II. Precautions
- This topic covers a general approach to Acute Leukemia and its diagnosis
- See specific Acute Leukemia types for the most updated information
III. Types
-
Acute Myelogenous Leukemia
- Most cases occur in adults
-
Acute Lymphocytic Leukemia (or Acute Lymphoblastic Leukemia)
- Most cases (80%) occur in children (esp. age <5 years)
- Remaining 20% of Acute Lymphoblastic Leukemia cases occur in age >50 years old
IV. Findings: Signs and Symptoms (within 3 months of presentation)
- Anemia symptoms and signs
- Bleeding symptoms and signs
- Gingival Bleeding
- Gastrointestinal Bleeding
- Petechiae
- Easy bruisability
- Hematologic findings other than bleeding (rare in adults)
- Infectious symptoms and signs
- Fever
- Cellulitis
- Gingiva infection
- Candida infection
- Pneumonia
- Perirectal Abscess
- Urinary Tract Infection
- Chloroma development in any location
- Soft Tissue Masses of leukemic cells
- Expanding cell mass symptoms (50%)
- Bone pain (spine and long bones) is present in 43% of children
- Sternal tenderness
- Renal related symptoms and signs
- Nephrolithiasis (Uric Acid stones)
- Urate nephropathy
V. Labs
- Complete Blood Count with differential (Pancytopenia)
-
Peripheral Smear
- Circulating blast cells may not be seen
- Chemistry panel (Chem 7)
-
Liver Function Tests
- Lactate Dehydrogenase (LDH) increased
VI. Imaging
- Bone XRay
- Osteopenia
- Metaphyseal bands
- Lytic lesions
- Sclerotic changes
- Bone destruction
VII. Diagnosis
-
General (both ALL and AML)
- Blast cell predominance
- However, blast cell absence on Peripheral Smear does not exclude Acute Leukemia
- Immunophenotyping (flow cytometry, cytogenetic testing) distinguishes between AML and ALL
- Blast cell predominance
-
Acute Lymphoblastic Leukemia
- Lymphoblasts represent >20% of cells in Bone Marrow sample
- Also obtain Lumbar Puncture for CSF
-
Acute Myelogenous Leukemia
- Myeloblasts represent >20% of cells in Bone Marrow or peripheral blood sample
- Auer rods on Peripheral Smear (not often found)
- Also obtain Lumbar Puncture for AML patients if undergoing intrathecal therapy
VIII. Management: Remission
- Goal
- Criteria for Remission
- Less then 5 percent blast cells in Bone Marrow
- Leukemic cells absent in Bone Marrow
- Normal peripheral blood cell counts Restored
- Signs of extramedullary Leukemia involvement absent
- Overall Management Strategy
- Step 1: Remission Induction Chemotherapy
- Intensive systemic Chemotherapy
- Drives leukemic cell mass below detectable level
- Step 2: Early Intensification (Consolidation)
- Intensive Chemotherapy after Remission Induction
- Further reduce and possibly eradicate Leukemia
- Step 3: Maintenance
- Lower dose Chemotherapy continued over years
- Step 4: Late Intensification
- Intensive Chemotherapy restarted after 6 months
- Step 5: Local elimination of common relapse sites
- Local Chemotherapy or radiation to sanctuary sites
- Step 1: Remission Induction Chemotherapy
IX. Management: Supportive care of Pancytopenia
-
Anemia
- Treat with packed Red Blood Cell Transfusion
-
Thrombocytopenia
- Keep Platelet Count above 20 x 10^9/L
- Platelet Transfusion effective initially
- Antiplatelet Antibody develops over time
- Shortens Platelet survival
- Render patient unresponsive to transfusion
- May respond to HLA Identical Platelets
-
Granulocytopenia (Neutropenia)
- Granulocyte transfusions not recommended
- Prevent infection
- Reverse isolation rooms
- Face Masks
- Careful Hand Washing
- Observation for Bacterial and fungal infection
X. Complications
-
Leukostasis
- Occurs when circulating blasts > 100 x10^9/L
- Examples
- Lung hypoperfusion
- Brain hypoperfusion
-
Thrombocytopenia related bleeding complications
- Occurs when Platelet Count < 20 x10^9/L
- Examples
-
Neutropenia related infections
- Occurs when Neutrophil Count < 0.5 x10^9/L
- Examples
- Gram NegativeSepsis
- Candida infection
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Related Studies
