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Understanding Acute leukaemia

Dr. Narender Kumar Thota, Monday, September 13, 2021

Understanding Acute leukaemia

1. How many types of leukemic are there?

Majorly two types

a. Acute lymphoblastic leukemic(ALL)

b. Acute myeloid leukaemia(AML)

How they present to doctor?

Among the most common clinical findings at the time of presentation with ALL/LBL are:

Commonly - liver enlargement - Hepatomegaly (64 percent) and/or spleen enlargement - splenomegaly (61 percent) 

Loss of appetite, low of weight, abdominal distension or abdominal pain 

Neck swelling or arm pit or groin swelling - Lymphadenopathy


Because of low platelets patients may present with bleeding (eg, petechiae, purpura)

Low haemoglobin - Anemia (eg, pallor, fatigue) 

The white blood cell (WBC) count may be low, normal, or high

Bone pain, body pain  - seen in nearly  40 percent of cases 

Less common manifestations of ALL/LBL in children include:

Blood cancer may involve brain and my cause headache, vomiting, lethargy, nuchal rigidity, and, rarely, with cranial nerve abnormalities 

Pain less Testis swelling , 

Mass in the chest which may cause the neck veins engorgement   - superior vena cava (SVC) syndrome, which may be manifest as pain, dysphagia, dyspnea, or swelling of the neck, face, and upper limbs due to obstruction the SVC. 

How they are diagnosed? 

1. Complete blood picute

2. Bone marrow aspiration and biopsy studies

3. Cytochemistry studies

4. Flowcytometry studies

How to know a blood cancer is a good one or bad one?

1. Cytogenetics

2. Molecular test

3. NGS based new technology tests

4. After completion of 1st month treatment – checking for minimal residual disease – most important 

Are there any types and stages of blood cancer?

In blood cancers there are no stages 

There are different types of blood cancers

In AML – 

AML with recurrent genetic abnormalities

1. AML with myelodysplasia-related changes

2. Therapy-related myeloid neoplasms


4. Myeloid sarcoma


Two types majorly

1. T cell ALL

2. B cell ALL

In B cell ALL


2. Ph+; t(9;22)(q34.1; q11.2); BCR-ABL1 

3. t(v;11q23.3); KMT2A-rearranged 

4. t(12;21)(p13.2;q22.1); ETV6-RUNX1 

5. Hyperdiploidy —

6. Hypodiploidy 

7. t(5;14)(q31.1;q32.1); IGH/IL3 

8. BCR-ABL1-like (Ph-like) 

Which set of patients do badly? 

Generally – based on clinical feature some patient may do badly in ALL patients

1. Less than 1 year babies do very bad. – especially if they have KMT2A (MLL) at 11q23, 

2. Children more than 10yrs.

3. Adult B-ALL/LBL is more often associated with the poor-prognosis t(9;22) or t(v;11q23.3) abnormalities, and survival is poorer than in childhood cases 

4. White blood cells  ≥50,000/microL

5. Male patients 

How the blood cancers are treated? 

AML and ALL are treated differently 

AML – treated with 7 +3 regimen

ALL – BFM Protocol, UK ALL protocol, COG protocol etc l, different protocols are available in world, depending on the country they live, and these protocols are adapted in their respective countries 

But end results are same irrespective of the protocol

Are there any targeted therapies for blood cancers?


For FLT 3 mutations -  midostaurin may be added for patients with FLT3 mutation,  

For IDH 1 and IDH 2 mutations -  ivosidenib or enasidenib 

For CD 33 - gemtuzumab ozogamicin


Dr. T. Narender Kumar

Consultant Medical & Hemato Oncologist and BMT Physician

KIMS Hospitals, Secunderabad. 



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