Acute promyelocytic leukemia differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Acute promyelocytic leukemia}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Acute_promyelocytic_leukemia]]
{{CMG}} {{shyam}}
{{CMG}} {{shyam}} {{AE}} {{S.G.}}; {{GRR}} {{Nat}}
 
==Overview==
The differential diagnosis of acute promyelocytic leukemia includes a variety of other [[hematologic]] [[malignancies]], specifically [[acute myeloid leukemia]] (AML), [[acute lymphoblastic leukemia]] (ALL), [[Chronic myelogenous leukemia|chronic myeloid leukemia]] (CML), and [[chronic lymphocytic leukemia]] (CLL). Each of these conditions has distinct causes and therapies. There is some overlap between the causes and [[Medical laboratory|laboratory]] [[abnormalities]] amongst these [[Disease|diseases]].
 
==Differentiating Acute promyelocytic meukemia from other Diseases==
==Differentiating Acute promyelocytic meukemia from other Diseases==
Acute promyelocytic leukemia can be distinguished from other types of AML based on morphologic examination of a [[bone marrow biopsy]] or aspirate.  Definitive diagnosis requires testing for the ''RARα'' fusion gene. This may be done by [[polymerase chain reaction]] (PCR), [[fluorescent in situ hybridization]] (FISH), or conventional [[cytogenetics]] of peripheral blood or bone marrow.
The following table differentiates acute promyelocytic leukemia from other [[Leukemia|leukemias]] that may present with similar [[clinical]] features such as [[fever]], [[fatigue]], [[weight loss]], recurrent [[infections]] and elevated [[White blood cells|leukocyte]] counts. The following are the differentials:
 


{| class="wikitable"
{| class="wikitable"
!Characteristic
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Characteristic
!Causes
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Causes
!Laboratory abnormalities
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Laboratory abnormalities
!Physical examination
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Physical examination
!Therapy
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Therapy
!Other associations
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other associations
|-
|[[Acute myeloid leukemia|'''Acute myeloid leukemia''']]
|
* [[Chromosomal]] instability
* Sporadic [[mutations]]
* Prior exposure to [[benzene]]
* Prior exposure to alkylating agents
* Prior exposure to [[Topoisomerase II|topoisomerase II inhibitors]]
* [[Germline]] ''[[RUNX1]]'' [[mutation]]
|
* [[Anemia]]
* [[Thrombocytopenia]]
* [[Neutropenia]]
* Elevated [[LDH]]
* Elevated [[uric acid]]
* Elevated [[phosphorus]]
* Elevated [[potassium]]
* Low [[calcium]]
* Greater than 20% [[myeloblasts]] on [[bone marrow]] aspirate<ref name="pmid27895058">{{cite journal| author=Döhner H, Estey E, Grimwade D, Amadori S, Appelbaum FR, Büchner T et al.| title=Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. | journal=Blood | year= 2017 | volume= 129 | issue= 4 | pages= 424-447 | pmid=27895058 | doi=10.1182/blood-2016-08-733196 | pmc=5291965 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27895058  }} </ref>
|
* [[Pyrexia]]
* Evidence of [[infection]]
* [[Pallor]]
* [[Mucosal]] [[bleeding]] (less common than in [[acute promyelocytic leukemia]])
* [[Bruising]] (less common than in [[acute promyelocytic leukemia]])
|
* [[Cytarabine]]
* [[Anthracycline]]
* [[Enasidenib]]
* [[Liposomal]] [[daunorubicin]] plus [[cytarabine]]
* [[Gemtuzumab ozogamicin|Gemtuzumab ozogamycin]]
* [[Midostaurin]]
* [[Enasidenib]]
* Ivosidenib
* [[Stem cell transplant]]
|
* Variable [[prognosis]] based on [[cytogenetic]] and molecular profile
* Five new [[Food and Drug Administration|FDA]]-approved therapies became available in 2017-2018
|-
|-
|Acute promyelocytic leukemia
|[[Acute promyelocytic leukemia|'''Acute promyelocytic leukemia''']]
