University of MilanoBicocca, Monza, Italy

ACUTE LEUKEMIAS

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

Epidemiology Epidemiology

Etiolgy Etiolgy

Clinical presentationClinical presentation

Classification/Staging/PrognosisClassification/Staging/Prognosis

University of MilanoBicocca, Monza, Italy

Incidence of Incidence of HematologicHematologic MalignanciesMalignancies

Type of LeukemiaType of Leukemia Incidence per Incidence per 100,000*100,000*

Overall Overall 66––1010CMLCML 11––22CLLCLL 22––33AMLAML 22––33ALLALL 11––22

University of MilanoBicocca, Monza, Italy

Table 46.2-1 Diagnosis and Evaluation of Acute Leukemia-------------------------------------------------------------------

Symptoms

Fatigue, malaise, dyspneaEasy bruisability, weight loss

Bone pain or abdominal pain (less common)Neurologic symptoms (rare)

SignsAnemia and pallor

Thrombocytopenia, hemorrhage, ecchymoses, petechiae, fundal hemorrhage

Fever and infection (pneumonia, sepsis, perirectal abscess)Adenopathy, hepatosplenomegaly, mediastinal mass

Gum or skin infiltration (rare)Renal enlargement and insufficiency (rare)

Cranial neuropathy (rare)

University of MilanoBicocca, Monza, Italy

AMLAML

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

MyelodysplasiasMyelodysplasias

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

TABLE 175–1. DIFFERENTIAL DIAGNOSIS OF MDS

Congenital disordersHereditary sideroblastic anemiaFanconi's anemiaDiamond-Blackfan syndromeKostmann's syndromeShwachman syndromeDown syndromeVitamin deficiencyB12, folate, or iron deficiencyDrug toxicityMarrow suppression from oral or parenteral medicationsToxinsChemotherapy and/or radiation therapyAlcoholAnemia of chronic diseaseRenal failureChronic infection, including tuberculosisRheumatologic disordersViral marrow suppressionIncluding Epstein-Barr virus, parvovirus B19, human immunodeficiency virus, and othersMarrow infiltrationAcute and chronic leukemiasMetastatic solid tumor infiltrationParoxysmal nocturnal hemoglobinuriaHypersplenism

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

TABLE 175–2. INTERNATIONAL PROGNOSTIC SCORING SYSTEM

PROGNOSTIC VARIABLESCORE VALUE

0 0.5 1.0 1.5 2.0

Bone marrow blasts (%) <5 5–10 — 11–21 21–30

Karyotype* Good Intermediate Poor

Cytopenias† 0 or 1 2 or 3

Karyotype scores:* Good: normal - Y, del(5q), del(20q) Poor: complex (greater than or equal to 3), any abnormality of chromosome 7 Intermediate: any other cytogenetic abnormality

Cytopenias:† Hemoglobin less than 10 g/dL Absolute neutrophil count less than 1,500/μL Platelet count less than 100,000/μL

Score for each of the three variables are summed for an overall score. Overall scores for risk groups are low: 0; intermediate-1: 0.5–1.0; Intermediate-2: 1.5–2.0; and high: ≥2.5.

From Greenberg P, Cox C, LeBeau MM, et al: International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood 89:2079, 1997.

University of MilanoBicocca, Monza, Italy

ALLALL

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy

University of MilanoBicocca, Monza, Italy