Chronic Leukemia Dr. Rania Alhady Chronic Lymphocytic leukemia (CLL): Definition: Chronic neoplastic disorder characterized by accumulation of small mature-looking lymphocytes which are immunologically immature in blood, bone marrow and lymph nodes. • It is of either B- or T-cell type. • Chronic persistent of lymphocytosis. • Subtypes of CLL are distinguished by morphology, immunophenotyping and cytogenetics. Dr. Rania Alhady

Chronic Leukemia Dr. Rania Alhady B-cell Chronic lymphocytic leukaemia (B-CLL): Affects people between 60-80 years of age. • The tumor cell appears to be a relatively mature B cell with weak surface expression of immunoglobulin (Ig)M. • The cells accumulate in the blood, bone marrow, liver, spleen and lymph nodes. • Tumor cells have long survival with impaired apoptosis. Dr. Rania Alhady

Chronic lymphoid leukemia Clinical features of B-cell CLL: 1- The disease occurs in older subjects (> 50 years old). 2- Most cases are diagnosed when a routine blood test is performed. 3- Enlargement of cervical, axillary or inguinal lymph nodes is the most frequent clinical sign (Generalized lymphadenopathy) 4- Features of anemia may be present. 5- Bruising or purpura may occur due to thrombocytopenia. 6- Splenomegaly and, less commonly, hepatomegaly. 7- Immunosuppression is a significant problem. Bacterial infections followed by viral and fungal infections such as herpes zoster are also seen. Dr. Rania Alhady

Chronic lymphoid leukemia Clinical features of B-cell CLL Cervical lymphadenopathy Herpes zoster infection Dr. Rania Alhady

Chronic lymphoid leukemia Laboratory findings of B-cell CLL 1- Peripheral blood: WBCs: Absolute lymphocytosis (↑↑↑ >100.000) Morphology: - Small mature looking lymphocytes - Dense chromatin - Small rim of cytoplasm RBCs: Normocytic normochromic anaemia is present in later stages. Platelets: ↓ . 2- Bone marrow: shows lymphocytic replacement of normal marrow elements (> 40%) 3- L.N.: Diffuse infiltration by mature looking lymphocytes. 4- Immunophenotyping: cells express CD5 (+ve in 90% of cases) Pan B markers +ve: CD19, CD20, CD22 5- Cytogenetics. Dr. Rania Alhady

Chronic lymphoid leukemia Blood film in B-cell CLL Dr. Rania Alhady

Chronic Myeloid Leukemia Chronic Myeloid leukemia (CML): Definition: It is a clonal disorder of a stem cell. • Accounts for around 15% of leukemias and may occur at any age. • The main feature is the presence of Philadelphia chromosome (Ph) which occurs due to t(9,22) translocation. Dr. Rania Alhady

Chronic Myeloid Leukemia Clinical features CML most frequently affect people between the ages of 40 and 60 years. However, it may occur in children. Symptoms include: 1- Symptoms related to hyper-metabolism (e.g.weight loss, anorexia-poor appetite- or night sweats). 2- Splenomegaly. 3- Features of anemia may include pallor, dyspnoea and tachycardia. 4- Gout or renal impairment caused by elevated levels of uric acid may be a problem. 5- Rare symptoms include visual disturbances. 6- In up to 50% of cases the diagnosis is made incidentally from a routine blood count. Dr. Rania Alhady

Chronic Myeloid Leukemia Lab findings in CML 1- Peripheral blood: WBCs: - ↑↑↑ >50.000 - The levels of neutrophils and myelocytes exceed those of blast cells and promyelocytes - Increased circulating basophils. RBCs: Normocytic normochromic anaemia. Platelets: ↑↑ 2- Bone marrow: Aspirate: Hypercellular with predominance of granulopoiesis Biopsy: No fat spaces & ↑↑ reticulin 3- Cytogenetics: Ph chromosome 4- Serum uric acid is usually high. Dr. Rania Alhady

Chronic Myeloid Leukemia CML: peripheral blood film showing various stages of granulopoiesis Dr. Rania Alhady