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Approach to Acute Leukemia Dr. Nikhil Patkar Clinician Scientist & Asst Professor Hematopathology Laboratory Tata Memorial Centre

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Presentation on theme: "Approach to Acute Leukemia Dr. Nikhil Patkar Clinician Scientist & Asst Professor Hematopathology Laboratory Tata Memorial Centre"— Presentation transcript:

1 Approach to Acute Leukemia Dr. Nikhil Patkar Clinician Scientist & Asst Professor Hematopathology Laboratory Tata Memorial Centre

2 History 59 year old female, easy fatiguability Leucocytosis, decrease in platelets – TLC:90,000/mm 3 – Platelet counts: 54,000/mm 3 Suspected to have acute leukemia and referred to TMH

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4 Questions to ask when faced with acute leukemia Is there an increase in blasts or blast equivalents? Are there abnormal promyelocytes? Are there Auer rods? Is cytochemical MPO positive? Is cytochemical NSE positive? Must send for immunophenotyping. YES? NO?

5 Cytochemical MPO

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7 Summary Morphology – Myeloid Blasts – Strong MPO positive Immunophenotype – CD34 Negative – HLA-DR Negative – CD13,CD33positive, CD117 dim-negative

8 DIAGNOSIS?

9 Questions to ask when faced with acute leukemia Is there an increase in blasts or blast equivalents? Are there abnormal promyelocytes? Are there Auer rods? Is cytochemical MPO positive? Is cytochemical NSE positive? Must send for immunophenotyping. YES? NO?

10 Is this acute promyelocytic leukemia? Yes / No Is this distinction important? How urgent is the report ?

11 APL with t(15;17)(q22;q12); PML-RARA

12 How does this determine treatment? AML with t(15;17) – Treated with All Trans Retinoic Acid Or Arsenic Trioxide – Excellent survival – High mortality if not detected early & treated correctly DIC and bleeding complications eg intracranial bleeding – Practical working algorithm in a pathology lab AML M3 or non M3 AML

13 Overall survival (top) and disease-free survival (bottom) curves of 14 relapsed APL patients after As2O3-induced CR. Shen Z et al. Blood 1997;89: ©1997 by American Society of Hematology

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15 Cup Shaped Blasts Cytochemical MPO Positive

16 Typical morphology of myeloid blasts with cup-like nuclear invagination in AML. (A) The “cup” seems to be a part of the nucleus in Pappenheim staining, however it is positive for myeloperoxidase (MPO) in reactive blasts. Kroschinsky F P et al. Haematologica 2008;93: ©2008 by Ferrata Storti Foundation

17 Cup shaped blasts are often associated with NPM1 Mutations NPM WT 169bp NPM Mutant 173 bp FLT3-WT 330bp

18 Final Diagnosis NPM1 Mutated AML, FAB AML M1


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