Leukemias and Lymphomas: A primer

Leukemias and Lymphomas: A primer

Normal blood contains circulating white blood cells, red blood cells and platelets 700 red cells (oxygen) 1 white cell Neutrophils (60%) bacterial infection Lymphocytes (30%) viral infection Monocytes, eosinophils, basophils (10%) 35 platelets (blood clotting) 35,000,000,000 (billion) white cells in the average body

Neutrophil

Lymphocyte

Monocyte

Eosinophil

Basophil

Any sufficiently advanced technology is indistinguishable from magic. - Arthur C. Clarke

Leukemias and lymphomas are both malignancies of white blood cells Like all malignancies, there is some genetic change which prevents the WBC from responding to normal stop growing signals from the body Leukemias present in the liquid phase in the blood Lymphomas present in the solid phase in the lymph nodes (spleen, liver, other organs)

Leukemia Recent 2014 statistics: 28,000 new acute leukemias 25,000 new chronic leukemias 24,000 deaths

Leukemia Acute vs. chronic Acute rapid growth of immature white blood cells (blasts) resulting in bone marrow failure within months Chronic slower growth of immature and mature white blood cells which may take years to show symptoms Myeloid vs. Lymphoid

Leukemia Marrow space becomes filled with abnormal cells, crowding out the normal cells Red blood cells Anemia fatigue shortness of breath White blood cells Neutropenia - infections Platelets Thrombocytopenia bleeding problems

Leukemia Classification Acute Myelogenous (AML) Chronic Myelogenous (CML) Acute Lymphocytic (ALL) Chronic Lymphocytic (CLL)

Chronic Myelogenous Leukemia (CML) Slow growth of cells that show features of the myeloid white blood cell group Often found incidentally when a CBC is ordered for some other reason Tends to occur over age 50

Year 1960

Acute Myelogenous Leukemia (AML) Rapid growth of generally immature cells that show features of the myeloid white blood cell group Tends to occur over age 50

Acute Myelogenous Leukemia WHO Classification AML with recurrent genetic abnormalities t(15;17) t(8;21) inv(16) 11q23 abnormalities AML with multilineage dysplasia AML secondary to chemotherapy/radiation AML, not otherwise specified (NOS)

Acute Lymphocytic Leukemia (ALL) Rapid growth of cells that show features of the lymphoid white blood cell group Tends to occur in pediatric patients

Chronic Lymphocytic Leukemia (CLL) Slow proliferation of mature lymphocytes over many years resulting in a slowly rising total lymphocyte count Often found incidentally Patients often die with the disease but from some other cause i.e., the disease is relatively benign in it s course

CLL ALL

Lymphomas In contrast to leukemias, these present as solid masses e.g., swollen lymph nodes, tumors in various parts of the body, enlarged liver or spleen 2 categories Hodgkins lymphoma Non-Hodgkin s lymphoma

Non-Hodgkin s Lymphomas Roughly divided into 2 categories Low grade Slowly growing and death may not occur for years of may occur from some other cause Almost impossible to cure High grade More rapidly growing Death may occur in the short time Somewhat better chances for cure

Low grade lymphomas Follicular lymphoma Mantle cell lymphoma (classified as low grade but can be aggressive) Small lymphocytic lymphoma (tissue counterpart of CLL) Marginal zone lymphoma

Follicular lymphoma

Small lymphocytic lymphoma

High grade lymphoma Diffuse large cell lymphoma Usually B-cells Burkitt s lymphoma Very aggressive, occurs in children Excellent cure rate with modern therapy Lymphoblastic lymphoma Tissue counterpart of ALL

Diffuse large cell lymphoma

Hodgkin s lymphoma Used be called Hodgkin s disease Now termed lymphoma since recent studies have determined the abnormal cells are lymphoid in origin First described in 1832 as morbid appearance of the absorbent glands and spleen Not until 1898-1902 that the diagnostic microscopic description was made by Dorothy Reed and Carl Sternberg

Hodgkin s lymphoma Diagnostic cell is the Reed Sternberg cell Key is that it must be present with the appropriate background cells: Plasma cells Eosinophils Lymphocytes

Hodgkin s lymphoma Nodular sclerosis 60-70% stage I 90% stage IV 65% Mixed cellularity 25% Lymphocyte predominant 5% Lymphocyte depleted 4%