Chronic Leukemia

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Chronic Leukemia
Kristine Krafts, M.D. November 5, 2013
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Hematologic Malignancies

• Leukemias

• Acute leukemias
• Chronic leukemias

Lymphomas

• Hodgkin lymphoma
• Non-Hodgkin lymphoma

Plasma cell disorders

• Multiple myeloma

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Chronic myeloid leukemia
Chronic lymphocytic leukemia
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Hematologic Malignancies

• Leukemias

• Acute leukemias
• Chronic leukemias
• Chronic myeloproliferative disorders
• Chronic lymphoproliferative disorders

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Hematologic Malignancies

• Leukemias

• Acute leukemias
• Chronic leukemias
• Chronic myeloproliferative disorders

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Chronic Myeloproliferative Disorders
Things You Must Know

• Malignant proliferation of myeloid cells (not
  blasts, but maturing cells) in blood, bone marrow
• Four disorders CML, PV, ET, MF
• Occur only in adults
• Long course

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Four Chronic Myeloproliferative Disorders

• Chronic myeloid leukemia
• Polycythemia vera
• Essential thrombocythemia
• Myelofibrosis

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Features common to all 4 disorders

• Occur only in adults
• Long clinical course
• ? WBC with left shift
• Hypercellular marrow
• Big spleen

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Chronic Myeloid Leukemia
Things You Must Know

• Neutrophilic leukocytosis
• Basophilia
• Philadelphia chromosome
• Three phases

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Chronic Myeloid Leukemia
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Chronic Myeloid Leukemia
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Normal chromosomes
Chromosomes in CML
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Cytogenetics
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Phases of CML

• Chronic phase
• Stable counts
• Easily controlled
• 3-4 years (without therapy)
• Accelerated phase
• Unstable counts
• Fatal within months
• Blast crisis
• Lots of blasts
• Fatal within weeks

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Treatment and Prognosis of CML

• Treatment
• Used to be bone marrow transplant
• Now, imatinib (Gleevec)
• Prognosis
• Median survival used to be 5-6 years
• Now ??

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Chronic Myelofibrosis
Things You Must Know

• Panmyelosis
• then marrow fibrosis
• Extramedullary hematopoiesis
• Teardrop red cells

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Chronic myelofibrosis
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Chronic myelofibrosis
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Polycythemia Vera
Things You Must Know

• High RBC (makes blood sludgy)
• Different from secondary polycythemia!

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Polycythemia vera
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Essential Thrombocythemia
Things You Must Know

• Very high platelet count in blood
• Different from secondary thrombocythemia!

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Essential thrombocythemia
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Hematologic Malignancies

• Leukemias

• Acute leukemias
• Chronic leukemias
• Chronic myeloproliferative disorders
• Chronic lymphoproliferative disorders

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Chronic Lymphoproliferative Disorders
Things You Must Know

• Malignant proliferation of lymphocytes in blood,
  bone marrow
• Many disorders CLL most important
• Occur only in adults
• Long course indolent but incurable

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Chronic Lymphocytic Leukemia
Things You Must Know

• Small, mature lymphocytes
• small lymphocytic lymphoma
• Weird B cells but CD5
• Long but inexorable course

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Chronic lymphocytic leukemia
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Chronic lymphocytic leukemia
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Treatment and Prognosis of CLL

• Treatment
• Conservative
• Reduce organomegaly, infections
• Prognosis
• Counts, adenopathy
• BM pattern, chromosomal abnormalities
• Mean survival 9 years
• Death usually from infection