In. Children's hospital of a day for you guys to get the kids in their lives and I will be there by noon tomorrow morning and get back to you on that one is a good time to come over and watch the kids tonight and I will be there in about an hour or so ago and I was like a good time to come over and watch the kids tonight and I will be there in about an hour or so ago and I was like a good time to come home for the weekend and then the next week I think we will get to meet you at the house yet uu

1. ACUTE LEUKEMIAS
By Janet M. Amanya

2. What is leukaemia
 Leukemias may be defined as a group of
malignant diseases in which genetic
abnormalities in a hematopoietic cell give
rise to an unregulated clonal proliferation
of cells. (Cancer of the WBC)
 All blood cells are produced in the bone
marrow,
 Bone marrow contains: RBCs which carry
oxygen
 platelets, which help the blood to clot and

3.  There are two different types of WBCs:-
 lymphocytes and
 myeloid cells (including neutrophils).
 These WBCs work together to fight infection.
Normally WBC develop, repair and reproduce
themselves in an orderly and controlled way.
 In leukaemia, however, the process gets out
of control and the cells continue to divide in
the bone marrow, but do not mature.
(Proliferation)

4. Cont.
 These immature dividing cells fill up the
bone marrow and stop it from making
healthy blood cells.
 As the leukaemia cells are immature, they
cannot work properly.
 This leads to an increased risk of
infection.
 Because the bone marrow cannot make
enough healthy red blood cells and
platelets, symptoms such as anaemia and

5. Classification of leukemias
Acute Chronic
Myeloid
origin
Lymphoid
origin
Acute Myeloid
Leukemia (AML)
Acute Lymphoblastic
Leukemia (ALL)
Chronic Myeloid Leukemia
(CML)
Chronic Lymphocytic Leukemia
(CLL)

6. Myeloid maturation
myeloblast promyelocyte myelocyte metamyelocyte band neutrophil
MATURATION
Adapted and modified from U Va website

7. Acute Leukemia
 accumulation of blasts in the marrow

8. ALL – On peripheral smear

9. Aetiology
 1. idiopathic
 Predisposing factors
 congenital syndromes
 Genetic aberrations - cell proliferation
 Chromosomal translation
 Increased risk with Down’s syndrome,
Klinefelter’s, Fanconi’s, Bloom’s, ataxia
telangectasia.
 Increased risk in twins
 20-fold risk in survivors of Atomic bomb

10. Classification of acute
leukemias
ALL
 mainly children
 M > F
 curable in 70% of
children
 curable in minority
of adults
AML
 mainly adults
 M > F
 curable in minority
of adults

11. Clincal manifestations
 symptoms due to:
marrow failure
tissue infiltration
Leukostasis(Respiratory distress and
altered mental status)
constitutional symptoms
other (DIC)
 usually short duration of symptoms

12. Marrow failure
 neutropenia: infections, sepsis
 anemia: fatigue, pallor
 thrombocytopenia: bleeding

13. Infiltration of tissues/organs
 enlargement of liver, spleen, lymph nodes
 gum hypertrophy
 bone pain
 other organs: CNS, skin, testis, any organ

14. Gum hypertrophy

15. A
B
C
Chloromas
NEJM 1998

16. Leukostasis
 accumulation of blasts in microcirculation
with impaired perfusion
 lungs: hypoxemia, pulmonary infiltrates
 CNS: stroke
 only seen with WBC >> 50 x 109/L

17. Constitutional symptoms
 fever and sweats common
 weight loss less common

18. Laboratory features
 WBC usually elevated, but can be normal or
low
 blasts in peripheral blood
 normocytic anemia
 thrombocytopenia
 DIC

19. 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)

20. Distinguishing AML from ALL
 light microscopy
 AML: Auer rods, cytoplasmic granules
 ALL: no Auer rods or granules.
 special stains (cytochemistry)
 flow cytometry

21. AML

22. AML

23. Auer rods in AML

24. ALL

25. Treatment of acute leukemias
Choice of Rx is influenced by:
 type (AML vs ALL)
 age
 curative vs palliative intent

26. 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

27. Chemotherapy for acute
leukemias
 Phases of ALL treatment
 induction
 intensification
 CNS prophylaxis
 maintenance
 AML treatment
 induction
 consolidation (post-remission therapy)
post-remission therapy

28. Hematopoietic stem cell
transplantation
 permits “rescue” from otherwise
excessively toxic treatment
 additional advantage of graft-vs-leukemia
effect in allogeneic transplants
 trade-off for allogeneic transplantation:
greater anti-leukemic effect but more toxic