Chronic Leukemias

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Chronic Leukemias
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Lymphoblasts

• CD19
• CD20
• tDT
• L1
• Small uniform lymphoblasts
• Homogenous chromatin
• No nucleoli
• Scant cytoplasm
• No vacuoles

• L2
• Pleomorphic lymphoblasts
• Heterogenous chromatin
• Irregular nuclear shape
• One or more nucleoli
• Variable cytoplasm
• Variable vacuoles
• L3
• Large homogeneous lymphoblasts
• Burkitts type
• Fine stippled chromatiin
• Regular nuclear shape
• One or more nucleoli
• Moderate cytoplasm
• Prominent vacuoles

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Chronic

• Mature forms
• Lymphoid
• Chronic Lymphocytic Leukemia (CLL)
• What type?
• Myeloid
• Chronic Myelocytic Leukemia (CML)
• Which myelocytic line?

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Chronic Lymphocytic Leukemia

• CLL
• Lymphoproliferative disorder
• Most common in older adults
• Usually B-cell in nature
• Pre-B
• T-cell
• NK cell
• Smudge cells

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CLL -cont

• Good Prognosis 5 10 years
• Variables include
• Organ infiltration
• Immunosuppresion
• Anemia
• Thrombocytopenia
• Infections

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Etiology

• No cause currently known
• Viral?
• Autoimmune?
• -other

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Immunological Classification

• B-cell
• CD5
• CD9
• CD19
• CD20
• CD22
• CD23
• CD24

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Immunological Classification

• T-cell
• CD1
• CD2
• CD3
• CD4
• CD5
• CD7
• CD8
• CD25
• CD57

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Immunological Classification

• NK-cell
• CD56

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CLL

• Non functional cells or products
• Complete Ig or parts
• Heavy chains
• Light chains
• Alpha, Mu, Gamma, Delta, Epsilon chains
• Fragments J fragment
• Bence-Jones protein
• Mature cell type

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CLL

• Mature Cell Types
• Mantle Cell
• CD43
• Hairy Cell
• CD22, CD103
• Sezary Cell
• CD2, CD3, CD4, CD5
• DNA Markers - future

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CLL Staging

• Rai system
• 0 LC in Blood, BM gt12.5
• I LC enlarged nodes 8.5
• II LC SM EN 6
• III LC SM EN anemia 1.5
• IV all above ltplts 1.5

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Table 17-1

• Know ALL, CLL, HCL, Sezary, IM
• Flow Cytometry

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CML

• Chronic Granulocytic
• Chronic Myeloid
• Chronic Granulocytic

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Etiology

• No known cause
• But- 95
• Nearly all cases of CML (95) involve a
  chromosomal translocation in which a small
  portion of the long arm of chromosome 9 is
  translocated to the long arm of chromosome 22.
  This translocation is known as the Philadelphia
  Chromosome. Molecular studies have shown that a
  portion of the c-abl gene is translocated from
  chromosomes 9 and 34 to chromosome 22 and 11,
  into the c-bcr region. The chimeric gene, termed
  bcr-abl, produces an abnormal 8.5 kb mRNA that
  encodes for a 210 kD fusion protein. This figure
  illustrates the several fusion points.

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Alk Phos

• Functional Neutrophils
• DONT Have NON-FUNCTIONAL
• Leukocyte Alk Phos LAP
• 0 no reaction
• 1 small
• 2 25
• 3 50
• 4 gt50
• Add up results CML lt20

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Myeloid Reaction

• gt LAP 125
• WBC up to 75,000
• Good Prognosis

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Eosinophils

• HES
• gtEosinophils
• Functional
• Older Men
• lt5 years
• 65,000
• 98 eosinophils

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CMML

• or CMonoL

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Pure RBC Leukemia

• Decrease in WBC Plts production