Acute leukemia

Myeloid- AML&

Lymphoblastic- ALL

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

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.

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

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%

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

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.

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

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%