Leukemia

Question 1

Leukemia

Answer 1

• White Blood Cell cancer in the blood

Question 2

Leukemia

Answer 2

2 Presentations:

• Chronic
• Acute

Question 3

Chronic Leukemia

Answer 3

• Mature developed WBCs
  
  • Look pretty normal in smear
  • BUT More of them!
• In older patients
• Asymptomatic
• Elevated WBC Count 60-100!

Question 4

Differentials for Chronic Leukemia

Answer 4

• Smear will look pretty normal, but look for:
  
  • Neutrophils =
    
    • Chronic myelogenous leukemia
      
      • (CML)
  • Lymphocytes =
    
    • Chronic Lymphocytic Leukemia
      
      • (CLL)
• Confirm Dx w/ Bone Marrow Biopsy!

Question 5

Chronic myelogenous leukemia

(CML)

Answer 5

• Disease of Middle Age
• Present w/ chronic picture
  
  • Elevated White Count
  • Asymptomatic
• Differential:
  
  • Neutrophils predominate
• Bx: t(9:22) = Philadelphia Chromosome
  
  • ​Tyrosine Kinase
  • Need to treat w/ Imatinib
    
    • B/c Tyrosine Kinase inhibitor
• These patients will undergo Blast Crisis = no good.

Question 6

Chronic Myelogenous Leukemia

(CML)

Treatment

Answer 6

• Responds to
  
  • Imatinib (chemo)
    
    • Tyrosine kinsae inhibitor

Question 7

Chronic Lymphocytic Leukemia

(CLL)

Treatment Options

Answer 7

• Responds to:
  
  • Nothing
    
    • If pt. 65+ and no donor
    • Can do Chemo for these pts
    • Reassure, watch, wait for symptoms
  • Chemo
  • Stem Cell Transplant
    
    • Younger patient, w/ donor

Question 8

Acute Leukemias

Answer 8

• Blasts: Big ugly cells that are not mature
  
  • Lots of cytoplasms, little nucleus
• Symptomatic!!!
  
  • Anemia
  • Bleeding
  • Fevers
  • Infections
  • Bone Pain
• Lots of WBCs, crowd out Marrow
• More Agressive
• Patients are Younger
  
  • *

Question 9

Acute Leukemias

Answer 9

• Look at Smears:
  
  • Acute Myelogenous Leukemia
    
    • Neutrophils
  • Acute Lymphocytic Leukemia
    
    • Lymphs

*Get Bone Marrow Bx

Question 10

Acute Myelogenous Leukemia

(AML)

Answer 10

• Neutrophils
• Blasts, not developed
• Average pt. age: 27yo
• Need exposure to get:
  
  • Benzene,
  • or past Chemo/Radiation
  • or former CML w/ Blast Crisis

Dx: Smear then Bone Marrow bx (+myeloperoxidase)

Question 11

Acute Myelogenous Leukemia

(AML)

Treatment

Answer 11

• +M3 (Auer Rods)
  
  • Use Vit. A
• If not M3
  
  • Use Chemo

Question 12

Acute Lymphocytic Leukemia

(ALL)

Answer 12

• Blastic, immature Lymphocytes
• Young patients; childhood disease (~7yo)
• Acute presentation
• Dx: Blood Smear, then Bone Marrow Bx
  
  • need 20% Blasts!
  • • cALLa, or
  • • Tdt

Question 13

Acute Lymphocytic Leukemia

(ALL)

Treatment

Answer 13

• Treat with Chemo
• prophylaxis CNS with Ara-C
  • B/c ALL is in CNS

Question 14

Chronic Lymphocytic Leukemia

(CLL)

Answer 14

• Predominately Lymphocytes
  
  • No blasts (b/c not acute!)
• Found in Elderly!
• Asymptomatic
  
  • Elevated WBC count
• Differential:
  
  • Predominately Lymphocytes
• Test: Bone Marrow Biopsy
• “Patients die with it, not from it”

Question 15

Let’s Drive it Home….

Answer 15

• Acute = Blasts! & Get a Smear!
• Chronic = No Blasts! & Get a Diff!
• ALL = Kids; Prophylaxis CNS
• AML = Teens & 20s; M3 variant?
• CML = Middle-aged; Philly chromosome; Imatinib
• CLL = Elderly; watch & wait? stem cell? Chemo?