Introduction

• Includes:
  • Acute lymphoblastic leukemia (ALL) Acute lymphoblastic leukemia.
  • Chronic lymphocytic leukemia (CLL) Chronic lymphoid leukemia.
  • Myeloma Myeloma.
  • Lymphoma (LSA) Lymphoma.
• Cause: unknown.
• Signs: referrable to cytopenia due to neoplastic cell infiltration of bone marrow, eg anemia, thrombocytopenia, granulocytopenia. May also be secondary to hyperglobulinemia, eg hemorrhagic diathesis.
• Diagnosis: hematology, biochemical profile (if myeloma), biopsy of any discrete mass, bone marrow aspirate, radiography.
• Treatment: cytotoxic drugs.
• Prognosis: poor if ALL; reasonable if CLL, myeloma or LSA.

Pathogenesis

Etiology

• Unknown.

Pathophysiology

• Malignant proliferation of lymphoid cells Lymphoma arising in any area containing lymphoid tissue → focal or diffuse masses lymph nodes, liver, spleen, bone marrow, intestines, thymus, or skin → may progress to involve kidneys, CNS, lungs, myocardium.
• Paraneoplastic effects, eg hypercalcemia Hypercalcemia: overview.

• Marrow infiltration → cytopenia, characterized initially by neutropenia Hematology: neutrophil , thrombocytopenia, progresses to pancytopenia Leukemia.

• Hypergammaglobulinemia → hyperviscosity → neurological signs, bleeding diathesis, thromboembolism.
• Marrow infiltration → cytopenia (rarely seen). If present characterized by neutropenia, thrombocytopenia, and progression to pancytopenia.
• Lytic bone lesions → focal or multifocal → bone pain as lesions progress, risk of pathologic fracture.

Timecourse

• Acute over weeks, eg ALL; chronic over months, eg CLL, myeloma, lymphoma.

Diagnosis

Treatment

Outcomes