Leukemia Types of Leukemia: Francisco, Frances Lorraine R. Hematology BSMT / Eac-C Sir Carlo Ace de Belen

Francisco, Frances Lorraine R.
HEMATOLOGY
BSMT / EAC-c Sir Carlo Ace De Belen
LEUKEMIA
Types of Leukemia
Leukemia is classifed by how quickly it progresses. Acute leukemia is fast-growing and can overrun the body within
a few weeks or months. By contrast, chronic leukemia is slow-growing and progressively worsens over years.
Acute leukemia
- Blast cells
- Rapidly fatal if not treated
Chronic Leukemia
- More mature Cells
- Longer life expectancy
The types of leukemia also can be grouped based on the type of white blood cell that is affected. Leukemia can start in
lymphoid cells or myeloid cells. Leukemia that affects lymphoid cells is called lymphoid, lymphocytic or lymphoblastic
leukemia. Leukemia that affects myeloid cells is called myeloid, myelogenous, or myeloblastic leukemia.
There are four common types of leukemia:
• Chronic lymphocytic leukemia (CLL): CLL affects lymphoid cells and usually grows slowly. It accounts for more than
15,000 new cases of leukemia each year. Most often, people diagnosed with the disease are over age 55. It almost never
affects children.
• Chronic myeloid leukemia (CML): CML affects myeloid cells and usually grows slowly at first. It accounts for nearly
5,000 new cases of leukemia each year. It mainly affects adults.
• Acute lymphocytic (lymphoblastic) leukemia (ALL): ALL affects lymphoid cells and grows quickly. It accounts for more
than 5,000 new cases of leukemia each year. ALL is the most common type of leukemia in young children. It also affects
adults.
• Acute myeloid leukemia (AML): AML affects myeloid cells and grows quickly. It accounts for more than 13,000 new
cases of leukemia each year. It occurs in both adults and children.
CLASSIFICATION
ACUTE
• Acute Myeloblastic Leukemia ( AML)

• Acute Lymphoblastic Leukemia ( ALL)
• Acute Monoblastic Leukemia ( AMOL)
CHRONIC
• Chronic Lymphocytic Leukemia ( CLL)

• Chronic Monocytic Leukemia ( CMOL)
• Chronic Granulocytic Leukemia ( CGL)
ACUTE LEUKEMIA
• Found frequently in children and young adults

• Incidence - 5 out of 100000
• Abrupt onset
• Runs a rapidly fatal course
• Fever
• Rapidly developing anemia, thrombocytopenia and hemorrhage
• Bone pain ( ALL)
• Lymphadenopathy (ALL)
• Splenomegaly & hepatomegaly
• Bleeding gums & bruising
• Headache,nausea
• Normochromic normocytic anemia
• WBC count –normal / raised
• Blast Cells seen in the peripheral blood
• Decreased platelet count
• Bonemarrow hypercellular with characteristic blast cells
TYPES : AML; ALL; AMOL
ACUTE LYMPHOBLASTIC LEUKEMIA ( ALL)
• Proliferation of lymphoblasts
• WBC count – 20,000 – 1 lakh /cu mm
• > 50 % of the cells are lymphoblasts
• They are 1½ times the size of lymphocytes
• Smudge cells in the peripheral blood smear
• The most vulnerable section to be affected are children. 1 person per 100,000 affected
• Anemia, thrombocytopenia,lymphadenopathy & splenomegaly.
• Bone marrow infiltrated with lymphoblasts
• 25% adults and 3% children diagnosed with ALL have Philadelphia Chromosome
CLINICAL FEATURES
- Fever , sore throat
- Enlargement of liver, lymph nodes, spleen
- Bone pain
ACUTE MYELOBLASTIC LEUKEMIA ( AML)
• Cell count – 20000-10000/cu mm

• Incidence – 1 in 40000 (1in 25,000 people over 50 is at risk from AML, while in the age group of 70 and above 1 in
7000 people is at risk. )
• Occurs in adults (People over the age of 50)
• Peripheral blood - 90% blast cells
• Cytoplasm of these cells blue with vacuoles
• Nucleus round,2-5 distinct nucleoli
• Nuclear chromatin – fine
• Auer rods / bodies – in the cytoplasm
• Swollen, painful, and bleeding gums - if AML has spread to the oral tissue;
• Pigmented (colored) rash-like spots - if AML has spread to the skin;
• Poorly differentiated myeloblasts are present.
• Some contain azurophil granules, but the percentage of maturing granulocytes is less than 10%.
• Peroxidase stain reveals the Auer rods
• Peroxidase stain used to differentiate ALL from AML
• AML - Peroxidase positive
• ALL – not Peroxidase positive
• Sudan Black B - used to differentiate ALL from AML
• AML – positive; ALL – negative
ACUTE MONOBLASTIC LEUKEMIA ( AMOL)
• Leucocyte count –20000 – 1 lakh / cu mm

• Promonocyte and monoblast make up 25 -75% of cells
• Monoblasts have muddy / smoggy grey-blue cytoplasm with tiny granules
• Cytoplasmic protrusions common
• Nucleus – indentation / irregularity with 1 – 5 large nucleoli
• Nuclear chromatin – reticulogranular
• Severe thrombocytopenia, nucleated red cells seen
CHRONIC
• Occurs in middle aged individuals

