1. Introduction To Haematological Malignancies
By Tiffany Shaw
MBChB II
July 2002

2. Common Malignancies Acute Chronic Lymphoid Myeloid
Acute lymphoblastic leukemia
Chronic lymphocytic leukemia
Lymphoma
Myeloma
Myeloid
Acute myeloid leukemia
Chronic myeloid leukemia

3. Acute Leukemias -- Definition
A malignant disorder in which haemopoietic blast cells proliferate and constitute > 30% of the bone marrow.
Lymphoblasts  Lymphoblastic leukemia
Myeloblasts  Myeloid leukemia

4. Acute Leukemias -- PC Bone marrow infiltrated by blasts cells
Bone marrow failure
Pan-cytopenia
Anaemia  fatigue, SOB on exersion
Thrombocytopenia  bleeding / DIC
Neutropenia  infections
Constitutional symptoms (malaise, anorexia, night sweat, fever)
Lymphadenopathy, hepatospenomegaly

5. Acute Leukemias -- Ix Low Hb Low platelets
High WCC (increased blast cells)
Low neutrophils
Elevated serum uric acid
Bone marrow biopsy: infiltration by blast cells

6. Acute Leukemias – Risk Factors
Familial
Down’s syndrome
Viral infection (EBV  Burkitt’s)
Radiation
Chemotherapy

7. Acute Leukemias – AML VS ALL
Myeloblastic
Any age
1/3 transformation from other myeloproliferative disorders
Increased DIC
ALL
Lymphoblastic
Commonly children
Primary event
More lymphadenopathy and hepatosplenomegaly

8. Acute Leukemias -- Classification
French-American-British Classification
Morphology
Cytochemistry
Immunophenotype
Cytogenetics
DNA analysis

9. Examples AML Promyelocytic Myelomonocytic Monocytic Erythroid
Megakeryoblastic
Undifferentiated
…. ect.
ALL
Small cells
Large cells
Vacuolated basophillic blast cells

10. Acute Leukemias -- Mx Supportive Rx Anaemia: blood transfusion prn
Bleeding: platelets prn
Infection: antibiotics prn
Social support + issues

11. Acute Leukemias -- Mx Chemotherapy: Remission-induction phase
Consolidation phase
Maintenance phase (for ALL)
prednisone, daunorubicin, vincristine, thioguanine, cyclophosphamide…

12. Acute Leukemias -- Mx Bone Marrow Transplantation: High-dose chemo Rx
Removal of stem cells from donor
Transplantation into recipient

13. Acute Leukemias -- Prognosis
AML
~ 30-40% cured
Varies widely with age, co-morbidity..etc.
ALL
In children, ~ 70% cured
In adults, ~ 30-40%

14. Chronic Myeloid Leukemia
Increase in neutrophils and their precursors
Really a myeloproliferative disorder
> 95% patients have chromosomal mutation --- Philadelphia chromosome

15. CML -- PC
Constitutional symptoms (anorexia, weight loss, fatigue, night sweat)
Splenomegaly (hypochondrial pain)
Asymptomatic – incidental finding

16. CML -- Ix Increased WCC (neutrophils and precursors)
Later  bone marrow failure (anaemia + thrombocytopenia)
Raised serum B12
Raised serum uric acid
Bone marrow biopsy  hypercellular with high myeloid:erythroid ratio

17. CML – Course/Progression
Chronic Phase
Raised WCC
Constitutional symptoms / Asymptomatic
Accelerated Phase
Anaemia + thrombocytopenia
Splenomegaly
Bone marrow fibrosis
Acute Phase
Transformation to acute leukemia (80% AML, 20% ALL)

18. CML -- Mx Chronic Phase Acute Phase Hydroxyurea Interferons Chemo Rx
Bone marrow transplantation
Acute Phase
Same as acute leukemia

19. Chronic Lymphcytic Leukemia
Increased lymphocytes (B cells) in the blood, bone marrow, lymph nodes, and spleen.
Lymphoproliferative disorder

20. CLL -- PC Asymptomatic Lymphadenopathy
Constitutional symptoms (night sweat, weight loss, anorexia)
Symptoms of bone marrow failure
Splenomagaly

21. CLL -- Ix Lymphocytosis (B cells) Low serum Ig Raised serum uric acid
Bone marrow biopsy  lymphocytic infiltration

22. CLL -- Ix Depends on stage: Stage A B C
< 3 lymph node groups involvement
Bloods normal
> 3 lymph node groups involvement
Bloods abnormal (anaemia + thrombocytopenia)

23. CLL -- Mx Observation (stage A)
Chlorambucil PO (lower lymphocyte count and lymphadenopathy)
Corticosteroid
Fludarabine IV
Other chemo Rx
Supportive care

24. CLL -- Prognosis Variable May remain stationary or progress
Some stay asymptomatic for > 10 years
Cause of death = bone marrow failure, infiltration of other organs