What are the guideline sources, guidelines and references for Acute leukemia ?
Guideline sources The following summarized guidelines for the evaluation of acute leukemia are prepared by our editorial team based on guidelines from the American Society of Hematology (ASH/ACP 2017). 1 2 2 3 4 5 Definition Acute leukemia is a malignant disorder that results from the clonal expansion of an abnormal early hematopoietic progenitor cell. 2 Epidemiology The precise cause of acute leukemia is unknown; however, congenital factors, chromosomal abnormalities (in Down's syndrome, Bloom syndrome, Fanconi's anemia), immunodeficiency states (ataxia telangectasia, Wiskott-Aldrich syndrome), chemotherapy, ionizing radiation, myelodysplastic syndrome, and retrovirus HTLV-1 have been implicated as causative factors in acute leukemia. 2 Disease course Abnormal clonal proliferation of hematopoietic stem cells in the bone marrow results in acute leukemia. In children, it mostly presents as acute lymphoblastic leukemia presenting with fever, lethargy, bleeding, musculoskeletal symptoms (in the spine and long bones), hepatosplenomegaly, lymphadenopathy, and CNS involvement. In adults, it mostly presents as acute myelogenous leukemia presenting with fever, fatigue, weight loss, shortness of breath, chest pain, excessive bruising, nosebleeds, heavy menstrual periods in women, and CNS involvement. 3 https://web.pathway.md/diseases/rec0gYACAyJ8cog7m 1/4 6/23/23, 1:57 AM Acute leukemia Pathway Prognosis and risk of recurrence Age-adjusted mortality rates for acute myeloid leukemia is 1.81/100,000 (95% CI 1.30-2.26). The 5- year survival for adults with acute lymphoblastic leukemia in developed countries is between 30% to 45%. 4 5 Calculator Calculator Eastern Cooperative Oncology G Karnofsky performance status s Guidelines 1. Classification and risk stratification Classification and terminology: Ensure that all tests performed for classification, management, predicting prognosis, and disease monitoring are entered into the patient's medical records. A Use the current WHO terminology for the final diagnosis and classification of acute leukemia. A 2. Diagnostic investigations Clinical history: provide relevant clinical data with pathological specimens, or ensure that such data is readily accessible by the pathologist. A Physical examination: document relevant physical examination and imaging findings or ensure that those results are readily accessible by the pathologist. B Complete blood count: obtain a complete blood cell count, leukocyte differential, and formal review of a peripheral blood smear by a pathologist. A Coagulation studies: obtain rapid detection of PML-RARA in patients with suspected acute promyelocytic leukemia, and obtain appropriate coagulation tests to evaluate for DIC. A Genetic studies: ensure that the following testing is obtained for pediatric patients with suspected or confirmed B-cell acute lymphoblastic leukemia: t(12;21)(p13.2;q22.1); ETV6-RUNX1, t(9;22) (q34.1;q11.2); BCRABL1, KMT2A (MLL) translocation, iAMP21, and trisomy 4 and 10. A 3. Diagnostic procedures Tissue biopsy: refer patients who present with extramedullary disease without bone marrow or blood involvement to a pathologist, who should evaluate a tissue biopsy and process it for https://web.pathway.md/diseases/rec0gYACAyJ8cog7m 2/4 6/23/23, 1:57 AM Acute leukemia Pathway morphologic, immunophenotypic, cytogenetic, and molecular genetic studies, as recommended for the bone marrow. A Bone marrow aspirate: obtain a fresh bone marrow aspirate for all patients with suspected of acute leukemia, a portion of which should be used to make bone marrow aspirate smears for morphologic evaluation. A Lumbar puncture: obtain a CSF sample for patients with acute lymphoblastic leukemia receiving intrathecal therapy. Ensure that a cell count is performed and that examination/enumeration of blasts on a cytocentrifuge preparation is performed and is reviewed by the pathologist. A Additional studies: obtain sufficient samples and perform conventional cytogenetic analysis such as karyotype, appropriate molecular genetic and/or FISH testing, and flow cytometric immunophenotyping, in addition to morphologic assessment. A Cytochemical studies: consider obtaining cytochemical studies in patients with suspected or confirmed acute leukemia to assist in the diagnosis and classification of acute myeloid leukemia. E Molecular studies: Use any of the following for molecular or genetic studies in which the use of such material has been validated: cryopreserved cells or nucleic acid formalin fixed, nondecalcified paraffin-embedded tissue unstained marrow aspirate or peripheral blood smears obtained and prepared from peripheral blood, bone marrow aspirate or other involved tissues. B Mutational analysis: obtain mutational analysis for NPM1, CEBPA, and RUNX1 in patients other than those with confirmed core-binding factor-acute myelocytic leukemia, acute promyelocytic leukemia, or acute myeloid leukemia with myelodysplasia-related cytogenetic abnormalities. A References 1. Arber DA, Borowitz MJ, Cessna M et al. Initial Diagnostic Workup of Acute Leukemia: Guideline From the College of American Pathologists and the American Society of Hematology. Arch Pathol Lab Med. 2017 Oct;141 10 1342 1393. Open 2. K Stewart, A Keating. Acute leukemia: diagnosis, management, and potential for cure. 1988 Nov;34 2463 7.1988 Nov;34 2463 7. Open 3. Amanda S Davis, Anthony J Viera, Monica D Mead. Leukemia: an overview for primary care. 2014 May 1;89 9 731 8.2014 May 1;89 9 731 8. Open 4. Maksimovic N, Zaric M, Gazibara T et al. Incidence and Mortality Patterns of Acute Myeloid Leukemia in Belgrade, Serbia 1999 2013 . Medicina Kaunas). 2018 Mar 20;54 1 . pii: E5. Open 5. Jose Carlos Jaime-Perez, Raul Alberto Jimenez-Castillo, Jose Luis Herrera-Garza et al. Survival Rates of Adults With Acute Lymphoblastic Leukemia in a Low-Income Population: A Decade of Experience at a Single Institution in Mexico. 2017 Jan;17 1 60 68.2017 Jan;17 1 60 68. Open https://web.pathway.md/diseases/rec0gYACAyJ8cog7m 3/4 6/23/23, 1:57 AM Acute leukemia Pathway 6. Tzu-Fei Wang, Robert S Makar, Darko Antic et al. Management of hemostatic complications in acute leukemia: Guidance from the SSC of the ISTH. J Thromb Haemost. 2020 Dec;18 12 3174 3183. Open 7. Val rie de Haas, Nofisat Ismaila, Anjali Advani et al. Initial Diagnostic Work-Up of Acute Leukemia: ASCO Clinical Practice Guideline Endorsement of the College of American Pathologists and American Society of Hematology Guideline. J Clin Oncol. 2019 Jan 20;37 3 239 253. Open https://web.pathway.md/diseases/rec0gYACAyJ8cog7m 4/4