• Onset is gradual (insidious)
• Anemia slow to develop
• More differentiated cells
• Terminal stages – more blast cells
TYPES
• Chronic Granulocytic Leukemia ( CGL)
• Chronic Lymphocytic Leukemia ( CLL)
• Chronic Monocytic Leukemia ( CMOL)
CHRONIC LYMPHOCYTIC LEUKEMIA ( CLL)
• Disease of middle aged and elderly - cases reported in individuals older than 55 years
• WBC count – 2 – 2.5lakhs / cu mm
• 95% small lymphocytes 5% blast cells
• Prolymphocytes are seen
• Clinical features – fever, lethargy, wt.loss
• infections
• Moderate enlargement of lymph nodes
• Splenic and hepatic enlargement
• Mild anemia
• As disease progresses – severe hemolyticanemia develops
• Benign condition – lasts upto 20years
• Initial course that is relatively benign but followed by a terminal progressive and resistant phase lasting 1-2 years.
CHRONIC GRANULOCYTIC LEUKEMIA ( CGL)
• Uncommon form of leukemia

• Characterized by the presence of Philadelphia Chromosome
• Occurs in the middle aged and the elderly
• Highest leucocyte count -4 to 8 lakhs / cu mm
• 30 -70% neutrophils, 2 – 20% Basophils, 2 – 10% Eosinophils
• 0 – 10 % are myeloblasts
• Other myeloid precursors (myelocytes, metamyelocytes) are also found.
• Leucocyte alkaline phosphatase (LAP) is very low.
• Level of serum vitamin B12 and B12 binding protein elevated
• Normal Hb – eventually anemia develops
• Platelet count normal / slightly elevated
• Hypercellular marrow
• CML – slow progression – Enlarged Spleen ( splenomegaly)
• Survival of about 3 -5years
CHRONIC MONOCYTIC LEUKEMIA

• Chronic monocytic leukemia (CMOL) is a poorly documented, rare disease.
• Most patients are adults, and present with fever,
• Hepatomegaly. Splenomegaly has been a consistent manifestation.
• Hematologic findings. CMOL is the only form of human leukemia that
usually does not initially appear to present with abnormal circulating cells
• Thrombocytopenia and anemia may be present.
• Absolute monocytosis may be detected
• Monocytes in the peripheral blood have a ground glass or slate grey
cytoplasm with a variable number of vacuoles and lilac granules
• Nucleus may reveal delicate lace like chromatin, and may be round, oval.
• Nucleoli are usually absent or inconspicuous
• The Sudan black B reactions are variably positive.
• Leucocyte count - 3-70 X 109/L
• Pseudopodial protrusions common
• Anemia
• Platelets moderately reduced
CAUSES AND RISK FACTORS
Smoking is a considerable risk factor for leukemia, especially a type of leukemia called acute myelogenous leukemia, or AML. The
carcinogens in cigarettes are absorbed by the lungs and then travel to the bloodstream. It is estimated that 1 in 4 cases of AML are
caused by smoking.
Very high levels of radiation — People exposed to very high levels of radiation are much more likely than others to develop
leukemia. Very high levels of radiation have been caused by atomic bomb explosions (such as those in Japan during World War II) and
nuclear power plant accidents (such as the Chernobyl accident in 1986
Working with certain chemicals — Exposure to high levels of benzene in the workplace can cause leukemia. Benzene is used
widely in the chemical industry.
Chemotherapy — Cancer patients treated with certain cancer-fighting drugs sometimes later develop leukemia. For example, drugs
known as alkylating agents are associated with the development of leukemia many years later.
Down syndrome and certain other genetic diseases — Some diseases caused by abnormal chromosomes may increase the risk of
leukemia. Children and adolescents with Down's syndrome have a 10 to 30-fold increased incidence of leukemia
Human T-cell leukemia virus-I (HTLV-I) — This virus causes a rare type of Chronic Lymphocytic Leukemia known as Human T-cell
leukemia.HTLV II – Hairy cell leukemia
Chromosomal aberration – observed in ALL & CGL – presence of Philadelphia Chromosome

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Francisco, Frances Lorraine R.

There are four common types of leukemia:

• Acute Myeloblastic Leukemia ( AML)

• Chronic Lymphocytic Leukemia ( CLL)

• Found frequently in children and young adults

TYPES : AML; ALL; AMOL

ACUTE LYMPHOBLASTIC LEUKEMIA ( ALL)

ACUTE MYELOBLASTIC LEUKEMIA ( AML)

• Cell count – 20000-10000/cu mm

ACUTE MONOBLASTIC LEUKEMIA ( AMOL)

• Leucocyte count –20000 – 1 lakh / cu mm

• Occurs in middle aged individuals

CHRONIC LYMPHOCYTIC LEUKEMIA ( CLL)

CHRONIC GRANULOCYTIC LEUKEMIA ( CGL)

• Uncommon form of leukemia

CHRONIC MONOCYTIC LEUKEMIA

CAUSES AND RISK FACTORS

Chromosomal aberration – observed in ALL & CGL – presence of Philadelphia Chromosome

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