K. (2018). Approach to pancytopenia: Diagnostic algorithm for
clinical hematologists. Blood Reviews, 32(5), 361-367.
doi:10.1016/j.blre.2018.03.001
▹ Kasper, D. L., Fauci, A. S., Hauser, S. L., Longo, D. L., Jameson, J. L., &
Loscalzo, J. (2018). Harrison's Principles of Internal Medicine (20th ed.). New
York, NY: McGraw Hill Professional.

23