|
|
* Translocation between chromosomes 15 and 17
* Prior exposure to alkylating agents
* Creation of PML-RAR''alpha''gene product
* Prior exposure to [[topoisomerase II]] inhibitors
* [[Chromosomal translocation|Translocation]] between [[Chromosome 15 (human)|chromosomes 15]] and [[Chromosome 17 (human)|17]]
* Creation of PML-RAR''alpha'' [[gene]] product
* [[Differentiation]] block in [[myeloid cells]]
|
|
* Low [[white blood cell]] count (typically)
* Low [[white blood cell]] count (typically)
Line 24: Line 68:
* [[Thrombocytopenia]]  
* [[Thrombocytopenia]]  
* Low [[fibrinogen]]
* Low [[fibrinogen]]
* Elevated [[prothrombin time]] ([[Prothrombin time|PT]])
* Elevated [[partial thromboplastin time]] ([[Partial thromboplastin time|PTT]])
|
|
* [[Mucosal bleeding]]
* [[Mucosal bleeding]]
* [[Bruising]]
* [[Petechiae]]
* Infections
* [[Ecchymoses]]
* Fatigue
* Evidence of [[infection]]
* [[Pallor]]
* [[Thrombosis]]
|
|
* All-''trans'' retinoic acid (ATRA)
* [[All-trans retinoic acid|All-''trans'' retinoic acid]] ([[ATRA]])
* Arsenic trioxide
* [[Arsenic trioxide]]
* [[Cytarabine]]
* [[Cytarabine]]
* [[Anthracycline]]
* [[Anthracycline]]
|
|
* Presence of Auer rods in promyelocytes
* Presence of [[Auer rods]] in promyelocytes
* High risk for early death from hemorrhagic complications
* High risk for early death from [[hemorrhagic]] [[Complication (medicine)|complications]]<ref name="pmid21993679">{{cite journal| author=McClellan JS, Kohrt HE, Coutre S, Gotlib JR, Majeti R, Alizadeh AA et al.| title=Treatment advances have not improved the early death rate in acute promyelocytic leukemia. | journal=Haematologica | year= 2012 | volume= 97 | issue= 1 | pages= 133-6 | pmid=21993679 | doi=10.3324/haematol.2011.046490 | pmc=3248942 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21993679  }} </ref>
|-
|-
|Acute myeloid leukemia  
|[[Acute lymphoblastic leukemia|'''Acute lymphoblastic leukemia''']]
|
|
* Chromosomal instability
* [[Chromosomal]] instability
* Sporadic mutations
* Sporadic [[mutations]]
|
|
* [[Schistocytes]] on peripheral blood smear
* [[Anemia]]
* Low hemoglobin
* [[Thrombocytopenia]]
* [[Thrombocytopenia]]
* Elevated [[creatinine]]
* [[Neutropenia]]
|
* Bleeding
* Thrombosis
* Pyrexia
* Altered mental status
* Neurologic deficits
* Impaired urine output
|
* Treatment of the underlying cause
* Plasmapheresis if [[thrombotic thrombocytopenia purpura]] is the underlying cause
|
* Can be life-threatening pending the underlying cause
* TTP required immediate treatment
|-
|Paroxysmal cold hemoglobinuria
|
* Production of [[Donath-Landsteiner antibody]], triggered by viral or bacterial infection<ref name="pmid25699184">{{cite journal| author=Akpoguma AO, Carlisle TL, Lentz SR| title=Case report: paroxysmal cold hemoglobinuria presenting during pregnancy. | journal=BMC Hematol | year= 2015 | volume= 15 | issue=  | pages= 3 | pmid=25699184 | doi=10.1186/s12878-015-0023-7 | pmc=4334594 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25699184  }} </ref>
|
* Positive Donath-Landsteiner antibody
* Microscopic hematuria
* Negative Coombs' test for IgG or C3d
* Negative cold agglutinin titer
* Indirect [[hyperbilirubinemia]]
* [[Reticulocytosis]]
* Low [[haptoglobin]]
* Elevated [[LDH]]
* Elevated [[LDH]]
* Elevated [[uric acid]]
* Elevated [[phosphorus]]
* Elevated [[potassium]]
* Low [[calcium]]
* Greater than 20% [[lymphoblasts]] on [[bone marrow]] aspirate
|
|
* [[Hematuria]] in the presence of cold weather
* [[Neurological|Neurologic]] deficits
* [[Jaundice]]
* [[Pallor]]
* [[Lymphadenopathy]]
|
|
* Removal of offending agent
