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Acute leukemia Resident Survival Guide
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];

Synonyms and keywords: Acute lymphocytic leukemia, Acute myeloid leukemia, ALL, AML

Overview

Acute Leukemia is a malignancy of bone marrow myeloid and lymphoblastic precursor cells, in which these poorly differentiated hematopoietic cells proliferate rapidly. Hence, their accumulation would disrupt the performance of bone marrow to produce normal blood cells

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Causes

AML and ALL are life-threatening diseases, which would result in death if left untreated. In the majority of cases, etiology is not apparent.

Common Causes of AML

• Gene mutations:FLT3, IDHI, IDH2, KRAS, DNMT3A, NPM1
• Chromosomal translocations, deletions, and inversions
• Benzene or radiation exposure chronically

Common Causes of ALL

• Radiation exposure:
• Genetic disorders; e.g., Down syndrome, ataxia-telangiectasia, Fanconi anemia
• Certain infections: e.g., HTLV-1

FIRE

A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.[5]

Boxes in red color signify that an urgent management is needed.

• Focused Initial Rapid Evaluation (FIRE) in AML:

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Obtain patient's medical history and focus on these signs and symptoms: ❑ Fatigue ❑ Weight loss ❑ Anorexia ❑ Bone pain ❑ Bleeding ❑ Early satiety ❑ History of specific and chronic exposures such as alkylating agents, benzene, radiation, or previous chemotherapy ❑ Headache ❑ History of recurrent fever

Examine the patient: ❑ Fever ❑ Tachycardia ❑ Ecchymosis ❑ Lymphadenopathy ❑ Splenomegaly ❑ Hepatomegaly ❑ Abnormalities in cranial nerve examination ❑ Skin nodules ❑ Dental abcess ❑ Papilledema

Hematologic evaluation: ❑ CBD including platelets and WBCs) ❑ Uric acid, BUN, Cr, Liver function tests, bilirubin,Ca, P, Sodium, potassium, ❑ amylase, and lipase ❑ Lactate dehydrogenase ❑ PT, PTT ❑ D-dimer, fibrinogen ❑ Viral antibodies, (varicella-zoster, CMV), HSV-1

Radiologic assessment: ❑ CXR(PA and lateral) ❑ PET or CT scan (if extramedullary disease is doubted based on symptoms and physical exam) ❑ CT, or MRI, and other imaging methods to diagnose ICH, brain or spinal cord tumors, and leptomeningeal disease (if patient presenting notable CNS signs and symptoms

❑ Bone marrow aspiration and biopsy

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Diagnosis

Treatment

Do's

Don'ts

References