Chronic leukemia

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Chronic leukemia

  1. 1. Chronic Leukemia
  2. 2. Leukemias• Acute leukemias• Chronic leukemiasLymphomas• Hodgkin lymphoma• Non-Hodgkin lymphomaPlasma cell disorders• Multiple myelomaHematologic Malignancies
  3. 3. Chronic myeloid leukemia Chronic lymphocytic leukemia
  4. 4. Leukemias• Acute leukemias• Chronic leukemias• Chronic myeloproliferative disorders• Chronic lymphoproliferative disordersHematologic Malignancies
  5. 5. Leukemias• Acute leukemias• Chronic leukemias• Chronic myeloproliferative disordersHematologic Malignancies
  6. 6. • Malignant proliferation of myeloidcells (not blasts, but maturing cells) inblood, bone marrow• Four disorders: CML, PV, ET, MF• Occur only in adults• Long courseChronic Myeloproliferative DisordersThings You Must Know
  7. 7. • Chronic myeloid leukemia• Polycythemia vera• Essential thrombocythemia• MyelofibrosisFour Chronic Myeloproliferative Disorders
  8. 8. • Occur only in adults• Long clinical course•  WBC with left shift• Hypercellular marrow• Big spleenFeatures common to all 4 disorders:
  9. 9. • Neutrophilic leukocytosis• Basophilia• Philadelphia chromosome• Three phasesChronic Myeloid LeukemiaThings You Must Know
  10. 10. Chronic Myeloid Leukemia
  11. 11. Chronic Myeloid Leukemia
  12. 12. NormalchromosomesChromosomesin CML
  13. 13. Cytogenetics
  14. 14. Chronic phase• Stable counts• Easily controlled• 3-4 years (without therapy)Accelerated phase• Unstable counts• Fatal within monthsBlast crisis• Lots of blasts• Fatal within weeksPhases of CML
  15. 15. Treatment• Used to be bone marrow transplant• Now, imatinib (Gleevec)Prognosis• Median survival used to be 5-6 years• Now: ??Treatment and Prognosis of CML
  16. 16. • Panmyelosis…• …then marrow fibrosis• Extramedullary hematopoiesis• Teardrop red cellsChronic MyelofibrosisThings You Must Know
  17. 17. Chronic myelofibrosis
  18. 18. Chronic myelofibrosis
  19. 19. • High RBC (makes blood sludgy)• Different from secondary polycythemia!Polycythemia VeraThings You Must Know
  20. 20. Polycythemia vera
  21. 21. • Very high platelet count in blood• Different from secondarythrombocythemia!Essential ThrombocythemiaThings You Must Know
  22. 22. Essential thrombocythemia
  23. 23. Leukemias• Acute leukemias• Chronic leukemias• Chronic myeloproliferative disorders• Chronic lymphoproliferative disordersHematologic Malignancies
  24. 24. • Malignant proliferation oflymphocytes in blood, bone marrow• Many disorders; CLL most important• Occur only in adults• Long course; indolent but incurableChronic Lymphoproliferative DisordersThings You Must Know
  25. 25. • Small, mature lymphocytes• = small lymphocytic lymphoma• Weird: B cells but CD5+• Long but inexorable courseChronic Lymphocytic LeukemiaThings You Must Know
  26. 26. Chronic lymphocytic leukemia
  27. 27. Chronic lymphocytic leukemia
  28. 28. Treatment• Conservative• Reduce organomegaly, infectionsPrognosis• “Counts,” adenopathy• BM pattern, chromosomal abnormalities• Mean survival: 9 years• Death usually from infectionTreatment and Prognosis of CLL

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