LEUKEMIA

dr. Meddy Setiawan, SpPD

FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH MALANG
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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
origin

Acute Myeloid
Leukemia (AML)

Chronic Myeloid Leukemia

(CML)

Lymphoid
origin

Acute Lymphoblastic
Leukemia (ALL)

Chronic Lymphocytic Leukemia

(CLL)

Hematopoiesis
PLURIPOTENT
MIXED
STEM CELL PROGENITOR
CELL

COMMITTED
PROGENITOR
CELL

RECOGNIZABLE
BONE MARROW
PRECURSOR CELL

BFU-E/CFU-E

CFU-Eos

red cell
neutrophil
monocyte
eosinophil

CFU-Baso

basophil

CFU-GM

myeloid
progenitor
cell
pluripotent
stem cell
lymphoid
progenitor
cell

pronormoblast
myeloblast
monoblast

MATURE
BLOOD
CELL

CFU-Meg

megakaryocyte

platelet

pre-T

lymphoblast

T-cell

pre-B

lymphoblast

B-cell
& plasma cell
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Myeloid maturation
myeloblast promyelocyte

myelocyte

metamyelocyte

band

neutrophil

MATURATION
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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
blasts
promyelocytes
myelocytes
metamyelocytes
bands
neutrophils

CML
q
q
q
q
q
q

AML
q

normal

q
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Classification of acute
leukemias
ALL

AML

mainly children
M>F
curable in 70% of
children
curable in minority
of adults

mainly adults
M>F

curable in minority
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

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Infiltration of tissues/organs
Enlargement of liver, spleen, lymph
nodes
Gum hypertrophy
Bone pain
Other organs: CNS, skin, testis, any
organ

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Gum hypertrophy

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Leukostasis
Accumulation of blasts in
microcirculation with impaired
perfusion
Lungs:
hypoxemia, pulmonary
infiltrates
CNS: stroke
Only seen with WBC >> 50 x 109/L

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Causes of acute leukemias

Idiopathic (most)
Underlying hematologic disorders
Chemicals, drugs
Radiation
Viruses
Hereditary/genetic conditions

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Constitutional symptoms
Fever and sweats common
Weight loss less common

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Laboratory features
WBC usually elevated, but can be
normal or low
Blasts in peripheral blood
Normocytic anemia
Thrombocytopenia

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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)
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Distinguishing AML from ALL

Light microscopy
AML: Auer rods, cytoplasmic granules
ALL: no Auer rods or granules.

Special stains (cytochemistry)

Flow cytometry

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AML

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ALL

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Auer rods in AML

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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
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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

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