1) M0 (acute myeloid leukemia, minimally differentiated type)

2) M1 (acute myeloid leukemia undifferentiated type)

3) M2 (partially differentiated acute myeloid leukemia)

4) M3 (acute promyelocytic leukemia, APL)

5) M4 (acute myeloid-monocytic leukemia)

6) M5 (acute monocytic leukemia)

7) M6 (erythroleukemia)

8) M7 (acute megakaryoblastic leukemia)

1) L1: Primitive and prolymphocytes are mainly small cells (diameter ≦12 μm)

2) L2: Primitive and prolymphocytes are mainly large cells (diameter >12 μm)

3) L3 (Burkitt type): Primitive and prolymphocytes are mainly large cells, relatively consistent in size, with obvious vacuoles in the cells, basophilic cytoplasm, and deep staining.

1) AML with recurrent genetic abnormalities

2) AML with myelodysplasia-related changes

3) Treatment-related AML

4) Non-special type AML

5) Myeloid sarcoma

6) Myeloid proliferation associated with Down syndrome

1) Primitive B lymphocytic leukemia

2) Primitive T lymphocyte leukemia

Pale skin and conjunctiva

Increased body temperature, lung infection

Bleeding gums and skin bruising

Stasis and infiltration of a large number of leukemia cells in blood vessels, thrombocytopenia, abnormal coagulation, and infection are the main causes of bleeding.

Lymph node enlargement is more common in ALL

Often there is localized tenderness in the lower sternum

When bone marrow necrosis occurs, it can cause severe bone pain

Some AML may be accompanied by granulocytic sarcoma, or chloroma

Blue-gray maculopapular rashes may appear on the skin, with local skin swelling, hardening, and purple-blue nodules.

It is the most common extramedullary infiltration site of leukemia.

Can cause central nervous system leukemia (CNSL)

It is usually painless swelling of one testicle. Although there is no swelling on the other side, leukemia cell infiltration is often found during biopsy.

It is the site of extramedullary leukemia recurrence second only to CNSL.

a MorphologyM

b Immunology I

c CytogeneticsC

dMolecular BiologyM

Less than 20% blast cells in bone marrow

Abnormal lymphocytes appear in the blood picture, but their shape is different from the original cells

There is no increase in blast cells in the bone marrow, and the PAS reaction of young red blood cells is often negative. Treatment with folic acid and Vit B2 is effective.

Increased neutrophils and myelocytes in bone marrow

a White blood cell count >100×10^9/L can cause leukostasis

b Manifested as dyspnea, hypoxemia, unresponsiveness, intracranial hemorrhage, etc.

c Use a blood cell separator urgently to remove excessive white blood cells by apheresis (not recommended by APL), and give hydrotherapy and chemotherapy at the same time

1) ALL chemotherapy: The VP regimen consisting of vincristine (VCR) and prednisone (P) is the basic regimen for ALL

2) AML (non-M3) chemotherapy: the most commonly used are the IA regimen (I stands for IDA, that is, daunorubicin) and the DA (D stands for DNR, that is, daunorubicin) regimen

3) M3 (APL) chemotherapy: trans retinoic acid (ATRA) and anthracyclines are mostly used

Intensive consolidation: chemotherapy and HSCT

Maintenance treatment

1) Symptoms and signs of leukemia disappear

2) No blast cells in the periphery, no extramedullary leukemia

3) Bone marrow three-line hematopoiesis recovery, blast cells <5%

4) Peripheral blood neutrophils >1.0×10^9/L, platelets ≧100×10^9/L

5) Immunological, cytogenetic and molecular biology abnormal signs disappear at the time of initial diagnosis

1) Symptoms of hypermetabolism such as fatigue, low fever, excessive sweating or night sweats, weight loss, etc.

2) Splenomegaly is often the most obvious sign

3) When white blood cells increase extremely (reaching 100×10^9/L), leukocyte stasis may occur: chest tightness, difficulty breathing, etc.

1) The number of white blood cells increases significantly

2) There is a significant increase in granulocytes in the blood film, mostly neutrophils, late juveniles and rod-shaped granulocytes

3) Increased eosinophils and basophils

4) Platelets may be at normal levels, but in nearly half of the patients, platelets will increase, and in the late stages, platelets will gradually decrease.

Reduced activity or negative reaction

1) Bone marrow hyperplasia is obvious to extremely active

2) Mainly granulocytes, of which neutrophils, late juveniles and rod-shaped granulocytes are significantly increased, and blast cells are <10%

3) Increased eosinophils and basophils

4) Megakaryocytes are normal or increased, and decreased in the late stage

1) Ph chromosome (small chromosome 22)

2) The C-ABL proto-oncogene on the long arm of chromosome 9 is translocated to the breakpoint cluster region (BCR) on the long arm of chromosome 22 to form a BCR-ABL fusion gene

Schistosomiasis, chronic malaria, kala-azar, cirrhosis, etc.

It is often complicated by basic diseases such as serious infections and malignant tumors, and has clinical manifestations corresponding to the primary disease.

a Significant splenomegaly, increased white blood cells, and the presence of myelocytes in the blood picture

bPh chromosome and BCR-ABL fusion gene negative

c Multiple bone marrow punctures and dry aspiration at multiple locations

Inhibits the proliferation of BCR-ABL positive cells

Reducing or stopping drugs at will is likely to cause mutations in the BCR-ABL kinase region, leading to secondary drug resistance.

1) Cell cycle-specific chemotherapeutic drugs have a rapid onset of action. The white blood cell count will drop two or three days after taking the drug, and then rise quickly after stopping the drug.

2) Patients with advanced age, comorbidities, TKI and interferon intolerance, and leukocyte-lowering treatment for high leukocyte stasis

Arsenic agent