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Leukemias
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
AML is a heterogeneous clonal disease characterized by recurrent genetic, epigenetic, and metabolic abnormalities. It arises from the malignant transformation of immature hematopoietic cells following the acquisition of multiple driver mutations in the HSC and committed progenitors.7 These mutations inform on the World Health Organization (WHO) classification and the prognosis. Though there are some unique subtypes, such as acute promyelocytic leukemia (APL), characterized by a t(15;17) translocation with fusion of PML-RARA genes and cell-cycle arrest at the promyelocyte stage, and RUNX1 encoding core binding factor (CBFα) AML, the prognosis of most patients is poor, with a 5-year survival of 28%, following conventional treatment. The outcome in older patients is even worse, with a median survival of less than 12 months.8
Haematological malignancy
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
CML represents neoplastic proliferation of granulocyte precursors and is characterized by an excess of metamyelocytes and myelocytes in the peripheral blood. Promyelocytes and myeloblasts can also be present and often there is an excess of basophils and eosinophils.
Acute Leukemia and Myelodysplastic Syndromes
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Mark D. Brissette, James D. Cotelingam
M2 is myeloblasts leukemia with maturation, which makes up 25–30% of AML (Fig. 6, Tables 6 and 7). More than 10% of cells are maturing granulocytes (promyelocytes to segmented neutrophils), while less than 20% of cells are of monocytic origin. Auer rods may be seen. The t(8;21) (q22;q22) is commonly seen in AML M2.
Does leukocytosis remain a predictive factor for survival outcomes in patients with acute promyelocytic leukemia receiving ATRA plus a chemotherapy-based regimen? A prospective multicenter analysis from TALWG
Published in Hematology, 2023
Smith Kungwankiattichai, Weerapat Owattanapanich, Thanawat Rattanathammethee, Ekarat Rattarittamrong, Chantiya Chanswangphuwana, Chantana Polprasert, Wasithep Limvorapitak, Supawee Saengboon, Pimjai Niparuck, Teeraya Puavilai, Jakrawadee Julamanee, Pirun Saelue, Chinadol Wanitpongpun, Kannadit Prayongratana, Chantarapa Sriswasdi, Chajchawan Nakhakes
Regarding the initial complete blood count (CBC), the mean hemoglobin was 8.4 ± 2.2 g/dL, median WBC count was 3.6 × 109/L (IQR: 1.4–15.6 × 109/L), and the median platelet count was 31 × 109/L (IQR: 18–54 × 109/L). The median bone marrow blasts with promyelocytes were 80% (IQR: 70–90%). Among 75 cases with available cytogenetic results, 57 patients (76%) had the t(15; 17) abnormality. Approximately one-fifth (21.3%) of the cases had normal cytogenetic, and 2.6% had t(11; 17). The PML-RARA gene detected by the polymerase chain reaction method was found in all cases, including those with normal cytogenetic or lack of cytogenetic results to confirm the APL diagnosis. Based on the WBC count, patients were categorized into the high-risk group (31.6%) and low-risk group (68.4%). Table 1 demonstrates the detailed baseline characteristics of the patients.
Shifting gears to differentiation agents in acute promyelocytic leukemia with resource constraints—a cohort study
Published in Acta Oncologica, 2022
Tejasvini Vaid, Mukul Aggarwal, Jasmita Dass, Rishi Dhawan, Pradeep Kumar, Ganesh Kumar Viswanathan, Seema Tyagi, Tulika Seth, Manoranjan Mahapatra
We retrospectively reviewed the data of consecutive patients with newly diagnosed APL between 1 January 2016 and 31 December 2020 at the Department of Haematology, All India Institute of Medical Sciences, New Delhi, a tertiary care referral centre in India. A presumptive diagnosis of APL was made based on the presence of abnormal promyelocytes in peripheral blood or bone marrow morphology and flow cytometry (CD13, CD33 positive, HLA DR, CD34 negative). Patients were included in the study after confirmation of diagnosis by the presence of PML-RARA fusion gene by reverse transcriptase polymerase chain reaction (RT-PCR). To ensure the completeness of the study, inpatient records and laboratory immunophenotyping records were extracted. Patients were followed till 1 November 2021 and the median duration of follow-up was 678 days.
Acute promyelocytic leukemia presenting as recurrent venous and arterial thrombotic events: a case report and review of the literature
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Kira MacDougall, Divya Chukkalore, Maryam Rehan, Meena Kashi, Alexander Bershadskiy
To further evaluate the patient’s neutropenia, human immunodeficiency virus was tested and was negative. JAK-2 mutation was negative. Flow cytometry, which included cytogenetics, was negative for paroxysmal nocturnal hemoglobinuria but revealed t(15;17)(q26;q25), consistent with APL. The patient underwent a bone marrow biopsy which demonstrated diffuse infiltration of abnormal promyelocytes (Figure 3(a-c)). Before treatment for APL could be initiated, the patient developed left lower extremity and right upper extremity pain. Ultrasonography revealed thrombosis of the right cephalic vein, left basilic vein, and a superficial thrombosis of the left great saphenous vein. International normalized ratio was therapeutic at 2.80. Patient was transitioned from coumadin back to unfractionated heparin. Aspirin was discontinued due to the high-risk of bleeding.