COMMON TYPES OF LEUKEMIAS, THEIR SALIENT CLINICAL FEATURES, MORPHOLOGY AND IMMUNOPHENOTYPES
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NAME |
CLINICAL FEATURES |
SALIENT MORPHOLOGY |
IMUNOPHENOTYPE |
CHROMOSOMAL ABNORMALITIES |
 ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) |
ABRUPT STORMY ONSET
SYMPTOMS RELATED TO DEPRESSION OF BONE MARROW FUNCTION; ANEMIA, INFECTION, BLEEDING
GENERALIZED LYMPHADENOPATHY, SPLENOMEGALY, HEPATOMEGALY
BONE MARROW INVOLVEMENT CAUSING BONE TENDERNESS AND PAIN
MENINGEAL INVOLVEMENT LEADINT TO VOMITING, PAPILLEDEMA, CRANIAL NERVE PASLIES. INTRACEREBRAL OR SUBARACHNOID HEMORRHAGE
LABORATORY FINDINGS; LOW RBC, LOW WBC (,10,000/mm3), IMMATURE BLAST CELLS IN THE BLOOD AND BONE MARROW (6-100% OF CELLS), LOW PLATELET COUNT (<100,000/mm3)
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COARSE GRANULAR CHROMATIN ONE TO TWO NUCLEOLI ABSENCE OF AZUROPHILIC GRANULES LARGE AGGREGATES OF PAS POSITIVE MATERIAL
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80% B CELL (CD19, NUCLEAR TdT). SOME ARE B CELLS EXPRESSING SURFACE IgG AND NEGATIVE TdT
T LYMPHOBLASTS. NUCLEAR TdT |
HYPERDIPLOIDY (51-60 CHROMOSOMES); GOOD PROGNOSIS
PHILADELPHIA CHROMOSOME (Ph1) IN 15% OF PATIENTS; POOR PROGNOSIS
CHROMOSOMAL TRANSLOCATION (20-25%) t(1:19); POOR PROGNOSIS
CHROMOSOMAL TRANSLOCATION T(8;14); POOR PROGNOSIS |
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ACUTE MEYLOBASTIC LEUKEMIA (AML) |
DELICATE NUCLEAR CHROMATIN
3-5 NUCLEOLI
FINE AZUROPHILIC GRANULES IN THE CYTOPLASM
RED STAINING ROD-LIKE STRUCTURES (AUER RODS)
POSITIVE MYELOPEROXIDASE (S0ME CASES)
LYSOSOMAL NON-SPECIFIC ESTERASES |
TdT POSITIVITY, RARE |
VARIOUS CHROMOSOMAL TRANSLOCATIONS |
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CHRONIC MYELOID LEUKEMIA (CML) |
NON-SPECIFIC INITIAL SYMPTOMS
EASY FATIGABILITY, WEAKNESS, ANOREXIA, WEIGHT LOSS, PRESSURE IN THE ABDOMEN DUE TO EXTREME SPLENOMEGALY
ACCELERATED PHASE IN 50% OF PATIENTS CHARACTERIZED BY ANEMIA, THROMBOCYTOPENIA AND TRANSFORMATION TO ACUTE LEUKEMIA (BLAST CRISIS)
LACK OF ACCELERATED PHASE PHASE IN 50% OF PATIENTS WITH ABRUPT DEVELOPMENT OF BLAST CRISIS |
MARKEDLY ELEVATED LEUKOCYTE COUNT (>100,000)
PREDOMINANTLY NEUTROPHILS AND METAMYELOCYTES
BASOPHILS AND EOSINOPHILS MAY BE PROMINENT
SMALL NUMBER OF MYELOBLASTS (<10%)
THROMBOCYTOSIS (~50% OF PATIENTS) |
PLURIPOTENT CELLS
LACK OF ALKALINE PHOSPHATASE IN THE GRANULOCYTES |
Ph1 (90% OF PATIENTS) REPRESENTING T(9;22) CHROMOSOMAL TRANSLOCATION
bcr-abl GENE REARRANGEMENTS |
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CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) |
OFTEN ASYMPTOMATIC
NON-SPECIFIC SYMPTOMS SUCH AS LOSS OF WEIGHT, ANOREXIA, EASY FATIGABILIGY
GENERALIZED LYMPHADENOPATHY AND HEPATOSPLENOMEGALY (60% OF PATIENTS)
SLIGHTLY TO MARKEDLY INCRESED LEUKOCYTE COUNT (200,000/mm3) WITH ABSOLUTE LYMPHOCYTOSIS |
MATURE B CELLS |
MATURE B CELLS (CD19+, CD20+, sIg+) ALSO EXPRESSING T CELL MARKERS (CD5+) |
TRISOMY 12 (50% OF PATIENTS)
COMPLEX CHROMOSOMAL ABNORMALITIES INVOLVING CHROMOSOME 11 AND 14
GENE REARRANGEMENT OF bcl-2 (10-15% OF PATIENTS)
MUTATION OF bcl-2 (5% OF PATIENTS)
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