acute leukemia AL

chronic leukemia CL

AL

CL

Rare and special types of leukemia

AML classification

ALL classification

Fever can be low-grade, or can reach temperatures as high as 39 to 40°C, accompanied by chills, sweating, etc. Higher fever often indicates secondary infection. Infection can occur in various parts. Stomatitis, gingivitis, and angina are the most common, and ulcers or necrosis can occur. Pulmonary infection, perianal inflammation, and paraanal abscess are also common, and in severe cases, septicemia can occur. The most common pathogenic bacteria are Gram-negative bacilli, others include Staphylococcus aureus, Streptococcus faecalis, etc. Fungal infections can also occur, and patients with immune deficiency are prone to viral infections.

It can occur in any part of the body, with skin petechiae, nosebleeds, gum bleeding, and menorrhagia being the most common. Acute promyelocytic leukemia is prone to be complicated by DIC. Thrombocytopenia is the main cause of bleeding, and intracranial hemorrhage is the main cause of death from leukemia hemorrhage.

It is often the first manifestation and develops progressively, mainly due to the reduction of normal RBC production.

Enlarged liver, spleen, and lymph nodes

Bone and joint pain

nervous system

other

leukemia. In the blood film classification examination, primitive and/or immature cells generally account for 30% to 90%, and can be as high as more than 95%. However, it is difficult to find primitive cells on the blood film of cases with leukocytosis. There are varying degrees of normocytic anemia. About 50% of patients have platelets less than 60×109/L. Late-stage platelets are often extremely low.

In most cases of bone marrow morphology, there is a significant increase in nucleated cells in the bone marrow, mainly leukemic blasts, accounting for more than 30% of non-erythroid cells. However, cells in the more mature intermediate stages are absent, and a small number of mature granulocytes remain, forming so-called "holes". Phenomenon. (Very important terminology) The number of normal red blood cells and megakaryocytes is reduced. About 10% of acute non-lymphocytic leukemic blasts are hypoproliferative acute leukemias, but leukemic blasts still account for more than 30% of non-erythroid cells. The morphology of leukemic blasts often changes abnormally. Auer bodies are more common in the cytoplasm of acute myeloid leukemia but not in acute lymphoid leukemia, which is helpful in distinguishing acute lymphoid leukemia from acute non-lymphocytic leukemia.

Bone marrow contains less than 30% blast cells

It usually lasts for 1 to 4 years. Patients usually have symptoms of hypermetabolism such as fatigue, low fever, night sweats, and weight loss. Splenomegaly is the most prominent feature. Patients often have a feeling of distension in the left upper quadrant. The spleen is usually found to have reached the level of the umbilicus. If splenic infarction occurs, there will be tenderness and friction in the spleen area. Patients may experience liver enlargement, and some patients may experience tenderness in the middle and lower sternum. Increased blood WBC can cause varying degrees of fundus hemorrhage and even leukocyte stasis (manifested by respiratory distress, dizziness, slurred speech, central nervous system bleeding, priapism, etc.)

It can last from several months to several years, often with symptoms such as progressive weight loss, progressive enlargement of the spleen, fever, bone pain, anemia, and bleeding.

CML blast change is usually blast myeloid change, and a few may show acute lymphoid change or acute mononuclear change. When any proportion of lymphoid blasts increases, it should be diagnosed as blast phase.

The number of white blood cells in the blood picture is significantly increased, often exceeding 20×109/L, and the number of neutrophils in the blood film is significantly increased, with the majority of neutrophils, late juveniles, and rod-shaped granulocytes; blast cells are generally 1% to 3%, and are not More than 10%; eosinophilic and basophilic increase, which is helpful in diagnosis. In the early stage of the disease, the number of platelets is normal. In the late stage, the platelet count gradually decreases and anemia may occur.

The bone marrow hyperplasia is obvious to extremely active, mainly granulocytes, and the granulocyte:red ratio can increase to 10 to 50:1. Among them, the number of neutral, late, and rod-shaped granulocytes is significantly increased. Red blood cells are relatively reduced. Megakaryocytes are normal or increased, and decrease in late stages. Neutrophil alkaline phosphatase (NAP) activity is reduced or negative.

Cytogenetic and molecular biology changes Ph chromosome, t(9;22)(q34;q11), appears in blood cells of more than 90% of patients, and the C-abl proto-oncogene is translocated from the long arm of chromosome 9 to the long arm of chromosome 22 The breakpoint concentration region (bcr) forms the bcr/abl fusion gene. The protein it encodes is P210. P210 enhances tyrosine kinase activity, leading to granulocyte transformation and proliferation, and plays an important role in the pathogenesis of chronic myelogenous leukemia.

Chronic phase

acceleration period

period of acute change

Tyrosine kinase inhibitor TKL

Allogeneic hematopoietic stem cell transplantation allo-HSCT

Hydroxyurea

Interferon-alpha (IFN-alpha)

Indirubin and its derivatives

Accelerated phase treatment

blast crisis treatment