LEUKEMIAS

General Classification
Acute Chronic
Age All ages Adults
Clinical onset Sudden Gradual
Course of disease Weeks to months Months to years
Predominant cell Blasts Mature forms
Some mature forms
Anemia Mild-severe Mild
Thrombocytopenia Mild-severe Mild
WBC Variable Increased
Organomegaly Mild Prominent
Blood Picture
Acute Chronic
How Do Leukemias Arise?

Somatic mutation of a single

hematopoietic stem or
progenitor cell
Unlimited self-renewal of the
cancer-initiating cell
As the mutant cell line
predominates, normal
hematopoiesis is inhibited
causing leukemic cells to spill
into peripheral blood
Schematic
representation of
the modern
concept of how
cancer arises
Proto-oncogenes and Oncogenes
Proto-Oncogenenormal unaltered gene that has the
potential to become an oncogene
OncogeneAltered cell genes that cause tumors
Located at breakpoints of chromosomal aberrations, such
as translocations
Stem cells and growth factors in haematopoietic cell
development.
Hematopoietic stem cells give rise to two major progenitor
cell lineages, myeloid and lymphoid progenitors
 ALL CLL Lymphomas MM
nave

B-lymphocytes

Plasma
Lymphoid cells
progenitor T-lymphocytes

AML Myeloproliferative disorders

Hematopoietic Myeloid Neutrophils
stem cell progenitor

Eosinophils

Basophils

Monocytes

Platelets

Red cells
Oncogene Activation
Factors
Genetic susceptibility
Fanconis anemia
Downs syndrome (18-20 fold increased incidence)
Somatic mutation
Ionizing radiation, nuclear weapons
Chemicals and drugs
Benzene,Chloramphenicol, phenylbutazone
Certain chemotherapy drugs that are cytotoxic, especially when used in
conjuction with therapeutic radiation
Viral infection
Retrovirus-HIV-1, HTLVI, II
Immunologic dysfunction
Ataxia-telangiectasia - lymphoid leukemia or lymphoma
Sex-linked agammaglobulinemia
Clinical Findings
Anemia
Due to erythropenia
Infection
Due to neutropenia
Bleeding Episodes
Due to thrombocytopenia
Bone pain
Due to marrow expansion
Weight loss