Chronic Leukemia Kristine Krafts, M.D.
Hematologic Malignancies Leukemias Acute leukemias Chronic leukemias Lymphomas Hodgkin lymphoma Non-Hodgkin lymphoma Plasma cell disorders Multiple myeloma
Chronic myeloid leukemia Chronic lymphocytic leukemia
Hematologic Malignancies Leukemias Acute leukemias Chronic leukemias Chronic myeloproliferative disorders Chronic lymphoproliferative disorders
Hematologic Malignancies Leukemias Acute leukemias Chronic leukemias Chronic myeloproliferative disorders
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
Four Chronic Myeloproliferative Disorders Chronic myeloid leukemia Polycythemia vera Essential thrombocythemia Myelofibrosis
Features common to all 4 disorders: Occur only in adults Long clinical course WBC with left shift Hypercellular marrow Big spleen
Chronic Myeloid Leukemia Things You Must Know Neutrophilic leukocytosis Basophilia Philadelphia chromosome Three phases
Chronic Myeloid Leukemia
Chronic Myeloid Leukemia
Normal chromosomes Chromosomes in CML
Cytogenetics
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
Treatment and Prognosis of CML Used to be bone marrow transplant Now, imatinib (Gleevec) Prognosis Median survival used to be 5-6 years Now: ??
Chronic Myelofibrosis Things You Must Know Panmyelosis… …then marrow fibrosis Extramedullary hematopoiesis Teardrop red cells
Chronic myelofibrosis
Chronic myelofibrosis
Polycythemia Vera Things You Must Know High RBC (makes blood sludgy) Different from secondary polycythemia!
Polycythemia vera
Essential Thrombocythemia Things You Must Know Very high platelet count in blood Different from secondary thrombocythemia!
Essential thrombocythemia
Hematologic Malignancies Leukemias Acute leukemias Chronic leukemias Chronic myeloproliferative disorders Chronic lymphoproliferative disorders
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
Chronic Lymphocytic Leukemia Things You Must Know Small, mature lymphocytes = small lymphocytic lymphoma Weird: B cells but CD5+ Long but inexorable course
Chronic lymphocytic leukemia
Chronic lymphocytic leukemia
Treatment and Prognosis of CLL Conservative Reduce organomegaly, infections Prognosis “Counts,” adenopathy BM pattern, chromosomal abnormalities Mean survival: 9 years Death usually from infection