Leukemias & Lymphomas
Predominant Age Group
- ALL: Child (peak 2-5y)
- AML: Adult (>60y most common, but any age)
- CML: Adult (45-65y)
- CLL: Elderly (>65y)
- HL: Young Adult (~20s) & >55y (bimodal)
- NHL (general): Older Adult (>60y)
- Burkitt: Child/Young Adult
- MM: Elderly (>65y)
- MDS: Elderly (>65y)
Typical WBC & Key Cell Type
- ALL: Often ↑↑; Lymphoblasts
- AML: Often ↑↑; Myeloblasts (+/- Auer rods)
- CML: ↑↑↑; Full myeloid spectrum, Basophilia, Low LAP
- CLL: ↑↑; Mature Lymphocytes, Smudge cells
- HCL: Pancytopenia; Hairy cells
- HL/NHL/MM: WBC variable, often normal initially.
Pathognomonic/Classic Smear/Biopsy Finding
- ALL: TdT+ lymphoblasts
- AML: Auer rods (esp. APL/M3)
- CML: <10% blasts (chronic phase), basophilia
- CLL: Smudge cells
- HCL: TRAP+ Hairy cells, "dry tap" marrow
- HL: Reed-Sternberg cells (CD15+, CD30+)
- Burkitt NHL: "Starry sky" appearance, t(8;14)
- Follicular NHL: t(14;18) (BCL2)
- Mantle Cell NHL: t(11;14) (Cyclin D1)
- MM: >10% clonal plasma cells in marrow; Rouleaux
- MDS: Dysplastic cells; <20% blasts
Key Genetic/Molecular Marker
- ALL (some): t(9;22) Ph chr (BCR-ABL1) - poor prognosis
- AML (APL/M3): t(15;17) (PML-RARα) - ATRA tx
- CML: t(9;22) Ph chr (BCR-ABL1) - diagnostic, TKI tx
- Follicular NHL: t(14;18) (BCL2)
- Mantle Cell NHL: t(11;14) (Cyclin D1)
- Burkitt NHL: t(8;14) (c-MYC)
- PV/ET/PMF: JAK2 V617F mutation common
Classic Clinical Snippet / Buzzword
- ALL: Child + bone pain, fever, LAD (lymphadenopathy, presents in lymphoblastic leukemia except HCL)
- AML (APL): DIC, bleeding
- CML: Massive splenomegaly, fatigue, night sweats
- CLL: Elderly + asymptomatic lymphocytosis OR fatigue, LAD
- HCL: Middle-aged man + splenomegaly + pancytopenia
- HL: Young adult + painless cervical LAD + "B symptoms"
- Burkitt: Jaw (endemic) or abdominal (sporadic) mass, rapid growth
- MM: Elderly + bone pain + CRAB (HyperCalcemia, Renal failure, Anemia, Bone lytic lesions/pain)
- MDS: Elderly + unexplained cytopenias + risk of AML
- PV: Aquagenic pruritus, plethora, ↑Hct, ↓EPO