Acute Leukemias

1. ACUTE LEUKEMIAS
DR. SOOKUN RAJEEV K
(MD)
DEPT OF GENERAL MEDICINE
ANNA MEDICAL COLLEGE

2. WHAT ARE LEUKEMIAS?
Leukemias are a group malignant
disorders of hematopoietic tissues
characterised by increased number of
white cells in the bone marrow and/or
peripheral blood.

3. WHAT IS ACUTE LEUKEMIA?
Failure of cell maturation associated with
proliferation of abnormal cells which are of
no function and take up more bone marrow
space at the expense of the normal
Haematopoietic elements.

4. TYPES
Acute Leukemias
Acute Myeloid
Leukemia
(AML)
Acute
Lymphoid
Leukemia (ALL)

5. SUBCLASSIFICATIONS
Acute
Lymphoblastic
Leukemia
Common
Type
(pre B)
T-cell B-cell Undifferentiated

6. SUBCLASSIFICATIONS (ALL)
 T-cell
Undifferentiated
Common type( pre-B)
B-cell

7. Acute
Myeloid
Leukemia
M0-Undifferentiated
M1-Minimal differentiated
M2-Differentiated
M3-Promyelocytic
M4-Myelomonocytic
M5-Monocytic
M6-Erythrocytic
M7-Megakaryocytic
SUBCLASSIFICATIONS
(FAB)

8. ETIOLOGICAL FACTORS
Ionising Radiation
Iatrogenic : Drugs and Chemicals
Cytotoxic drugs : E.g. Alkylating Agents
Benzene Exposure
Infection : Retroviruses
Inherited : Down Syndrome
Immunological

9. CLINICAL PRESENTATION
Features of Bone Marrow failure
1. Anemia
2. Bleeding
3. Infection

10. CLINICAL PRESENTATION
ANEMIA
• Tiredness • Dyspnea
• Ankle Swelling • Mucous Memebrane
• Pallor • Tachypnea
• Increase JVP • Flow murmurs
• Postural
Hypotension
• Tachycardia

11. CLINICAL PRESENTATION
THROMBOCYTOPENIA
• Purpura
• Spontaneous Bruising
• Bleeding(Oral, Nasal, Gastrointestinal,
Genitourinary, Fundal and Fatal Intracranial
Infections.

12. CLINICAL PRESENTATION
SKIN INFILTRATION WITH AML

13. DIFFERENTIAL DIAGNOSIS
•Acute Myeloid Leukemia
Aplastic Anemia
Myelodysplasia
Marrow Infiltration with Fibrosis or tumour
Hypersplenism

14. DIFFERENTIAL DIAGNOSIS
•Acute Lymphoblastic Leukemia
Toxoplasmosis or acute viral infections such as
cytomega- lovirus and infectious mononucleosis
may present with a reactive lymphocytosis
The leukemic phase of certain lymphomas and the
occasional lymphoid blast crisis of chronic
myelogenous leukemia

15. INVESTIGATIONS
1. FBC
(Anemia, Normal or raised MCV)
2. Leucocyte Count
(Low to High)
3. Blood smear examination
(Appearance of Blast cells & other primitive cells)
4. Bone Marrow Examination
(Diagnostic -> decrease Blast cell count & Severe Thrombocytopenia
usually)

16. INVESTIGATIONS
PERIPHERAL BLOOD
SMEAR (AML)

17. BONE MARROW ASPIRATION

18. BONE MARROW ASPIRATION

19. INVESTIGATIONS
5. Bone Marrow Cytology, Cytogenetics, Immunological
phenotyping
6. Trephine Biopsy
(Marrow is hypercellular)
(Replacement of normal elements by Leukemic blast cells)
(Presence of Auer Rods – Myeloblastic Leukemia)

20. AUER RODS

21. OTHER INVESTIGATIONS
7. Hemostatic Function
•Coagulation screen
•Fibrinogen
•D-Dimmers
8. Renal Function Tests
•Plasma Urea & Creatinine

22. OTHER INVESTIGATIONS
9. Hepatic Functions Tests
•Total Protein
•Albumin
•Bilirubin
•Alkaline Phosphatase
•Alkaline Aminootransferase
10.Cellular Proliferation
•Plasma LDH
•Plasma Urate

23. TREATMENT
Treatment Aim - To destroy leukemic clone of cells
without destroying the residual normal cells
1 – Remission Induction
2 – Intensification (Consolidation) Therapy
3 – Maintenance Therapy
4 – CNS Prophylaxis
5 – Allogeneic Stem Cell Transplant

24. MANAGEMENT AND THERAPY
Phase Acute Myeloid Leukemia
Induction Daunorubicin (I.V.)
Cytarabine (I.V.)
Tioguanine (I.V.)
Etoposide (I.V.)
Consolidation Cytarabine (I.V.)
Amsarcine (I.V.)
Mitoxantrone (I.V.)

25. MANAGEMENT AND THERAPY
Phase Acute Lymphoblastic Leukemia
Induction Daunorubicin (I.V.)
Vincristine (I.V.)
Prednisolone (oral)
Consolidation Cytarabine (I.V.)
Methotrexate (oral)
Etoposide (I.V.)
Maintenance Prednisolone (oral)
Vincristine (I.V.)
Methotrexate (oral)

26. MANAGEMENT AND THERAPY AND SUPPORTIVE THERAPY
Combined chemotherapy
Hospitalisation for 3 to 4 weeks for transfusion of blood
product
Antibiotics
Following the induction of remission (less than 5% blasts in the
marrow) pts are treated with cycles of high dose chemotherapy
Bone Marrow Transplant -Pts with cytogenic abnormalities with
poor prognosis