#paeds see: [Dunn - leukaemia](x-devonthink-item://CDBBF2AC-B7F6-46A1-81B0-94C5B302F932), [Haeys' - acute leukaemia](x-devonthink-item://5230ED8C-F093-411D-812F-661EBC07E2AE) *Leukemia* - Lymphoid or myeloid neoplasm with widespread involvement of bone marrow. tumour cells are usually found in peripheral blood unregulated growth and differentiation fo WBC in bone marrow → marrow failure → anaemia, infections, and haemorrhage. compare with *lymphoma* which has a discrete tumour mass arising from lymph nodes. | type | findings | features | | ---- | ------------------ | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | ALL | - usually children | - T cell ALL can have a mediastinal mass (SVC-like syndrome)<br>- pancytopenia | | CLL | - age > 60 | - mod splenomegaly<br>+/- lymphadenopathy<br>- high total WCC<br>- lymphocyte count > 20 <br>- pancytopenia late manifestation <br>- apheresis for very high WCC > 50, symptoms of vascular occlusion, etc | | AML | - age ~ 65 years | - [[DIC]] is common presentation<br>- ↑ myeloblasts on peripheral smear<br>- splenomegaly<br>- pancytopenia <br>- | | APML | - age > 65 | - very high D-dimer suggestive<br>- associated coagulopathy even if plt count mildly affected<br>- tx with all-trans retinoic acid | | CML | age 45 - 85 | - philadelphia c/some<br>- dysregulated production of mature granulocytes (neutrophils, basophils)<br>- WCC > 100k<br>- anaemia common<br>- infections and bleeding rare<br>- *splenomegly always present* | # Acute Leukaemias > classic presentation is: > 1. moderate-severe anaemia > 2. thrombocytopenia > 3. ↑ WCC ## ALL - most common childhood type - abrupt onset -- prominent [[Anaemia]] and **bruising** - bone pain and secondary infection common - [[lymphadenopathy]] - hepatosplenomegaly -- can see on *ultrasound*! - mediastinal adenopathy - CNS involvement common - pancytopenia - circulating lymphoblasts **Risks for ALL** - family history - immunosuppression - alkylating agents (more AML than ALL) - trisomy 21 - neurofibromatosis - ataxia telangiectasia - bloom syndrome **Factors a/w good prognosis in ALL** - age > 1 and < 10 - WCC < 50 x 10^9 - no testicular involvement - no Trisomy 21 - no prior steroid exposure (risk of spont [[Tumour lysis syndrome]]) - no CNS disease ## AML - usually age 70 - [[pancytopenia]] - infection common - bone pain - splenomegaly Risk factors: - myelodysplasia - radiation - smoking - benzene - chemotherapy types according to cytogenic markers M0 - M7 # Chronic leukaemias > only seen in adults > **splenomegaly is always present in CML** - mild anaemia, pancytopenia common - infections and bleeding are NOT common ## CML - philadelphia chromasome → abnormal tyrosine kinase that causes cells to become malignant # Complications ## Leukostasis #radiology - medical emergency in pts with leukemia, particularly AML and blast phase of CML - over-accumulation of leukemic cells within the small vessels - affects lungs and brain most commonly, presenting with symptoms of vascular oclusion - often when WCC >100k - consider in pt with myeloid leukemia wiht acute onset dyspnea and normal CXR or [[Pulmonary oedema]]