Chronic leukemia

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Chronic Lymphocytic leukemia (CLL)

* Definition:

Chronic neoplastic disorder characterized by accumulation of small mature-looking lymphocytes

which are immunologically immature in blood, bone marrow and lymph nodes.

• It is of B-cell type.

• The cells accumulate in the bone marrow, blood, liver, spleen and lymph nodes.

• Characterized by chronic persistent of lymphocytosis.

Chronic Leukemia

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* Clinical features of CLL:

1- The disease occurs in older patients (> 50 years old).

2- Total leukocytic count: exceeds 200.000/mm3 with absolute lymphocytosis.

3- (Generalized lymphadenopathy): enlargement of cervical, axillary or inguinal lymph nodes

4- Hepato-splenomegaly occurs in 50-60% of cases.

5- Features of anemia may be present.

6- Bruising or purpura may occur due to thrombocytopenia.

7- Immunosuppression is a significant problem.

- Bacterial infections followed by viral and fungal infections such as herpes zoster are also seen.

Chronic lymphoid leukemia

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Chronic lymphoid leukemia

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Cervical lymphadenopathy Herpes zoster infection

* Laboratory findings of B-cell CLL:1- Peripheral blood:

WBCs: Absolute lymphocytosis (↑↑↑ >100.000)

Morphology: - Small mature looking lymphocytes

- Dense chromatin

- Small rim of cytoplasm

RBCs: Normocytic normochromic anaemia is present in later stages.

Platelets: ↓ .

2- Bone marrow: shows lymphocytic replacement of normal marrow elements (> 40%)

3- L.N.: Diffuse infiltration by mature looking lymphocytes.

4- Immunophenotyping: cells express CD5 (+ve in 90% of cases)

Pan B markers +ve: CD19, CD20, CD22

Chronic lymphoid leukemia

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CLL: This peripheral blood smear is flooded with small lymphocytes with condensed chromatin and scant

cytoplasm. A characteristic finding is the presence of disrupted tumor cells (smudge cells).

Chronic Myeloid leukemia (CML)* Definition:- It is a neoplastic proliferation of the pluripotent hematopoietic stem cell.

- The main feature is the presence of Philadelphia chromosome (Ph) which occurs due to t(9,22) translocation.

Chronic Myeloid Leukemia

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Chronic Myeloid Leukemia

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* Clinical features of CML:

1- Affects adults between 25-60 years.

2. Symptoms related to hyper-metabolism due to increased cell turnover (e.g.weight

loss, anorexia, night sweats).

3- Huge Splenomegaly and splenic infarction may occurs.

4- Features of anemia may include pallor, dyspnoea and tachycardia.

5- Gout or renal impairment caused by elevated levels of uric acid may be a problem.

6- In up to 50% of cases the diagnosis is made incidentally from a routine blood

count.

* Lab findings in CML:

1. Peripheral blood:

* WBCs: >100.000

- Predominantly of neutrophils, metamyelocytes and myelocytes exceed those of blast cells and promyelocytes

- Increased circulating basophils and esinophils.

* RBCs: Normocytic normochromic anaemia.

* Platelets: ↑↑

2. Bone marrow: Hypercellular with predominance of granulopoiesis

3. Cytogenetics: Philadelphia chromosome

4. Serum uric acid is usually high.

Chronic Myeloid Leukemia

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Chronic Myeloid Leukemia

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CML: peripheral blood film showing many mature neutrophils, some metamyelocytes, and a

myelocyte.

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