15-Leukemia (221014)

Myeloproliferative Disorders:

Leukemia

Susanto Nugroho

The Medical Study ProgramFaculty of Medicine University of Brawijaya

Clinical CompetenciesAfter this session:Students can describe the incidence, classification & diagnosis (based on clinical features and laboratory findings) of:

  acute myelogenous leukemia (AML)  acute lymphoblastic leukemia (ALL)  chronic myelogenous leukemia (CML)  chronic lymphoblastic leukemia (CLL)

Introduction

Leukemia  A disease resulting from the neoplastic

proliferation of hemopoietic or lymphoid cells  Lymphoid, myeloid and biphenotypic leukemias  The clinical manifestations are due to the

proliferation of leukemic cells & their infiltration into normal tissues

  Increased proliferation metabolic consequences(and infiltrating cells also disturb function)

  Infiltration of the bone marrow: anemia, neutropenia and thrombocytopenia can lead infection and haemorrhage

Introduction…..

Acute leukemia  A defect in maturation imbalance between

proliferation & maturation leukemic clone cells continue to proliferate without maturing immature leukemic cells

  If untreated lead to death in weeks or months

Chronic leukemia  An an expanded pool of proliferating cells that

retain their capacity to differentiate to end cells mature leukemic cells

  If untreated lead to death in months or years

Acute Leukemia

Acute Myelogenous Leukemia (AML)

A

B

A. ErythrocyteC B. Large lymphocyte

C. Neutrophil (segment)

D E D. Eosinophil

H E. Neutrophil (segment)F. MonocyteG. Thrombocyte

F H. Small lymphocyteG I. Neutrophil (band)

J. Basophil

I J

Blood film of AML– Auer Bodies

AML + Auer Rod

Acute Monocytic Leukemia (AMoL)

Acute Monocytic Leukemia (AMoL)

Blast ≥ 30% of ANC Blast ≥ 30% of NEC

Perform peripheral blood differen1al counts and 500 cell differen1al counts on bone marrow

Assess % erythroblasts of all nucleated cells (ANC)

erythroblasts <50% erythroblasts ≥ 50%

Assses blasts as % of ANC & look for specific features of M3

Assses blasts as % of all non – erythroid cells ( NEC)

Blast < 30% of ANC Blast < 30% of NEC

M0, M1-‐M5, M7 M6MDS

Acute Lymphoblastic Leukemia (ALL)

Acute Lymphoblastic Leukemia (ALL)

Chronic Lymphocytic Leukemia (CLL)

Chronic Lymphocytic Leukemia (CLL)

Chronic Myelogenous Leukemia (CML)

Chronic Myelogenous Leukemia (CML)

Figure of translocation between chromosomes 9 & 22

Chronic Myelogenous Leukemia (CML)

Modul Task1.  Describe definition, etiology & pathogenesis of

acute leukemia!2.  Describe in brief the FAB & WHO classification

of acute myeloid leukemia (AML)!3.  Describe clinical features & laboratory findings

to diagnose AML!4.  Describe in brief the treatment of AML!5.  Describe in brief classification of acute

lymphoblastic leukemia (ALL)!6.  Describe clinical features & laboratory findings

to diagnose ALL!7.  Describe in brief the treatment of ALL!

Modul Task8.  Describe etiology, pathology & immunologic

abnormalities of chronic lymphoid leukemia (CLL)!

9.  Describe clinical features & laboratory findings to diagnose CLL!

10.  Describe the treatment of CLL!11.  Describe etiology of chronic myelogenous leukemia

(CML)!12.  Describe clinical features & laboratory findings

to diagnose CML!13.  Describe the treatment of CML!

Please…….discuss this case in your group!!