Acute Leukemia

White Blood Cell Resources

Associated Diseases

Definition

When there is presence of more than 20% of blast cells in the peripheral blood or the bone marrow at the time of presentation. Can be categorized into Acute Myeloid Leukemia (AML) or Acute Lymphoblastic Leukemia (ALL).

Signs & Symptoms

Lethargy, pallor, fever, infections, spontaneous bruises, lymadenopathy, moderate hepatosplenomegaly and meningeal syndromes.

Risk Factors

AML occurs in all age groups. ALL is most common in children. B type ALL has equal sex incidence while T-ALL has a male predominance.

Causes

AML inv(16) and t(8;21); t(15;17). ALL t(12;21) (p13:q22).

Peripheral blood characteristics

Normochromic, normocytic anemia with thrombocytopenia. There’s variable number of blast cells.

BM characteristics

Hypercellular with more than 20% leukemic blast cells.

Important investigations & related results

AML MPO positive with Auer rods, Sudan black and PAS positive. ALL negative MPO and Sudan Black. Positive PAS with coarse block positivity.

Treatment & management

AML

ALL

Induction (e.g. vincristine, asparginase, dexamethasone ± daunorubicin)

↓

Consolidation (daunorubicin, cytosine arabinoside, vincristine, etoposide, thioguanine or mercaptopurine, cyclophosphoamide)

↓

Cranial prophylaxis

↓

Maintenance therapy (e.g. mercaptopurine, methotrexate, vincristine, dexamethasone)

↓

Late intensification

↓

Maintenance therapy

Induction (daunorubicin, cytosine arabinoside, etoposide)

↓

Consolidation (daunorubicin, cytosine arabinoside, etoposide)

↓

Consolidation (m-AMSA, etoposide, cytosine arabinoside)

↓

Possible stem cell transplantation / further consolidation (mitoxantrone, idarubicin, high dose cytosine arabinoside)

Acute lymphoblastic leukemia x 400

Acute myeloid leukemia x 400

Bone marrow aspirate with positive myeloperoxidase stain in AML x 400

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