Acute leukemia 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 • Bone marrow aspiration – Wright stained for morphology – Cytochemistry – Flow cytometry – Cytogenetics (Chromosome study) – Molecular study Cytochemistry • MPO • Sudan Black B • PAS • NSE Cytogenetic study AML FAB Classification M0 Undifferentiated acute myeloblastic leukemia M1 Acute myeloblastic anemia 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 monocytic leukemia 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 myeloid leukemia 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 : Myeloperoxidase, CD13, CD33, CD36, CD71, CD117, HLA-DR glycophorin A Complex chromosome abnormality 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 Philadelphia chromosome +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 chemotherapy 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 .