MLAB 1315 Hematology Keri BrophyMartinez

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MLAB 1315- HematologyKeri Brophy-Martinez

• Unit 22 Chronic Leukemia

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Chronic Lymphocytic Leukemia

• This is a general category of conditions known as
  lymphoproliferative disorders.
• General requirements for diagnosis
• Peripheral blood (gt5000 ALC) and bone marrow
  lymphocytosis (gt30)
• Lymphocytes are small to slightly larger than
  normal with mature appearance
• Nucleus has a condensed pattern
• Smudge cells (bare nuclei) are common. (To
  eliminate or reduce smudge cells, mix 4 drops
  blood with 1 drop albumin before making smear.)
• It is most frequently a leukemia involving B
  cells

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Chronic Lymphocytic Leukemia

• Clinical features
• Occurs in persons gt50 old
• Men are affected more than women 21
• Chronic fatigue, infection are result of bone
  marrow replacement of normal cells with
  lymphocytes.
• Skin and organ infiltration
• Median survival is 4-5 years, with 30 of
  patients surviving 10 years

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Chronic Lymphocytic Leukemia

• Treatment
• Usually treatment is not required until
  lymphocytosis causes other cells to be crowded
  out resulting in infections.
• Treatment depends on the stage at which the
  disease is diagnosed and is usually for the
  symptoms, not the disease.
• Radiation of localized infiltration
• Chemotherapy given according to stage of disease
• IV gamma globulin for prevention of infection
• Bone marrow transplant done on aggressive cases
• Staging of CLL is done using the Rai system

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Other lymphoproliferative disorders

• Prolymphocytic leukemia
• gt55 of circulating prolymphocytes
• Hairy cell leukemia (HCL)
• Lymphocytes have fine, hairlike, irregular
  cytoplasmic projections
• Cytochemical stain is strong acid phosphatase
  reaction that is not inhibited by tartaric acid
  (TRAP)
• Bone marrow aspirate may be difficult to obtain
  due to marrow fibrosis. Bone marrow biopsy shows
  hairy cells separated from each other by a clear
  zone with a fried egg appearance.
• Hairy cell leukemia can be treated with a
  one-time chemotherapy regimen with a good
  prognosis of long-term survival.

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Other lymphoproliferative disorders cont

• Sezary syndrome
• Leukemic phase of the most common cutaneous
  T-cell lymphoma, mycosis fungoides.
• Sezary cell is the size of a small lymphocyte and
  has a dark staining, hyperchromic nuclear
  chromatin pattern with numerous fold and grooves
  referred to as cerebriform.
• Diagnosis is confirmed by skin biopsy and
  presence of Sézary cells.

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Other lymphoproliferative disorders cont

• Plasma cell dyscrasias - to be discussed later.

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Chronic myelogenous leukemia (CML)

• Aka Chronic granulocytic leukemia (CGL)
• This is a clonal myeloproliferative disorder of
  the hematopoietic pluripotent stem cell that has
  undergone neoplastic transformation. It is
  characterized by an excessive increase of
  granulocytes and their precursors in the
  peripheral blood.

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Chronic myelogenous leukemia (CML)

• General characteristics
• 90-95 of patients have the Philadelphia
  chromosome - t(922)
• Marked leukocytosis with all stages of
  granulocytic cells
• Organomegaly especially the spleen
• Primarily seen in people 30-50 years of age
• Etiology is unknown

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Chronic myelogenous leukemia (CML)

• Phases of the disease
• Chronic
• Controllable with chemotherapy
• Lasts 2-5 years
• Chemotherapy-resistant (accelerated)
• Lasts 6-18 months
• Blastic acute
• Patient undergoes blast crisis
• Generally unresponsive to treatment

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Chronic myelogenous leukemia (CML)

• Clinical features
• Weakness
• Night sweats
• Weight loss
• Bone tenderness
• Abdomen fullness

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Chronic myelogenous leukemia (CML)

• Laboratory features
• Extreme leukocytosis (WBC gt 100,000 x 109)
• Marked left shift
• Normochromic-normocytic anemia (Hgb lt 10 g/dL)
• NRBCs
• Bone marrow ME ratio is 101
• Low LAP score (leukemoid reaction has high LAP)

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Chronic myelogenous leukemia (CML)

• Treatment
• Chemotherapy to reduce the myeloid mass
• Bone marrow transplant
• Interferon