a simplified approach to blood cancers

1. Acute leukemia
Myeloid- AML
&
Lymphoblastic- ALL

2. AML
 Common acute leukemia in adults
 Incidence increases with age
 Risk factors-
 MDS/MPD
 Chemotherapy- alkylating agents-chr. 5,7,11,17,
topoisomerase II inhibitors-chr. 11,21
 Radiation
 Benzene
 Genetic- Down’s syndrome, DNA repair defects

3. Diagnosis
 s/s- anemia, bleeding tendency, infection
 CBC- low Hb/platelets, WBC low/n/raised
 Bone marrow- >20% myeloblasts, Auer rods
 Cytochemistry- MPO/esterase +ve staining
 Immunohistochemistry- CD 13, 33 +ve
 Cytogenetics- inv 16, t(15:17)/(8:21), -5/-7
 LFT, RFT, aPTT/INR, CxR etc.

4. Classification
 WHO- prognosticates
 With charac. cytogenetics- inv16, t(15:17)/(8:21)- good Px
 With prior MDS/MPD- more in elderly- poor Px
 Prior therapy related- poor Px
 Other
 FAB- M0-M7- morphological
 M2- with granulocyte maturation- t(8;21)- good Px
 M3- promyelocytic- t(15:17)- bleeding tendency- best Px
 M4/5- monocytic- inv16- gum hypertrophy
 M5- erythroid
 M7- megakaryoblastic

5. Treatment & prognosis
 Induction chemotherapy- goal is remission-
normal CBC with BM
blasts <5%
 3+7- Dauno/Idarubicin + Cytarabine
 M3- ATRA + chemotherapy
 Consolidation chemo.- maintain remission
 Good Px- 3-5 cycles of 2+5/3+7
 Bad Px- allogeneic SCT
 Prognosis-
 Depends on- cytogenetics, primary/secondary, age, PS
 Cure rates- ~25%

6. ALL
 Common acute leukemia in children
 s/s-
 Fatigue, pallor, anemia
 Easy bruisability, petechiae
 Bone pains
 LNE
 HS’megaly
 Fever, frequent infection
 CNS (meningeal) involvement- cranial nerve defects
 Testicular involvement- painless asymmetrical enlargement

7. Diagnosis
 s/s
 CBC with PBS examination
 BM examination- >20% lymphoblasts
 Cytochemistry- MPO –ve
 IHC- CD 2/7/10/19 +ve, Tdt +ve, CALLA Ag +ve
 Cytogenetics-
 t(8:14)- Burkitt’s
 t(9:22)/(4:11)- poor Px,
 t(12:21)- good Px- commonest
 CSF examination
 CxR/CT chest, LFT, RFT, US/CT abdomen etc.

8. Classification-WHO
 ALL- precursor cell- FAB L1 or L2- Tdt +ve
 B-cell
 T-cell
 Burkitt’s leukemia- FAB L3- sIg +ve
 Biphenotypic
 Variants-
 With cytoplasmic granules
 Aplastic presentation
 With eosinophilia

9. Treatment & prognosis
 Chemotherapy- phases
 Remission induction- V.P.L.D & IT CNS prophylaxis
 Consolidation- multiple drugs in various combination
 Maintenance- 2-3 years- Mtx.6-MP.V.Steroids
 Prognosis-
 Worsens as age increases
 Worse with initial raised WBC, CNS involvement, 2° ALL
 t(9:22)/(4:11)/(8:14)- poor Px
 Hyperdiploidy, t(12:21)- good Px
 Cure rates- ~30%

10. Treatment & prognosis
 Chemotherapy- phases
 Remission induction- V.P.L.D & IT CNS prophylaxis
 Consolidation- multiple drugs in various combination
 Maintenance- 2-3 years- Mtx.6-MP.V.Steroids
 Prognosis-
 Worsens as age increases
 Worse with initial raised WBC, CNS involvement, 2° ALL
 t(9:22)/(4:11)/(8:14)- poor Px
 Hyperdiploidy, t(12:21)- good Px
 Cure rates- ~30%