* HyperCVAD ([[cyclophosphamide]], [[vincristine]], [[doxorubicin]], [[dexamethasone]])<ref name="pmid28665419">{{cite journal| author=Terwilliger T, Abdul-Hay M| title=Acute lymphoblastic leukemia: a comprehensive review and 2017 update. | journal=Blood Cancer J | year= 2017 | volume= 7 | issue= 6 | pages= e577 | pmid=28665419 | doi=10.1038/bcj.2017.53 | pmc=5520400 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28665419  }} </ref>
* [[Steroids]]
* R-HyperCVAD (inclusion of [[rituximab]])
* Alternative [[immunosuppression]]
* Peg-asparaginase
* [[Intrathecal]] [[methotrexate]]
* [[Intrathecal]] [[cytarabine]]
* [[Blinatumomab]] (bispecific [[T cell]] engager)
* [[Inotuzumab ozogamicin|Inotuzumab]] ozogamycin (anti-CD22 antibody)
* [[Tisagenlecleucel]] (chimeric antigen receptor T (CAR-T) cell therapy)
* [[Stem cell transplant]]
|
|
* Associated with syphilis<ref name="pmid25699184">{{cite journal| author=Akpoguma AO, Carlisle TL, Lentz SR| title=Case report: paroxysmal cold hemoglobinuria presenting during pregnancy. | journal=BMC Hematol | year= 2015 | volume= 15 | issue=  | pages= 3 | pmid=25699184 | doi=10.1186/s12878-015-0023-7 | pmc=4334594 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25699184  }} </ref>
* Sanctuary sites include the [[central nervous system]] ([[CNS]]) and [[testes]]<ref name="pmid23523389">{{cite journal| author=Inaba H, Greaves M, Mullighan CG| title=Acute lymphoblastic leukaemia. | journal=Lancet | year= 2013 | volume= 381 | issue= 9881 | pages= 1943-55 | pmid=23523389 | doi=10.1016/S0140-6736(12)62187-4 | pmc=3816716 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23523389 }} </ref>
* Maternal IgG can cross the placenta and affect the fetus<ref name="pmid25699184">{{cite journal| author=Akpoguma AO, Carlisle TL, Lentz SR| title=Case report: paroxysmal cold hemoglobinuria presenting during pregnancy. | journal=BMC Hematol | year= 2015 | volume= 15 | issue= | pages= 3 | pmid=25699184 | doi=10.1186/s12878-015-0023-7 | pmc=4334594 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25699184 }} </ref>
|-
|-
|Paroxysmal nocturnal hemoglobinuria
|[[Chronic myelogenous leukemia|'''Chronic myeloid leukemia''']]
|
|
* Genetic defect in anchoring proteins for complement factors on [[red blood cells]]
* [[Translocation]] between [[Chromosome 9 (human)|chromosomes 9]] and [[Chromosome 22|22]]
* Creation of [[Bcr-abl|BCR-Abl]] [[gene]] product
|
|
* Hemolysis due to loss of complement inhibition on the [[red blood cell]] surface, which in turn is due to defect in CD55 (decay accelerating factor) and CD59
* Elevated [[white blood cell]] count
|
* Presence of [[white blood cell]] precursors at various stages of maturation
* Splenomegaly
* Presence of excess metamyelocytes, [[basophils]], [[eosinophils]], and [[band cells]]
* Abdominal tenderness
* Pallor
|
* [[Eculizumab]]
* Immunosuppressive therapy
|
* Associated with [[myelodysplastic syndrome]]
* Associated with mesenteric and portal venous thrombosis
* Risk for progression to [[acute myeloid leukemia]]
|-
|[[Hereditary spherocytosis]]<ref name="pmid24237975">{{cite journal| author=Gallagher PG| title=Abnormalities of the erythrocyte membrane. | journal=Pediatr Clin North Am | year= 2013 | volume= 60 | issue= 6 | pages= 1349-62 | pmid=24237975 | doi=10.1016/j.pcl.2013.09.001 | pmc=4155395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24237975  }} </ref>
|
* Mutation in ankyrin<ref name="pmid24237975">{{cite journal| author=Gallagher PG| title=Abnormalities of the erythrocyte membrane. | journal=Pediatr Clin North Am | year= 2013 | volume= 60 | issue= 6 | pages= 1349-62 | pmid=24237975 | doi=10.1016/j.pcl.2013.09.001 | pmc=4155395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24237975  }} </ref>
* Mutation in alpha- or beta-spectrin<ref name="pmid24237975">{{cite journal| author=Gallagher PG| title=Abnormalities of the erythrocyte membrane. | journal=Pediatr Clin North Am | year= 2013 | volume= 60 | issue= 6 | pages= 1349-62 | pmid=24237975 | doi=10.1016/j.pcl.2013.09.001 | pmc=4155395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24237975  }} </ref>
