1. Chronic Leukemia
Kristine Krafts, M.D.

2. Hematologic Malignancies
Leukemias
Acute leukemias
Chronic leukemias
Lymphomas
Hodgkin lymphoma
Non-Hodgkin lymphoma
Plasma cell disorders
Multiple myeloma

4. Chronic myeloid leukemia Chronic lymphocytic leukemia

5. Hematologic Malignancies
Leukemias
Acute leukemias
Chronic leukemias
Chronic myeloproliferative disorders
Chronic lymphoproliferative disorders

6. Hematologic Malignancies
Leukemias
Acute leukemias
Chronic leukemias
Chronic myeloproliferative disorders

9. 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

10. Four Chronic Myeloproliferative Disorders
Chronic myeloid leukemia
Polycythemia vera
Essential thrombocythemia
Myelofibrosis

11. Features common to all 4 disorders:
Occur only in adults
Long clinical course
 WBC with left shift
Hypercellular marrow
Big spleen

12. Chronic Myeloid Leukemia
Things You Must Know
Neutrophilic leukocytosis
Basophilia
Philadelphia chromosome
Three phases

13. Chronic Myeloid Leukemia

14. Chronic Myeloid Leukemia

15. Normal
chromosomes
Chromosomes
in CML

16. Cytogenetics

17. 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

18. Treatment and Prognosis of CML
Used to be bone marrow transplant
Now, imatinib (Gleevec)
Prognosis
Median survival used to be 5-6 years
Now: ??

19. Chronic Myelofibrosis
Things You Must Know
Panmyelosis…
…then marrow fibrosis
Extramedullary hematopoiesis
Teardrop red cells

20. Chronic myelofibrosis

21. Chronic myelofibrosis

22. Polycythemia Vera Things You Must Know High RBC (makes blood sludgy)
Different from secondary polycythemia!

23. Polycythemia vera

24. Essential Thrombocythemia
Things You Must Know
Very high platelet count in blood
Different from secondary thrombocythemia!

25. Essential thrombocythemia

26. Hematologic Malignancies
Leukemias
Acute leukemias
Chronic leukemias
Chronic myeloproliferative disorders
Chronic lymphoproliferative disorders

27. 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

29. Chronic Lymphocytic Leukemia
Things You Must Know
Small, mature lymphocytes
= small lymphocytic lymphoma
Weird: B cells but CD5+
Long but inexorable course

30. Chronic lymphocytic leukemia

31. Chronic lymphocytic leukemia

32. Treatment and Prognosis of CLL
Conservative
Reduce organomegaly, infections
Prognosis
“Counts,” adenopathy
BM pattern, chromosomal abnormalities
Mean survival: 9 years
Death usually from infection