Leukemias Overview: ALL, CML, AML, APML, CLL



Acute leukemias > 20% blasts in the peripheral blood smear or on bone marrow leading to a more rapid onset of symptoms.

Chronic leukemia < 20% blasts with a relatively chronic onset of symptoms.





ALL (Acute Lymphoblastic Leukemia):

• Lymphocytes - T or B lineage

• Immature

• Age: 10

• 75% usually under 6 years age

• 75% of ALL is of B-cell lineage

ALL Symptoms:

• Malaise, bleeding, infections, bone pain

• Bulky lymphadenopathy

• Blast cells - Blood and Bone marrow

• Mature B-cell ALL can present as extramedullary disease, including gastrointestinal or testicular involvement

• T-cell ALL: mediastinal mass

• Rapidly rising blast cells - Blood & BM

• Bulky lymphadenopathy

• Cytopenia -> BM involvement

• 30%: CNS involvement



CML (Chronic Myeloid Leukemia):

• Neutrophils (myeloid)↑

• Mature

• Age: 40-60

• + (9;22) Philadelphia - BCR-ABL

	• ↑ Tyrosine Kinase activity

	• ↓ LAP Score

• CML -> AML: Blast crises

• Blasts > 10% leukocytes

Blast Phase:

• Headaches, bone pain, fever, joint pain, bleeding, infections, and lymphadenopathy

CML Findings:

• Splenomegaly

• ↑ Leukocyte count ↑ PLT

• ↑ PBS: Granulocytic cells in all phases of maturation

	• (Peripheral eosinophilia, basophilia, and thrombocytosis)

CML Symptoms:

• Fatigue, weight loss, abdominal fullness (splenomegaly), night sweats, bleeding

• Pruritis after hot bath/showers

• Lymphadenopathy



AML (Acute Myeloid Leukemia):

• Neutrophils

• Immature/Myeloblasts

• Age: 50-60

• Auer Rods

Significant ↓ PLT: Petechiae, bruising, bleeding, infection

RARE - Lymphadenopathy/HSM

Leukocyte Count:

• ↑ Can develop leukostasis syndrome: CNS manifestations, hypoxia, CXR - infiltrates (anemia, thrombocytopenia, or functional neutropenia)

• Bone pain, dyspnea, gingival hypertrophy

• Leukemia cutis (violaceous, nontender cutaneous plaques)

AML Dx:

• ↑ Leukocyte count

• ↓Hg & PLT

• Peripheral smear: Blasts



APML (Acute Promyelocytic Leukemia):

• Poorly differentiated leukocytes + distinctive primary granules

• t(15;17) translocation

• Significant bleeding: Fibrinolysis & DIC

• Tumor lysis syndrome: Develops in treated pts. Intracellular Urate, Potassium and Phosphorus



CLL (Chronic Lymphocytic Leukemia):

• Lymphocytes

• Mature

• Age: 60-80

Clonal Accumulation of Mature B Lymphocytes:

• In the peripheral blood, bone marrow and secondary lymphoid organs

When Cancer Cells are in the Lymph Nodes:

• Small lymphocytic lymphoma (SLL)

CLL Symptoms:

• Lymphadenopathy

• HSM

• Fevers

• Drenching night sweats/fatigue

• Exaggerated response to mosquito bites

CLL -> Invade Skin: Leukemia cutis

Labs:

• Lymphocytosis/Cytopenias

• AIHA, ITP, Agranulocytosis

• Hypogammaglobulinemia, smudge cells



Richter's Transformation:

• Complication of Chronic Lymphocytic Leukemia (CLL) and/or Small Lymphocytic Lymphoma (SLL)

• Sudden transformation of the CLL/SLL into a significantly more aggressive form of large cell lymphoma



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