Definition Hematopoiesis Types of Leukemia Acute Leukemias Chronic Leukemias Myeloid Leukemias Lymphoid Leukemias Causes and Risk

Factors Common Features Complications Leukemia vs. Lymphoma Prognosis

Vikkineshwaran
1

Leukemia
Cancer of blood-forming cells in the bone marrow. These unstable, immature cells accumulate in the blood and within organs of the body. They are not able to carry out the normal functions of blood cells.

Blood
Normal blood contains 3 major groups of cells: red blood cells (erythrocytes) white blood cells (leukocytes) Platelets (thrombocytes) All 3 types of blood cells develop from one immature cell type in a process called haematopoiesis. Hematopoiesis= formation of

 The stem cell divides and develops to a more developed, but still immature precursor, called a blast, which then develops through several more stages, into a mature blood cell.

 This process takes place in the bone marrow, which is the soft spongy material found in the centre of most bones.

Stem Cell Maturation

The first step in the process of stem cell maturation is differentiation into 2 groups:
myeloid stem cell line:
Forms into RBC, platelets and certain types of WBC (monocytes/ granulocytes)

lymphoid stem cell line:

forms into lymphocytes (another type of WBC)
6

Myeloid Stem Cell Line

Lymphoid Stem Cell Line

Blood Cell Development

 Either lineage can be affected by leukemia.

Affecting the myeloid lineage myelocytic leukemias
myelogenous, myeloblastic, or nonlymphocytic

Affecting the lymphoid lineage lymphocytic leukemias.

lymphoblastic or lymphogenous
10

11

Development of Leukemia in the Bloodstream

Stage 1- Normal

Stage 2- Symptoms

Stage 3- Diagnosis

Legend
White Cell Red Cell Platelet Blast Germ
Stage 5a- Anemia

Stage 4- Worsening
Sources from Leukemia, by D. Newton and D. Siegel

12

Stage 5b- Infection

Classification of Types
Lineage + Duration
Lineage: Duration Forms Myelogenous
Lymphocytic Acute Chronic
13

Acut Chroni e c
Myeloid Lymphoi d
AML
adult adult

CML CLL
adult

ALL
children

14

Leukemia
Abnormal stem cells in bone marrow

Acute Leukemias
Blasts predominate Children or elderly Short & drastic course

Chronic Leukemias
More mature cells Midlife age range Longer, less devastating course

ALL
Lymphoblasts (pre-B or Pre-T)

CLL AML
Myeloblasts Lymphocytes Non-antibody producing B cells

CML
Myeloid stem cells Blast crisis

15

 Incidence of different types of leukemias according to age. ALL is predominantly a childhood disease & CLL occurs mainly in the elderly. AML and CML have a wider age distribution. 16

17

18

Acute Leukemia
Short course of symptoms Fatigue, fever, easy bruising, bleeding Cytopenias - or pancytopenia
Cytopenia= reduction in the number of blood cells

Acute forms of leukemia can occur in children and young

19

Acute
Rapid growth of immature blood cells. More than 20% blasts in bone marrow Blasts in peripheral blood in 90% cases This crowding makes the bone marrow unable to produce healthy blood cells.
20

 Immediate treatment is required in acute leukemias due to the rapid progression and accumulation of the malignant cells, which then spill over into the bloodstream and spread to other organs of the body. If left untreated, the patient will die

21

Acute Leukemias
acute lymphoblastic leukaemia (ALL): childhood acute myeloblastic leukaemia (AML): adults

22

Chronic Leukemia
Chronic leukemia mostly occurs in older people, but can theoretically occur in any age group. Most are asymptomatic at presentation Strikingly elevated WBC Marked left-shift Splenomegaly typical Lymphocytosis 23

Chronic
The excessive build up of relatively mature, but still abnormal, blood cells. Typically taking months to years to progress, The cells are produced at a much higher rate than normal cells, resulting in many abnormal white blood cells in the blood.
24

Acute Myelogenous Leukemia

Most common type of Leukemia Fast growing cancer of the blood and bone marrow Characterized by

Myelogenous Leukemia: AML vs. CML

Chronic Myelogenous Leukemia

Slow growing cancer of white blood cells 3 Phases

Chronic Accelerated Blast Phase (Sometimes referred to as ALL)

Leukemia cells in the Bone Marrow Blast cells- increased proliferation

Characterized by
Too many white blood cells Philadelphia chromosome t(9;22) bcr/abl gene Makes tyrosine kinase 25

Acute Lymphocytic Leukemia

Lymphocytic Leukemia: ALL vs. CLL

Chronic Lymphocytic Leukemia

Risk associated with CLL increases rapidly after age 40.
90% Diagnosed over age 50

Greatest risk for ALL is in the first 5 years of life Fast growing cancer of the blood and bone marrow Characterized by
Uncontrollable and exaggerated growth of lymphoblasts
Also non-functional

Can be a very stable disease, some may not received treatment directly after the diagnosis Characterized by
Staging system (Rai or Binet) # of lymphocytes in blood and marrow Spleen size Lymph node distribution

Blockade of normal marrow cells

26

Causes and Risk Factors

There is no single known cause for all of the different types of leukemia. Four possible causes:
natural or artificial ionizing radiation, certain kinds of chemicals, some viruses, genetic predispositions.
27

Genetic Predispositions
Leukemia, like other cancers, result from,
somatic mutations in the DNA which activate oncogenes or deactivate tumor suppressor genes, and disrupt the regulation of cell death, differentiation or division.

Mutations may occur spontaneously or as a result of exposure to radiation or carcinogenic substances and are likely 28

Common features of Leukemia

diffuse replacement of normal bone marrow by leukemic cells with variable accumulation of abnormal cells in the peripheral blood infiltration of organs such as liver, spleen, lymph nodes, meninges and gonads by leukemic cells
29

30

Complications of Leukemia
infection (leukocytopenia), haemorrhage (thrombocytopenia), anemia

31

Lymphoma
A type of Cancer that begins with a malignant change in a lymphocyte, lymph node cell or lymphatic tissue of the marrow.
32

2 main categories
Hodgkins Non-Hodkins

12% of Lymphoma One of the most curable Presence of ReedSternberg cell

Distinctive Blymphocytes

Majority of lymphoma cases

4 types of B-cell Other types are T-cell and NK cell

Spreads through the lymphatic system in a

33

Leukemia vs. Lymphoma

Both Lymphocytic Leukemia and Lymphoma are the result of a malignant transformation of a cell destined to be a lymphocyte.

Distinction(s)
Lymphoma: The disease started from a lymphocytic cell in a lymph node or other part of the Lymphatic System (LS) Leukemia: The disease started from a lymphocytic cell in Bone marrow (BM)

In either case, the malignant cells can migrate from their source (BM or LS) and be found in34 the

Prognosis
Acute leukemia must be treated immediately, But chronic forms are sometimes monitored for some time before treatment to ensure maximum effectiveness of therapy.

35

P g o ic ro n st Fact o r

Su iv rv al

5 year sur vival is 1 0 -3 5 %for all pat ient s wit h AML AML 5 -1 0 %will sur vive mor e t han 5 year s 2 0 -3 5 %for young pat ient s who under go chemot her apy and BMT C hildr en AL L Adult s C ML St age O St age I C L L St age II St age III and IV 2 5 -3 5 %5 -year sur vival Median sur vival 5 -6 year s > 1 5 year s 9 year s 5 year s 2 year s
36

6 0 -7 0 %5 -year disease fr ee sur vival

Died of Myelodysplastic syndrome (MDS) aka Pre-leukemia which later develops to AML

Marie Curie

37