Acute

Kanchana Chansung M.D. Department of Medicine, Faculty of Medicine, Khon-Kaen University Normal Blood smear vs Acute leukemia Leukemia = White blood

Acute leukemia = Blast count in BM > 20% AML

ALL

Investigation for Diagnosis

• CBC • aspiration – Wright stained for morphology – Cytochemistry – Flow cytometry – Cytogenetics ( study) – Molecular study Cytochemistry

• MPO • Sudan Black B • PAS • NSE

Cytogenetic study AML FAB Classification M0 Undifferentiated acute myeloblastic leukemia M1 Acute myeloblastic with minimal maturation M2 Acute myeloblastic leukemia with maturation M3 Acute promyelocytic leukemia (APL) M4 Acute myelomonocytic leukemia M4Eo Acute myelomonocytic leukemia with eosinophilia M5 Acute M6 Acute erythroid leukemia M7 Acute megakaryoblastic leukemia AML AML (M1) (M2) M3 M4

M5a M5b M6 M7

Risk category of AML

(APL,M3)

CD33+, CD13+ Neg/low: CD34, CD11b, CD117, HLA-DR

T(15;17)(q22:q11-12) Acute with the t(8;21)(q22;22).

expression of CD13, CD19, CD33, CD34, CD117, and HLA-DR . Acute Megakaryoblastic Leukemia (AML , M7)

48,XY,del(9)(p13),add(11)(q24),+19[1]/50,idem+19,+22[5] and 46,XY[16]. Acute Erythroid Leukemia (M6)

Positive : , CD13, CD33, CD36, CD71, CD117, HLA-DR glycophorin A

Complex Treatment of AML (non M3)

Induction chemo ( IDA3+Ara-C7)1-2 cycles

No CR CR

Allogeneic -HSCT HiDAC 2-4 cycles Palliative care

Relapse Treatment of APL Induction chemo ( ATRA + IDA) 4-8 weeks

No CR ATO CR

Consolidation IDA x 3 cycles Palliative Maintenance (chemo + ATRA) 2 years care

Relapse Outcomes of AML in EUs

Po-Han Lin, et.al., Cancer Medicine, 2017 Outcome of AML in Thailand (N=679)

ALL FAB Classification

ALL(L1)

ALL(L2) ALL(L3)

T-cell lymphoblastic leukemia

• Young male • HTLV-1 associated • Poor prognosis • Treatment as aggressive lymphoma +ve ALL • 1/3 of adult ALL • Poor prognosis • Upfront transplant • Combination of chemo / TKI maintenance Burkitt’s leukemia (ALL,L3) • 5% of ALL , EBV associated • Aggressive , rapid progression • High risk of tumor lysis syndrome • Treatment with aggressive short course

Survival of Adult ALL in Thailand (N=172)

Overall Survival by Type of ALL 1.00

0.75

0.50

0.25

0.00

0 180 360 540 720 analysis time

Ty pe =T -ALL Ty pe =B -ALL Ty pe = Biphenoty pe Ty pe = Undiff

Survival according to treatments