Approach to Acute Leukemia Dr. Nikhil Patkar Clinician Scientist & Asst Professor Hematopathology...
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Approach to Acute Leukemia Dr. Nikhil Patkar Clinician Scientist & Asst Professor Hematopathology Laboratory Tata Memorial Centre [email protected]
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Transcript of Approach to Acute Leukemia Dr. Nikhil Patkar Clinician Scientist & Asst Professor Hematopathology...
Approach to Acute Leukemia
Dr. Nikhil PatkarClinician Scientist & Asst Professor
Hematopathology LaboratoryTata Memorial [email protected]
History
• 59 year old female, easy fatiguability
• Leucocytosis, decrease in platelets– TLC:90,000/mm3
– Platelet counts: 54,000/mm3
• Suspected to have acute leukemia and referred to TMH
Questions to ask when faced with acute leukemia
• Is there an increase in blasts or blast equivalents?
• Are there abnormal promyelocytes?• Are there Auer rods?• Is cytochemical MPO positive?• Is cytochemical NSE positive?• Must send for immunophenotyping.
YES?
NO?
NO?
NO?
NO?
Cytochemical MPO
Summary
• Morphology– Myeloid Blasts– Strong MPO positive
• Immunophenotype– CD34 Negative– HLA-DR Negative– CD13,CD33positive, CD117 dim-negative
DIAGNOSIS?
Questions to ask when faced with acute leukemia
• Is there an increase in blasts or blast equivalents?
• Are there abnormal promyelocytes?• Are there Auer rods?• Is cytochemical MPO positive?• Is cytochemical NSE positive?• Must send for immunophenotyping.
YES?
NO?
NO?
NO?
NO?
Is this acute promyelocytic leukemia?
Yes / No
Is this distinction important?How urgent is the report ?
APL with t(15;17)(q22;q12); PML-RARA
How does this determine treatment?
• AML with t(15;17)– Treated with
• All Trans Retinoic Acid• Or Arsenic Trioxide
– Excellent survival – High mortality if not detected early & treated
correctly • DIC and bleeding complications eg intracranial bleeding
– Practical working algorithm in a pathology lab• AML M3 or non M3 AML
Overall survival (top) and disease-free survival (bottom) curves of 14 relapsed APL patients after As2O3-induced CR.
Shen Z et al. Blood 1997;89:3354-3360
©1997 by American Society of Hematology
Cup Shaped BlastsCytochemical MPO Positive
Typical morphology of myeloid blasts with cup-like nuclear invagination in AML. (A) The “cup” seems to be a part of the nucleus in Pappenheim staining, however it is positive for
myeloperoxidase (MPO) in reactive blasts.
Kroschinsky F P et al. Haematologica 2008;93:283-286
©2008 by Ferrata Storti Foundation
Cup shaped blasts are often associated with NPM1 Mutations
NPM WT169bp
NPM Mutant173 bp
FLT3-WT330bp
Final Diagnosis
NPM1 Mutated AML, FAB AML M1
