Diagnostics leukemias

Flow cytometric evaluation of bone marrow and peripheral blood to characterize the type of leukemia, as well as to detect specific chromosomal rearrangements. The bone marrow at diagnosis usually is hypercellular, with normal hematopoiesis being replaced by leukemic blasts. The presence of greater than 20% blasts in the bone marrow is diagnostic for AML. 

Chronic Myelogenous Leukemia and Acute Leukemias Current Diagnostics. 57... 

Shimoyama, M., Diagnostic criteria and classification of clinical subtypes of adult T-cell leukemia-lymphoma. A report from the Lymphoma Study Group (1984-87). Br. J. Haematol. 79,428-437 (1991). 

Burger B, Zimmermann M, Mann G et al. Diagnostic cerebrospinal fluid (CSF) examination in children with acute lymphoblastic leukemia (ALL) significance of low leukocyte counts with blasts or traumatic lumbar puncture. J Clin Oncol 2003 21 184-188. 

Moreover gene-expression analysis of leukemia cells from B-lineage acute lymphoblastic leukemia pediatric patients has identified sets of differentially expressed genes that are associated specifically with sensitivity or resistance to chemotherapy. Such information can also be used in diagnostic assay to stratify the patients in sub-categories, to develop new drugs and later on to personalize the anti-cancer therapy. 

Relationships of radiogenic tumors to natural incidence The d n-dence of the minimal latent period upon age-at-exposure, and thus upon age at risk of cancer, and the apparent invariance of relative risk by sex for thyroid cancer and leukemia, contrast sharply with the marked differences in relative risk estimates for breast cancer between Japanese A-bomb survivors and North American women exposed to diagnostic or therapeutic x rays. The relationship of radiogenic cancer to naturally occurring cancer needs to be better understood if reliable projections of risk beyond the period of actual observations are to be made. The BEIR III Committee (NAS/NRC, 1980) was obliged to make its lifetime projections on the basis of both absolute and relative risk models. 

To establish a definitive diagnosis of acute leukemia the following diagnostic components are required bone marrow biopsy and aspirate (with >20% blasts), cytogenetics, and immunophenotyping. 

B-cell prolymphocytic leukemia rarely presents as a diagnostic dilemma in a lymph node, and although splenic involvement may raise the possibility of a splenic lymphoma, the elevated white blood cell count and typical smear make this unlikely. B-PLL may be CD5 and CD23 negative and is more likely to be CD22 positive than B-CLL/SLL.Not surprisingly, measures of mitotic index—such as Ki-67 —are higher in B-PLL. 

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