* Mutation in band 3<ref name="pmid24237975">{{cite journal| author=Gallagher PG| title=Abnormalities of the erythrocyte membrane. | journal=Pediatr Clin North Am | year= 2013 | volume= 60 | issue= 6 | pages= 1349-62 | pmid=24237975 | doi=10.1016/j.pcl.2013.09.001 | pmc=4155395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24237975  }} </ref>
* Mutation in protein 4.2<ref name="pmid24237975">{{cite journal| author=Gallagher PG| title=Abnormalities of the erythrocyte membrane. | journal=Pediatr Clin North Am | year= 2013 | volume= 60 | issue= 6 | pages= 1349-62 | pmid=24237975 | doi=10.1016/j.pcl.2013.09.001 | pmc=4155395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24237975  }} </ref>
|
* Positive eosin-5-maleimide binding to [[red blood cells]]<ref name="pmid24237975">{{cite journal| author=Gallagher PG| title=Abnormalities of the erythrocyte membrane. | journal=Pediatr Clin North Am | year= 2013 | volume= 60 | issue= 6 | pages= 1349-62 | pmid=24237975 | doi=10.1016/j.pcl.2013.09.001 | pmc=4155395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24237975  }} </ref>
* Positive osmotic fragility testing<ref name="pmid24237975">{{cite journal| author=Gallagher PG| title=Abnormalities of the erythrocyte membrane. | journal=Pediatr Clin North Am | year= 2013 | volume= 60 | issue= 6 | pages= 1349-62 | pmid=24237975 | doi=10.1016/j.pcl.2013.09.001 | pmc=4155395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24237975  }} </ref>
* Spherocytes on peripheral blood smear
|
|
* [[Splenomegaly]]
* [[Abdominal tenderness]]
* [[Pallor]]
* [[Pallor]]
* [[Jaundice]]
* Evidence of [[infection]]
* [[Splenomegaly]]
|
|
* Removal of offending [[medication]]
* [[Imatinib]]
* High-dose [[vitamin B6]] (up to 200mg daily)
* [[Nilotinib]]
* Avoidance of [[splenectomy]]
* [[Dasatinib]]
* Symptomatic [[Blood transfusion|transfusion]] support with [[iron]] [[chelation]] as needed
* [[Bosutinib]]
* [[Ponatinib]]
* [[Omacetaxine]]<ref name="pmid24516334">{{cite journal| author=Chen Y, Li S| title=Omacetaxine mepesuccinate in the treatment of intractable chronic myeloid leukemia. | journal=Onco Targets Ther | year= 2014 | volume= 7 | issue=  | pages= 177-86 | pmid=24516334 | doi=10.2147/OTT.S41786 | pmc=3916637 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24516334  }} </ref>
|
|
* Can be autosomal dominant or recessive
* High response rate to [[tyrosine kinase inhibitors]]
* Risk for development of T315I [[kinase]] domain [[mutation]]
* Typically does not require [[stem cell transplant]]
* Three phases include chronic, accelerated, and blast phase
|-
|-
|[[Pernicious anemia]]<ref name="pmid27602354">{{cite journal| author=Chan CQ, Low LL, Lee KH| title=Oral Vitamin B12 Replacement for the Treatment of Pernicious Anemia. | journal=Front Med (Lausanne) | year= 2016 | volume= 3 | issue=  | pages= 38 | pmid=27602354 | doi=10.3389/fmed.2016.00038 | pmc=4993789 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27602354  }} </ref>
|
* Autoimmune gastritis<ref name="pmid27602354">{{cite journal| author=Chan CQ, Low LL, Lee KH| title=Oral Vitamin B12 Replacement for the Treatment of Pernicious Anemia. | journal=Front Med (Lausanne) | year= 2016 | volume= 3 | issue=  | pages= 38 | pmid=27602354 | doi=10.3389/fmed.2016.00038 | pmc=4993789 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27602354  }} </ref>
* Production of anti-intrinsic factor antibodies<ref name="pmid27602354">{{cite journal| author=Chan CQ, Low LL, Lee KH| title=Oral Vitamin B12 Replacement for the Treatment of Pernicious Anemia. | journal=Front Med (Lausanne) | year= 2016 | volume= 3 | issue=  | pages= 38 | pmid=27602354 | doi=10.3389/fmed.2016.00038 | pmc=4993789 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27602354  }} </ref>
