acute leukemias - ilte-cml.org
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University of MilanoBicocca, Monza, Italy
ACUTE LEUKEMIAS
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
Epidemiology Epidemiology
Etiolgy Etiolgy
Clinical presentationClinical presentation
Classification/Staging/PrognosisClassification/Staging/Prognosis
University of MilanoBicocca, Monza, Italy
Incidence of Incidence of HematologicHematologic MalignanciesMalignancies
Type of LeukemiaType of Leukemia Incidence per Incidence per 100,000*100,000*
Overall Overall 66––1010CMLCML 11––22CLLCLL 22––33AMLAML 22––33ALLALL 11––22
University of MilanoBicocca, Monza, Italy
Table 46.2-1 Diagnosis and Evaluation of Acute Leukemia-------------------------------------------------------------------
Symptoms
Fatigue, malaise, dyspneaEasy bruisability, weight loss
Bone pain or abdominal pain (less common)Neurologic symptoms (rare)
SignsAnemia and pallor
Thrombocytopenia, hemorrhage, ecchymoses, petechiae, fundal hemorrhage
Fever and infection (pneumonia, sepsis, perirectal abscess)Adenopathy, hepatosplenomegaly, mediastinal mass
Gum or skin infiltration (rare)Renal enlargement and insufficiency (rare)
Cranial neuropathy (rare)
University of MilanoBicocca, Monza, Italy
AMLAML
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
MyelodysplasiasMyelodysplasias
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
TABLE 175–1. DIFFERENTIAL DIAGNOSIS OF MDS
Congenital disordersHereditary sideroblastic anemiaFanconi's anemiaDiamond-Blackfan syndromeKostmann's syndromeShwachman syndromeDown syndromeVitamin deficiencyB12, folate, or iron deficiencyDrug toxicityMarrow suppression from oral or parenteral medicationsToxinsChemotherapy and/or radiation therapyAlcoholAnemia of chronic diseaseRenal failureChronic infection, including tuberculosisRheumatologic disordersViral marrow suppressionIncluding Epstein-Barr virus, parvovirus B19, human immunodeficiency virus, and othersMarrow infiltrationAcute and chronic leukemiasMetastatic solid tumor infiltrationParoxysmal nocturnal hemoglobinuriaHypersplenism
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
TABLE 175–2. INTERNATIONAL PROGNOSTIC SCORING SYSTEM
PROGNOSTIC VARIABLESCORE VALUE
0 0.5 1.0 1.5 2.0
Bone marrow blasts (%) <5 5–10 — 11–21 21–30
Karyotype* Good Intermediate Poor
Cytopenias† 0 or 1 2 or 3
Karyotype scores:* Good: normal - Y, del(5q), del(20q) Poor: complex (greater than or equal to 3), any abnormality of chromosome 7 Intermediate: any other cytogenetic abnormality
Cytopenias:† Hemoglobin less than 10 g/dL Absolute neutrophil count less than 1,500/μL Platelet count less than 100,000/μL
Score for each of the three variables are summed for an overall score. Overall scores for risk groups are low: 0; intermediate-1: 0.5–1.0; Intermediate-2: 1.5–2.0; and high: ≥2.5.
From Greenberg P, Cox C, LeBeau MM, et al: International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood 89:2079, 1997.
University of MilanoBicocca, Monza, Italy
ALLALL
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy
University of MilanoBicocca, Monza, Italy