COMMON TYPES OF LEUKEMIAS, THEIR SALIENT CLINICAL FEATURES, MORPHOLOGY AND IMMUNOPHENOTYPES

NAME	CLINICAL FEATURES	SALIENT MORPHOLOGY	IMUNOPHENOTYPE	CHROMOSOMAL ABNORMALITIES
ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)	ABRUPT STORMY ONSET SYMPTOMS RELATED TO DEPRESSION OF BONE MARROW FUNCTION; ANEMIA, INFECTION, BLEEDING GENERALIZED LYMPHADENOPATHY, SPLENOMEGALY, HEPATOMEGALY BONE MARROW INVOLVEMENT CAUSING BONE TENDERNESS AND PAIN MENINGEAL INVOLVEMENT LEADINT TO VOMITING, PAPILLEDEMA, CRANIAL NERVE PASLIES. INTRACEREBRAL OR SUBARACHNOID HEMORRHAGE LABORATORY FINDINGS; LOW RBC, LOW WBC (,10,000/mm3), IMMATURE BLAST CELLS IN THE BLOOD AND BONE MARROW (6-100% OF CELLS), LOW PLATELET COUNT (<100,000/mm3)	COARSE GRANULAR CHROMATIN ONE TO TWO NUCLEOLI ABSENCE OF AZUROPHILIC GRANULES LARGE AGGREGATES OF PAS POSITIVE MATERIAL	80% B CELL (CD19, NUCLEAR TdT). SOME ARE B CELLS EXPRESSING SURFACE IgG AND NEGATIVE TdT T LYMPHOBLASTS. NUCLEAR TdT	HYPERDIPLOIDY (51-60 CHROMOSOMES); GOOD PROGNOSIS PHILADELPHIA CHROMOSOME (Ph1) IN 15% OF PATIENTS; POOR PROGNOSIS CHROMOSOMAL TRANSLOCATION (20-25%) t(1:19); POOR PROGNOSIS CHROMOSOMAL TRANSLOCATION T(8;14); POOR PROGNOSIS
ACUTE MEYLOBASTIC LEUKEMIA (AML)		DELICATE NUCLEAR CHROMATIN 3-5 NUCLEOLI FINE AZUROPHILIC GRANULES IN THE CYTOPLASM RED STAINING ROD-LIKE STRUCTURES (AUER RODS) POSITIVE MYELOPEROXIDASE (S0ME CASES) LYSOSOMAL NON-SPECIFIC ESTERASES	TdT POSITIVITY, RARE	VARIOUS CHROMOSOMAL TRANSLOCATIONS
CHRONIC MYELOID LEUKEMIA (CML)	NON-SPECIFIC INITIAL SYMPTOMS EASY FATIGABILITY, WEAKNESS, ANOREXIA, WEIGHT LOSS, PRESSURE IN THE ABDOMEN DUE TO EXTREME SPLENOMEGALY ACCELERATED PHASE IN 50% OF PATIENTS CHARACTERIZED BY ANEMIA, THROMBOCYTOPENIA AND TRANSFORMATION TO ACUTE LEUKEMIA (BLAST CRISIS) LACK OF ACCELERATED PHASE PHASE IN 50% OF PATIENTS WITH ABRUPT DEVELOPMENT OF BLAST CRISIS	MARKEDLY ELEVATED LEUKOCYTE COUNT (>100,000) PREDOMINANTLY NEUTROPHILS AND METAMYELOCYTES BASOPHILS AND EOSINOPHILS MAY BE PROMINENT SMALL NUMBER OF MYELOBLASTS (<10%) THROMBOCYTOSIS (~50% OF PATIENTS)	PLURIPOTENT CELLS LACK OF ALKALINE PHOSPHATASE IN THE GRANULOCYTES	Ph1 (90% OF PATIENTS) REPRESENTING T(9;22) CHROMOSOMAL TRANSLOCATION bcr-abl GENE REARRANGEMENTS
CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)	OFTEN ASYMPTOMATIC NON-SPECIFIC SYMPTOMS SUCH AS LOSS OF WEIGHT, ANOREXIA, EASY FATIGABILIGY GENERALIZED LYMPHADENOPATHY AND HEPATOSPLENOMEGALY (60% OF PATIENTS) SLIGHTLY TO MARKEDLY INCRESED LEUKOCYTE COUNT (200,000/mm3) WITH ABSOLUTE LYMPHOCYTOSIS	MATURE B CELLS	MATURE B CELLS (CD19+, CD20+, sIg+) ALSO EXPRESSING T CELL MARKERS (CD5+)	TRISOMY 12 (50% OF PATIENTS) COMPLEX CHROMOSOMAL ABNORMALITIES INVOLVING CHROMOSOME 11 AND 14 GENE REARRANGEMENT OF bcl-2 (10-15% OF PATIENTS) MUTATION OF bcl-2 (5% OF PATIENTS)