Acute Leukemias

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characteristics of acute leukemias

Back 1

• Uncontrolled proliferation
  
• Arrested maturation
  
• Hiatus development - can’t develop past a certain stage
  
• Decreased to moderately increased WBC
  
• Normal - decreased plts
  

Front 2

classifications of leukemias - FAB

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Based on bone marrow morphology and cytochemical stains

> 30 % Blasts

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classifications of leukemias - WHO

Back 3

Adds cytogenetics and molecular characteristics

> 20% Blasts

Useful to Dr. when diagnosing and planning appropriate treatment

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Acute Myeloblastic Leukemia without Cytologic Maturation (AML)

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• FAB M0
  
• Primitive leukemic blasts that show no distinct myeloid morphological features and lack reactivity with conventional cytochemical stains.
  
• Poor prognosis compared to other AMLs
  

Front 5

Acute Myeloblastic Leukemia without Maturation (AML)

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FAB M1

• > 30 % myeloblasts in blood and/or marrow
  
• Auer rods may be present
  
• WBC 4000 - 300,000 / mm3
  
• Decreased Plt
  
• Leukemia of adults but also neonates
  

• Cytochemical stains - MPO, SBB pos. NSE pos, SE weak pos and pos with NaF,
  
• PAS neg
  

Front 6

Acute Myeloblastic Leukemia with Maturation (AML)

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FAB M2

• > 30 % myeloblasts in blood and/or marrow
  
• Maturation promyelocyte stage and beyond
  
• May have Auer rods
  
• May be an “acute phase”or “blast crisis” of CML
  
• Cytochemical stains - MPO and SBB pos, SE pos, NSE pos + NaF pos, PAS neg (same as M1)
  

Front 7

Acute Promyelocytic Leukemia (APL)

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FAB M3 and M3m

• > 30 % myeloblasts and promyelocytes
  
• Frequently have Auer rods some in bundles (faggot cells)
  
• Abnormal promyelocytes have extremely heavy granulation
  
• WBC 4000 - 300,000 / mm3
  
• Decreased Platelets
  

DIC is a possible complication of treatment (Schistocytes)

Front 8

APL - Microgranular variant

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• Microgranular variant (FAB M3m)
  
• granules so small they cannot be seen by light microscopy
  
• abnormal nuclear shape in some promyelocytes
  
• Maybe mistaken for an AML or AMoL
  
• Also has DIC a complication
  

Front 9

Acute Myelomonocytic Leukemia (AMML)

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FAB M4

• > 30% blast with both myelocytic and monocytic features
  
• May have Auer rods
  
• WBC 4000 - 300,000 / mm3
  
• Decreased Plt
  
• Can demonstrate invasion of skin, gums, etc. - because of monocytic component (migrates to tissues)
  

Front 10

Acute Myelomonocytic Leukemia (AMML) - stains

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MPO pos

SBB POS

SE POS

NSE pos

NSE with NaF weaker pos

PAS neg

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Acute Myelomonocytic Leukemia w/ Eosinophilia

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FAB M4Eo

Similar to M4 with marrow eosinophilia in addition to myelo and mono (abnormal and immature)

Cytochemical stains - sames as M4

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Acute Monocytic Leukemias (AMoL) - poorly differentiated

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FAB M5a

• Usually found in children and young adults
  
• Infiltration of the skin, gums, meninges and other body tissues by malignant cells
  

• > 30% monoblasts in blood and/or marrow
  
• WBC 4000 - 300,000 / mm3
  
• Decreased Plt
  

Front 13

Acute Monocytic Leukemias (AMoL) -differentiated

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FAB M5b

> 30% monoblasts and a preponderance of promonos and monos in blood and/or marrow

MPO pos, SBB pos, SE neg, NSE pos and negative with NaF, PAS neg

Front 14

Acute Erythroid Leukemias - Acute Erythroleukemia

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FAB M6a

> 50% rbc precursors and > 20% myeloblasts

Other immature myeloid cells may be present

May see Auer Rods

Stains M5b: MPO neg, SBB neg, SE neg, NSE neg, PAS pos. If M5a, will have mixed staining indicative of myeloblasts

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Acute Erythroid Leukemias - Pure Erythroleukemia

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(M6b)

Pure rbc precursors > 80% of marrow cellularity

no myeloid component

Stains M5b: MPO neg, SBB neg, SE neg, NSE neg, PAS pos.

Front 16

Acute Erythroid Leukemias - both forms

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• Megaloblastoid changes
  
• Bizarre rbc morphology
  
• Many nrbcs (including blasts)Immature rbcs extremely abnormal
  
• giant and multinucleated forms
  
• nuclear budding and nuclear fragmentation, vacuolated cytoplasm
  
• cytoplasmic budding
  
• Intense erythroid hyperplasia in bone marrow
  
• Abnormal megakaryocytes and platelets may be present
  

Front 17

Acute Megakaryocytic Leukemia -

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• FAB M7
  
• 30% megakaryoblasts in marrow
  
• PAS positive
  
• Has been associated with myelofibrosis (stimulatory effect of megakaryoblasts on fibroblasts)
  

Front 18

Acute Leukemia of Ambiguous Lineage

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both lymphoid and myeloid characteristics

• Bilineage - mixed population of cells
• Biphenotypic - expressed on same cell
  

Front 19

Acute Basophilic Leukemia

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Must distinguish from CML in blast phase

Front 20

Acute Panmyelosis with Myelofibrosis

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Malignant proliferation in all myeloid cell lines (granulocytes, erythroid and megakaryocytes)

Bone marrow fibrosis

Front 21

Acute Lymphocytic Leukemias(ALL)

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• Disease of children (2-10 yrs)
  
• 2nd peak in mid life
  
• WBC often >100,000 /mm3 but 50% have normal or low
  
• WBC> 30% lymphoblasts in blood and/or marrow
  
• no Auer rods
  
• Plt and granulocytes decreased
  
• CNS infiltration is common
  
• stains: MPO neg, SBB neg, SE neg, NSE neg, PAS pos
  

Front 22

ALL Subclassifications - FAB L1

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• most common
  
• Small lymphoblasts
  
• occ. clefting
  
• inconspicuous nucleoli and scanty cytoplasm
  
• uniform population
  

Front 23

ALL Subclassifications - FAB L2

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• Large lymphoblasts
  
• irregular nucleus
  
• often prominent nucleoli
  
• often mod. abundant cytoplasm
  
• cellular heterogeneity
  
• may look like reactive lymphs
  

Front 24

ALL Subclassifications - FAB L3

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• Leukemic conversion of Burkitt’s lymphoma
  
• Large blasts with very basophilic cytoplasm
  
• Punch-out vacuoles
  
• TdT - negative