Leukemias

LEUKEMIAS
1. Leukemias, definition, classification

2. Etiology and pathogenesis of leukemias
3. General symptoms of leukemias and their pathogenesis
4. Acute and chronic myelocytic (myelogenous) leukemias, peripheral blood
film
5. Acute and chronic lymphocytic leukemias, peripheral blood film
Key words: leukemia, blast cells, maturation, differentiation, “hiatus leukemicus”
Leukemias are malignant neoplasms of the hematopoietic cells characterized

by diffuse replacement of the bone marrow by neoplastic cells. In most cases the
leukemic cells spill over into the blood, where they may be seen in large numbers.
These cells may also infiltrate the liver, spleen, lymph nodes, and other tissues
throughout the body, causing enlargement of these organs.
Leukemias account for 4% of all cancer deaths.
Classification
Leukemias are classified on the basis of the cell type, involved and the state
of maturity of the leukemic cells.
Acute leukemias are characterized by replacement of the marrow with very
immature cells (blasts) and by a rapidly fatal course in untreated patients. Chronic
leukemias are characterized by replacement of the marrow with well differentiated
(mature) leukocytes and by a relatively indolent course.
Leukemias
Acute: Chronic:
Lymphoblastic Lymphocytic
Myeloblastic Myeloid
According to the leukocyte count leukemias are divided into:
 Leukemic (leukocyte count is more than 30 -50x109/l)
 Subleukemic (leukocyte number is from normal to 30x109/l)
 Leukopenic (leukocyte number less than normal)
 Aleukemic (there are no blast cells in peripheral blood)
Etiology
1. Genetic factors – Philadelphia chromosome (22®9). Leukemias occur with
increased frequency with a variety of congenital disorders such as Down’s
disease, Kleinfelter’s syndrome. There is activation of oncogene by
translocations.
2. Oncoviruses – HTLV-I (T-cell leukemia)
3. Physical agents (ionizing radiation)
4. Chemical carcinogens (benzene, ethylene oxide, antineoplastic drugs)
Pathogenesis
Carcinogens ® activation of oncogenes, deletion of antioncogenes,
alteration the genes that regulate apoptosis® malignant transformation of a single
clone of cells, belonging to myeloid or lymphoid series, followed by proliferation
of the transformed clone ® progression® formation of more malignant clones ®
metastasis ® infiltration of other tissues such as lymph nodes, liver, spleen.
General symptoms of leukemias and their pathogenesis
Symptoms Pathogenesis
Anemia Suppression of normal hematopoietic stem cells,
hemorrhages, hemolysis
Bleeding (from gums, Thrombocytopenia, thrombocytopathy, high vascular
nose, petechiae) permeability
Infections Low phagocytic activity, reduced antibody production
Enlargement of lymph Leukemic infiltration – metastasis
nodes, spleen, liver,
gum hypertrophy
(leukemic stomatitis)
Autoimmune injuries Derangement of immune response
Acute myelocytic leukemia

 Primarily affects adults between the ages of 15 and 39 years
 50 to 70% of cases have caryotypic changes
 Poor prognosis (15% survival)
Peripheral blood smear: more than 60% of blood cells are myeloblasts, low
content of matured neutrophils, “hiatus leukemicus” – absence of intermediate
forms of neutrophil maturation normocytic, normochromic anemia (often severe)
with decreased reticulocyte count. Leukocyte count is usually normal or decreased.
Platelets usually low. Bone marrow shows blast prevalence.
Acute Lymphocytic leukemia
 Most common type of leukemia in children
 Peak incidence at approximately four years of age
 80% of B-cell origin; 15% of T-cell origin; 5% unclassifiable
 60% have karyotypic abnormalities (translocations)
Peripheral blood smear: the majority of leukocytes of blood are blasts, low
content of matured cell; Normocytic, Normochromic anemia, thrombocytopenia,
leukocytes may be low, normal or high. If high, lymphoblasts will be present.
Chronic myeloid leukemia
 Affects adults between 25 and 60 years of age.
 Slowly progressive clinical course (3-4 years)
 High white cell counts (more than 100x109/l)
 Presence of Philadelphia chromosome (bcr-abl oncogene)
 Massive splenomegaly
 Non-specific symptoms: weakness, weight loss, fatigue, anorexia
 “Blast crisis” = acute leukemia
Peripheral blood smear: cells of all stages of maturation are present in the
bone marrow and blood. There is increased number of basophils and eosinophils.
Myeloblasts are usually less than 5%. 50% of patients have thrombocytosis. The
bone marrow is hypercellular with hyperplasia of granulocytic and megacariocytic
lineages.
Chronic lymphocytic leukemia
 Affects persons older than 50 years
 Most indolent of the leukemias (median survival 4-6 years)
 Symptoms are often non-specific, generalized lymphadenopathy may be
present, splenomegaly and hepatomegaly
 Male: female=2:1
 95% of B-cell origin
 50% of the patients have abnormal karyotypes (Trisomy 12 is the most
common)
 Prognosis is variable
Peripheral blood: There is absolute lymphocytosis of small mature looking
lymphocytes (the count may be more than 200x109/l). Smear cells -degenerated
forms –are present (Klein-Humpreht-Botkin bodies) Hemolytic anemia.

Leukemias

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LEUKEMIAS

1. Leukemias, definition, classification

Leukemias are malignant neoplasms of the hematopoietic cells characterized

General symptoms of leukemias and their pathogenesis

Acute myelocytic leukemia

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