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Acute Leukemia – Incorporating Myelogenous and Acute Lymphocytic Leukemia – Understanding, Treating and Winning The Fight.
Chronic Lymphocytic Leukemia
The lymphoid cells”mature” along a recognizable pattern, and at any point in theirdevelopment a genetic error can give rise to a “malignant clone”. Forclassification purposes, the chronic form of these malignancies is called “Chronic Lymphocytic Leukemia”, or “CLL” for short.
The types of “leukemias” arising from mature plasma cells (Solitary Plasmacytomaand Malignant Myeloma) are classified as “Plasma Cell Cancers”, not ALL.
The Myeloid precursors developinto the Granulocytes, most notably the Neutrophils and Basophils. Thesephagocytic cells are crucial to enveloping and then destroying invading pathogens even withoutprior sensitization, also known as “cellular immunity” (certain “null” lymphocytes are also such “Natural Killer” cells).
The “myeloid” WhiteBlood Cells mature in a recognizable sequence: Immature Myeloblasts->MatureMyeloblasts->Promyelocytes->Myelomonocytes->Monocytes.
At any point in their maturation, the cells may give rise to a malignant clone, and the types of Acute MyelocyticLeukemia (“AML”) will be seen to derive from this sequence.
The “erythroid” linebreaks off early as a subset of the myeloid line from the pleuripotential StemCells, initially giving rise to nucleated Red Blood Cells (“Howell-JollyBodies”) which lose their nucleus to mature into the circulating typeRBC’s.
Since there is some commonalitybetween the origin of RBC’s and Myeloid WBC’s, we see (rare)”erythroleukemias” arise which are classified along with theMyelocytic types.
Finally, the”megakaryocytic” cells also derive from the myeloid line, normallygiving rise to the giant megakaryocyte cells which manufacture platelets in thebone marrow.
Thus some (rare) megakaryocyticleukemias are classified as subsets of the myeloid (or”Non-Lymphocytic”) variety. According to the FAB system:
M1 “Myeloblastic”cells, very immature can be confused with L2; 20%
M2 “Myeloblastic” cellswith maturation, larger cells, 30
M3 “Promyelocytic”cells are further developed than M1 or M2 10%
For AML M4″Myelomonocytic” more mature looking like monocytes 30%
M5 “Monocytic”- thecells look just like monocytes. 10%
M6 “Erythrocytic” meansit comes from red blood cell lineage <5% M7 “Megakaryoblastic” -it comes from platelet making cells <5%
The two major types of AcuteLeukemia are ALL and AML, with AML sometimes called “Acute Non-Lymphocytic Leukemia” (“ANNL”) .
All of the types can be tracedback to a common precursor, the Pleuripotential Stem Cell, and the type arisingin any specific patient depends upon the point in differentiation andmaturation it went awry.