Definition (NCI_NCI-GLOSS) | A rapidly progressing cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of white blood cells to be produced and enter the blood stream. |
Definition (NCI) | A clonal (malignant) hematopoietic disorder affecting the bone marrow and the peripheral blood. The malignant cells show minimal differentiation and are called blasts, either myeloid blasts (myeloblasts) or lymphoid blasts (lymphoblasts). According to the type of blasts present, acute leukemias are classified as acute myeloid leukemia (AML) and precursor lymphoblastic or acute lymphoblastic leukemia (ALL). |
Definition (CSP) | leukemia in which the involved cell shows little or no differentiation, usually consisting of blast cells; two types are distinguished, acute lymphocytic and acute myelogenous leukemia. |
Concepts | Neoplastic Process (T191) |
ICD9 | 208.0 |
ICD10 | M9801/3 , C95.0, C95.00 |
SnomedCT | 91855006, 24072005, 154599000, 188763007 |
English | Leukemia of unspecified cell type, acute, LEUKAEMIA ACUTE, LEUKEMIA ACUTE, Acute leukaemia NOS, Acute leukemia NOS, Acute leukaemia of unspecified cell type, Acute leukemia of unspecified cell type, Acute leukemias, [M]Acute leukaemia NOS, [M]Acute leukemia NOS, acute leukemia, leukemia acute, acute leukemia (diagnosis), Acute leukaemia, disease, Acute leukemia, disease, Acute leukemia, morphology, including blast cell OR undifferentiated leukemia, Acute leukaemia, morphology, including blast cell OR undifferentiated leukaemia, Leukaemia of unspecified cell type, acute, Leukaemia acute, Leukemia acute, acute leukaemia, acute leukaemias, acute leukemias, Acute leukaemia NOS (disorder), Acute leukemia NOS (disorder), Acute leukaemia, Acute leukemia, disease (disorder), Acute leukemia, morphology, including blast cell OR undifferentiated leukemia (morphologic abnormality), leukemia, acute, leukemia; acute, acute; leukemia, Acute leukemia, NOS, Acute leukemia, Acute Leukemia |
Spanish | leucemia aguda, enfermedad, Leucemia de tipo celular no especificado, aguda, Leucemia aguda de tipo de célula no especificado, Leucemia aguda de tipo celular no especificado, Leucemia aguda NEOM, LEUCEMIA AGUDA, leucemia aguda, SAI, leucemia aguda, SAI (trastorno), Acute leukaemia NOS, Acute leukemia NOS, leucemia aguda (anomalía morfológica), leucemia aguda, enfermedad (trastorno), leucemia aguda, Leucemia aguda |
Italian | Leucemia acuta, Leucemia di tipo cellulare non specificato, acuta, Leucemia acuta di tipo cellulare non specificato, Leucemia acuta, NAS |
Dutch | leukemie acuut, acute leukemie van niet-gespecificeerd celtype, acute leukemie NAO, acute leukemie niet-gespecificeerd celtype, leukemie ongekend celtype, acuut, acuut; leukemie, leukemie; acuut, Acute leukemie van niet gespecificeerd celtype, acute leukemie |
French | Leucémie à cellules de type non précisé, aiguë, Leucémie aiguë de type cellulaire non précisé, Leucémie aiguë à cellules de type non précisé, Leucémie aiguë SAI, LEUCEMIE AIGUE, Leucémie aiguë |
German | Leukaemie akut, akute Leukaemie NNB, Leukaemie eines unspezifischen Zelltyps, akut, akute Leukaemie eines unspezifischen Zelltyps, Akute Leukaemie nicht naeher bezeichneten Zelltyps, LEUKAEMIE AKUT, akute Leukaemie |
Portuguese | Leucemia aguda NE, Leucemia aguda de tipo de célula não especificado, Leucemia de tipo celular NE aguda, LEUCEMIA AGUDA, Leucemia aguda |
Japanese | 急性白血病, 急性白血病NOS, 急性白血病、細胞タイプ不明, キュウセイハッケツビョウ, キュウセイハッケツビョウNOS, キュウセイハッケツビョウサイボウタイプフメイ |
Czech | Akutní leukemie vycházející z blíže neurčeného buněčného typu, Akutní leukemie blíže neurčeného buněčného typu, Akutní leukemie, Akutní leukemie NOS |
Korean | 상세불명 세포형의 급성 백혈병 |
Hungarian | Nem meghatározott sejttípusú acut leukemia, Nem meghatározott sejttípusú fehérvérűség, heveny, Meghatározatlan sejttípusú acut leukaemia, Fehérvérűség heveny, Acut leukemia k.m.n., Acut leukaemia, Heveny fehérvérűség, Nem meghatározott sejttípusú acut leukaemia, Acut leukaemia k.m.n. |