Info

🌱 來自: acute leukemia

diagnostic evaluation of acute leukemia

(Blood 2009;114:937)

Peripheral smear: 

thrombocytopenia, blasts (seen in >95%; ⊕ Auer Rods in AML)

Bone marrow:

• 20% blasts

• mostly hypercellular
• test for cytogenetics and
• flow cytometry for immunophenotype (AML/ALL)

Cytogenetic anomalies:

AML

t(15;17), t(8;21), inv(16) or t(16;16), complex;

ALL

Ph-chromosome [t(9;22)], hyper or hypodiploid, complex

Molecular mutations

AML

• FLT3 (ITD and TKD), 
• TP53,
• NPM1; 

ALL

BCR-ABL1

Evaluate for complications

• TLS (↑ uric acid, ↑ LDH, ↑ K, ↑ PO4, ↓ Ca),
• DIC (PT, PTT, fibrinogen, D-dimer, haptoglobin, bilirubin),
• check for G6PD (prior to giving rasburicase)

LP

• (w/ co-admin of intrathecal chemotherapy to avoid seeding CSF w/ circulating blasts)

• all Pts w/ ALL

• AML w/ CNS sx

• CNS is sanctuary site

• TTE before use of anthracyclines

HLA typing

• Pt,
• siblings >parents/children
• potential allogeneic HSCT candidates