Leukemia

Description

• Neoplasms of WBCs that have undergone a malignant transformation
• Hyperleukocytosis:
  • Occurs with WBC >100,000/mm³
  • Leads to occlusions of small vessels primarily in brain or lungs
  • Present with confusion, stupor, or shortness of breath

• Overproduction of granulocytic WBCs (neutrophils)
• Neutrophil function preserved
• Thrombocytosis
• Basophilia
• Philadelphia chromosome present in bone marrow of >95%

• Most common leukemia in adults
• Overproduction of monoclonal lymphocytes
• Cells accumulate in lymph nodes, bone marrow, liver, spleen
• Particularly prone to herpes virus infections

• Proliferation of undifferentiated immature cells:
  • Acute myelogenous leukemia (AML) – immature myeloid cells
  • Acute lymphocytic leukemia (ALL) – immature lymphoid cells (blasts)
• Rapidly fatal

Etiology

• Arise from multiple genetic mutations that allow unchecked proliferation and abnormal maturation of cells
• Familial clustering in chronic lymphocytic leukemia (CLL)
• Increased incidence of AML, ALL, and chronic myelogenous leukemia (CML) with ionizing radiation

• Usually have ALL:
  • Most common pediatric cancer
• 60–80% remission in those who are standard risk
• Better overall prognosis, except if <1 yr of age
• May develop leukostasis at lower levels
• >30% present with bone or spine pain
• May have enlarged thymus
• Allopurinol dose is 3 mg/kg
• Ceftazidime dose is 50 mg/kg

• 90% of leukemias are AML or ALL
• Myeloid leukemias are more common
• CLL is very rare in pregnancy
• Chemotherapeutics may cause birth defects and/or preterm labor
• Same prognosis as nonpregnant; do not delay therapy
• Transfuse earlier than nonpregnant; keep hemoglobin >9.8 mg/dL