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Leukemia
LEUKEMIA
Definition
- Leukemia is a blood cancer
- Characterized by abnormal proliferation of immature white blood cells
- These cells originate in the bone marrow
- Bone marrow is filled with cancerous cells, suppressing normal cell production
- Leukemia arises from hematopoietic stem cells
- There is an arrest at an early stage of cell development (lymphoblastic or myeloblastic)
Hematopoietic Stem Cell Differentiation
Lymphoid Line
- B cells → Plasma cells → Antibody production
T cells:
- T helper cells (TH1, TH2)
- Cytotoxic T cells
- Natural Killer (NK) cells
Myeloid Line
- Myeloblasts
- Erythroblasts
- Megakaryocytes → Platelets
- Monocytes → Macrophages
Granulocytes:
- Neutrophils
- Eosinophils
- Basophils
Pathophysiology
- Leukemic cells are immature
- Proliferate uncontrollably in the bone marrow
- Normal hematopoiesis is suppressed
- Disease progression can stop at any stage of cell development
Types of Leukemia
- Acute Lymphoblastic Leukemia (ALL)
- Acute Myeloblastic (Myeloid) Leukemia (AML)
- Chronic Lymphocytic Leukemia (CLL)
- Chronic Myelogenous (Myeloid) Leukemia (CML)
- Acute Megakaryoblastic Leukemia
Signs and Symptoms
- Recurrent infections
- Bleeding (due to thrombocytopenia)
- Anemia
- Bone pain
- Generalized weakness
Laboratory Differentiation
To differentiate lymphoblastic from myeloblastic leukemia:
- PAS stain → Lymphoblastic
- Myeloperoxidase stain → Myeloblastic
Immunophenotyping using CD markers:
- CD-10
- CD-12
- CD-17
- CD-21
Genetic Associations
- Philadelphia chromosome → associated with Acute Lymphoblastic Leukemia
- Down syndrome → increased risk of Acute Lymphoblastic Leukemia
Investigations
Full Blood Count (FBC) with differential
- ↑ White blood cells
Bone marrow aspiration
- Specimen commonly taken from iliac crest
- Bone marrow biopsy
Peripheral blood smear
- Immature white cells present
- Chest X-ray
- Blood chemistry
- Urinalysis
- ECG / Echo (baseline before chemotherapy)
Treatment
Chemotherapy
- Cyclophosphamide
- Vincristine
- Doxorubicin
- Prednisolone
- Bleomycin
- Methotrexate
- Radiotherapy
- Bone marrow (stem cell) transplant
Management depends on:
- Type of leukemia
- Age
- Disease severity
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4.
Which leukemia predominantly affects older adults and involves mature B lymphocytes?
5.
A patient with leukemia develops recurrent infections. Which abnormality is most likely responsible?
6.
Pallor, fatigue and shortness of breath in leukemia are primarily caused by:
7.
Which investigation is most important for establishing the type and lineage of leukemia?
8.
Enlargement of the spleen and lymph nodes in leukemia is mainly due to:
9.
Why do patients with leukemia commonly develop bruising and bleeding?
10.
Which of the following best distinguishes acute leukemia from chronic leukemia?