Leukemia

Classification of leukemia
(According to the cell origin and the course of the disease)
Acute leukemia
• Lymphoblastic
• Myeloblastic
Chronic leukemia
• Myelocytic (myeloid)
• Lymphocytic.

Acute Leukemia
Definition:

Abnormal malignant proliferation of WBCs" blast cells"

cells and
then spread to peripheral blood and tissue.
Etiology: unknown
1. Genetic: chromosome 5,7
2. Irradiation
3. viral infection: Retroviruses
4. chemichals: procarbazine
5. toxins: benezene
clinical picture:

B.M failure:
 Severe progessive anemia
 Bleeding due thrombocytopenia
 Fever : mainly due to infection

WBCs: non-
non- functioning
 Recurrent infection; staph, candida, HsV
 Severe boneache
 Tender sternum
 Leukostais:
o Occlusion of blood vessels
o Hemiplegia, MI, any organ failure

Infiltration of the tissues
tissues
1. L.N: lymphadenopathy of cervical L.N, with mediastium
syndrome or L.N of porta hepatis with obstructive jaundice
2. Kidney: renal failure especially during treatment, Infarction,
infiltration or peylonephritis.
3. Spleen: splenomegaly, infarction or infection
4. CVS: MI, IHD or carditis
5. CNS: hemiplegia, cerebral infarction or meningitis
6. Liver: jaundice or hepatitis
Investigations:

CBC
 WBCs:  30 000- 50 000 up to 100 000/ cmm
 RBCs: ↓↓ normocytic normochromic anemia
 Platelets ↓↓
 Blast Cells +++
Subleukemic leukemia : WBCs normal with blast cells
Aleukemic leukemia : WBCs normal without blast cells
So, diagnosed only by BM examination

BM examination
 Blast cell > 30%

Others
 Uric acid, LDH:
Differential diagnosis:
1. Rheumatic fever
2. Aplastic anemia
3. Fever with L.Ns enlargement or sore throat
Causes of death:
1. Recurrent infections
2. Cerebral or internal hemorrhage
3. Multiple organ failure (MOF)
Treatment:
General supportive ttt.
 Blood transfusion
 Platlets transfusion
 Antibiotics for infection
 Allopurinol for hyperuricemia
 Leukopheresis for leukostasis
Acute lymphoplastic leukemia:

Chemotherapy
1. Induction of remission

Vincristine

Adriamycin

Prednisone
2. Consolidation:

Radiation to skull

Methotrxate
3. Maintenance

Mercaptopurine

Methotrexate
Very good prognosis 98%
Acute myeloplastic leukemia

Chemotherapy
1. Induction of remission

Cytosine arabinoside

Daunorubicin
2. B.M transplant after remission
3. Monocional Abs & Interleukin 2
Very bad prognosis
 Chronic Myeloid Leukemia

Clinical picture:

Infiltration of tissue
 Splenomegaly ( huge spleen)
 The same as acute leukemia:

L.N: lymphadenopathy of cervical L.N, with mediastium

syndrome or L.N of porta hepatis with obstructive jaundice
Kidney: renal failure especially during treatment, Infarction,
infiltration or peylonephritis.
CVS: MI, IHD or carditis
CNS: hemiplegia, cerebral infarction or meningitis
Liver: jaundice or hepatitis

B.M failure:
1. Severe progessive anemia
2. Bleeding due thrombocytopenia
3. Fever : mainly due to infection

WBCs: non- non- functioning
1. Recurrent infection; staph, candida, HsV
2. Severe boneache
3. Tender sternum
70% of patients will develop transformation to AML " blast crisis"
DD of huge splenomegally:
 Bilharziasis
 malaria
 Thalassemia
 Chronic meyloid leukemia & hair cell leukemia
 Polycythemia
 Myelofibrosis
 Meylosclerosis
Investigations:

CBC
1. WBCs : > million
2. RBCs : ↓↓
3. Platelets: M-shaped course
 at the start of the disease
 ↓ as blast cells encorches platelet precursors
 by blood transfusion and chemotherapy
 ↓ pancytopenia as chemotherapy long standing effect

B.M examination:
1. myelocytes is the roule.
2. In blast crisis 30% myeloblasts

Others
1. Uric acid & LDH 
2. Philadelphia chromosome in 90% of patients
Treatment:
General supportive ttt.
 Blood transfusion
 Platlets transfusion
 Antibiotics for infection
 Allopurinol for hyperuricemia
 Leukopheresis for leukostasis
Chemotherapy:

Induction of remission
1. Busulfan
2. hydroxyurea
B.M transplant after remission

Inerferon: ↓↓ viral infection and malignant growth.

 Chronic Lymphoid Leukemia
 The most common and the most benign type
 At the age of 60 years old
 Closely related to small lymphocytic lymphoma.
Clinical picture:
 25% of cases asymptomatic
 Lymphadenopathy:
Not tender may cause mediastinum $ or obstructive jaundice
 Hepatosplenomegaly
 Anemia: due to bleeding or autoimmune hemolysis
 Bleeding tendency
 Recurrent infections , fever due to non functioning WBCs
Investigations:

CBC:
1. WBCs :

mainly lymphocytes
2. RBCs :↓↓ anemia
3. Platelets: ↓↓ thrombocytopenia

B.M examination:
examination:
 30% lymphocytes

Others:
1. l.n biopsy lymphocytes
2. LDH, uric acid


treatment:

supportive treatment: as usuall

specific treatment:
1. chemothrapy
 Leukeran plus Prednisone.
2. Radiotherapy.
 Hairy Cell Leukemia

Definition:
It is a chronic lymphoid leukemia with abnormal cell which has
hairlike cytoplasmic projections on its surface. Hairy cell leukemia
is a B-cell disease.
Incidence:
mostly in middle-aged males, with a male-to-female ratio of 5:1 
clinical picture:

B.M failure:
 Anemia
 Bleeding due thrombocytopenia
 Fever : mainly due to infection

WBCs: non- functioning
 Recurrent infection; staph, candida, HsV, opportunistic infections

Infiltration of tissue as chronic leukemia but
 Splenomegaly (massive Splenomegaly)
It is the most common physical finding in virtually every patient with hairy cell leukemia

treatment:
 2-chlorodeoxyadenosine (2-CdA) is the corner stone of therapy
 Splenectomy in severe cases
 Supportive tereatment:
 Antibiotics
 Cortisone
 interferon