acute leukemia

Acute leukemia

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Acute leukemia is a stage of leukemia disease, blood cancer.

Epidemiology
The incidence of acute leukemias is low (about 1/100000 inhabitants). It is however the most frequent of leukemias and its frequency is related to age. It is the leading cause of cancer-related deaths in children.

Pathophysiological mechanism
There are two pathophysiological mechanisms that occur in the symptoms:

Proliferation of malignant cells, responsible for a tumor syndrome
Medullary deficiency: on 3 normal lines; The consequences of this medullary deficiency are anemia, neutropenia and thrombocytopenia
Symptoms
They include signs of blood insufficiency: paleness, infectious syndrome, classical cutaneous-mucosal haemorrhagic syndrome.

The signs of proliferation are bone and osteo-articular pain, adenopathies, a splenomegaly, rarely an enlarged body.

Biology
The CBC shows in a non-specific way anemia normocytic, macrocytosis, Arégénérative, a thrombocytopenia.

The number of leukocytes is increased with the presence of blastic cells signing the diagnosis

The Myelogram confirms the diagnosis of acute leukemia and allows its classification into two groups, acute myéloblastiques leukemias (LAM) and acute lymphoblastic leukemias (LAL). The cytological study makes it possible to count the blasts (abnormal cells) invading the marrow, of which a rate above 20% affirms acute leukemia. It also allows to describe the morphology of the blastic cells (size, nucleus, cytoplasm...), so the presence of cytoplasmic granulation basophils instead steers towards a LAM, similarly, the presence of Auer bodies signs a myeloid attack (the Auer bodies are azurophilic cytoplasmic granules often taking a form at the end of the sticks. A cytochemical study of the Myelogram, blast observation after a myeloperoxidase (DFO) test, is conducted. A DFO-positive blast rate greater than 3% affirms the myeloid nature of leukemia. A immunophenotyping (studies of cytometer differentiation clusters) of blasts allows the distinction between LAM and LAL when Cytology and cytochemistry are not informative enough.

The cytogenetic study has a prognosis interest, as well as for some classifications.

The balance sheet is completed before treatment: background, lumbar puncture (in order to find a meningeal localization), blood group determination, viral serology, hepatic balance, renal, coagulation, blood glucose, total protein, albumin ratio, balance phospho-calcium, uric acid, ionogram.

Osteo-medullary biopsy is performed only in case of failure of the myelogram or in the case of fibrosis of the marrow.

Treatment
The treatment of symptoms include blood transfusion in the case of poorly tolerated anemia, putting on antibiotics in case of infection.

Care must be taken in a specialized environment to start chemotherapy, called induction, adapted to the cytological type. It is followed by a chemotherapy called consolidation. The prevention of meningeal localization is done by chemotherapy and radiotherapy.

A bone marrow transplant can be proposed after aplasiante chemotherapy (resulting in the destruction of almost all of the patient's blood stem cells)