Department of dicine, Faculty of dicine, Khon-KaenUniversity

Acute leukemia

Kanchana Chansung M.D.

Department of Medicine, Faculty of Medicine,

Khon-Kaen University

Normal Blood smear vs Acute leukemia

Leukemia = White blood

Acute leukemia = Blast count in BM > 20%

ALL

AML

ALL

Investigation for Diagnosis

• CBC

• Bone marrow aspiration

– Wright stained for morphology

– Cytochemistry– Cytochemistry

– Flow cytometry

– Cytogenetics (Chromosome study)

– Molecular study

Cytochemistry

• MPO

• Sudan Black B

• PAS

• NSE

Cytogenetic study

AML

FAB Classification

M0 Undifferentiated acute myeloblastic leukemia

M1 Acute myeloblastic anemia with minimal maturation

M2 Acute myeloblastic leukemia with maturation

M3 Acute promyelocytic leukemia (APL)M3 Acute promyelocytic leukemia (APL)

M4 Acute myelomonocytic leukemia

M4Eo Acute myelomonocytic leukemia with eosinophilia

M5 Acute monocytic leukemia

M6 Acute erythroid leukemia

M7 Acute megakaryoblastic leukemia

AML(M1)

AML (M2) M3 M4

M5a M5b M6 M7

Risk category of AML

(APL,M3)

CD33+, CD13+

Neg/low: CD34, CD11b, CD117, HLA-DR

T(15;17)(q22:q11-12)

expression of CD13, CD19, CD33, CD34, CD117, and HLA-DR .

Acute myeloid leukemia with

the t(8;21)(q22;22).

Acute Megakaryoblastic Leukemia (AML , M7)

48,XY,del(9)(p13),add(11)(q24),+19[1]/50,idem+19,+22[5] and 46,XY[16].

Acute Erythroid Leukemia (M6)

Positive :

Myeloperoxidase,

CD13, CD33, CD36,

CD71, CD117, HLA-DRglycophorin A

Complex chromosome abnormality

Treatment of AML (non M3)

Induction chemo ( IDA3+Ara-C7)1-2 cycles

CR No

CR

Allogeneic -HSCT HiDAC 2-4 cycles Palliative

care

Relapse

Treatment of APL

Induction chemo ( ATRA + IDA) 4-8 weeks

CR No

CRATO

Palliative

care

Relapse

Consolidation

IDA x 3 cycles

Maintenance (chemo + ATRA)

2 years

Outcomes of AML in EUs

Po-Han Lin, et.al., Cancer Medicine, 2017

Outcome of AML in Thailand (N=679)

ALL

ALL(L1)

FAB Classification

ALL(L3)ALL(L2)

T-cell lymphoblastic leukemia

• Young male

• HTLV-1 associated

• Poor prognosis

• Treatment as aggressive lymphoma

Philadelphia chromosome +ve ALL

• 1/3 of adult ALL

• Poor prognosis

• Upfront transplant

• Combination of chemo / TKI maintenance

Burkitt’s leukemia (ALL,L3)• 5% of ALL , EBV associated

• Aggressive , rapid progression

• High risk of tumor lysis syndrome

• Treatment with aggressive short course

chemotherapychemotherapy

Survival of Adult ALL in Thailand

(N=172)

0.50

0.75

1.00 Overall Survival by Type of ALL

0.00

0.25

0.50

0 180 360 540 720analysis time

Ty pe =T-ALL Ty pe =B-ALL

Ty pe = Biphenoty pe Ty pe = Undiff

Survival according to treatments