* Production of anti-parietal cell antibodies<ref name="pmid27602354">{{cite journal| author=Chan CQ, Low LL, Lee KH| title=Oral Vitamin B12 Replacement for the Treatment of Pernicious Anemia. | journal=Front Med (Lausanne) | year= 2016 | volume= 3 | issue=  | pages= 38 | pmid=27602354 | doi=10.3389/fmed.2016.00038 | pmc=4993789 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27602354  }} </ref>
|
* Low vitamin B12 level
* Presence of anti-intrinsic factor antibodies
* Presence of anti-parietal cell antibodies
|
* Gastrointestinal discomfort
* [[Weakness]]
* [[Tingling]]
* [[Paresthesias]]
|
* Lifelong [[vitamin B12]] therapy (1000mcg daily)<ref name="pmid27602354">{{cite journal| author=Chan CQ, Low LL, Lee KH| title=Oral Vitamin B12 Replacement for the Treatment of Pernicious Anemia. | journal=Front Med (Lausanne) | year= 2016 | volume= 3 | issue=  | pages= 38 | pmid=27602354 | doi=10.3389/fmed.2016.00038 | pmc=4993789 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27602354  }} </ref>
|
* Associated with diabetes, thyroid disease, vitiligo and other autoimmune conditions
|-
|-
|[[Chronic lymphocytic leukemia]]<ref name="pmid28102226">{{cite journal| author=Kipps TJ, Stevenson FK, Wu CJ, Croce CM, Packham G, Wierda WG et al.| title=Chronic lymphocytic leukaemia. | journal=Nat Rev Dis Primers | year= 2017 | volume= 3 | issue=  | pages= 16096 | pmid=28102226 | doi=10.1038/nrdp.2016.96 | pmc=5336551 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28102226  }} </ref>
|[[Chronic lymphocytic leukemia|'''Chronic lymphocytic leukemia''']]<ref name="pmid28102226">{{cite journal| author=Kipps TJ, Stevenson FK, Wu CJ, Croce CM, Packham G, Wierda WG et al.| title=Chronic lymphocytic leukaemia. | journal=Nat Rev Dis Primers | year= 2017 | volume= 3 | issue=  | pages= 16096 | pmid=28102226 | doi=10.1038/nrdp.2016.96 | pmc=5336551 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28102226  }} </ref>
|
|
* Mutations in hematopoietic stem cells and B lymphocytes
* Chromosomal instability
* Sporadic [[mutations]]
* [[Infections]]
|
|
* Elevated absolute lymphocyte count
* Elevated absolute [[lymphocyte]] count (in all stages)
* Anemia (Rai stage III) and thrombocytopenia (Rai stage IV)
* Presence of >5000 clonal [[B cells]] per microliter in peripheral blood
* Anemia (in Rai stage III)
* [[Thrombocytopenia]] (in Rai stage IV)
|
|
* [[Lymph node enlargement]]
* [[Lymph node enlargement]] in Rai stage I
* [[Splenomegaly]] in Rai stage II
* [[Splenomegaly]] in Rai stage II
* [[Hepatomegaly]] in Rai stage II
* [[Hepatomegaly]] in Rai stage II
Line 155: Line 161:
* [[Bleeding]]
* [[Bleeding]]
|
|
* Chemotherapy with rituximab
* Fludarabine
* Cyclophosphamide
* Rituximab
* Obinutuzumab<ref name="pmid28182141">{{cite journal| author=Al-Sawaf O, Fischer K, Engelke A, Pflug N, Hallek M, Goede V| title=Obinutuzumab in chronic lymphocytic leukemia: design, development and place in therapy. | journal=Drug Des Devel Ther | year= 2017 | volume= 11 | issue=  | pages= 295-304 | pmid=28182141 | doi=10.2147/DDDT.S104869 | pmc=5279834 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28182141  }} </ref>
* Ofatumumab
* Ibrutinib
* Ibrutinib
* Venetoclax
* Venetoclax
|
|
* Secondary autoimmune hemolytic anemia occurs in 10-25% of patients with CLL
* Associated with [[autoimmune hemolytic anemia]], which occurs in 10-25% of patients with CLL
* Treatment with corticosteroids or anti-leukemic therapy will correct the underlying anemia
* Associated with [[immune thrombocytopenia purpura]]
* Associated with [[pure red cell aplasia]]
* Treatment with [[corticosteroids]] or anti-leukemic therapy will correct the autoimmune complications of CLL
|}
|}


==References==
==References==

Latest revision as of 16:15, 8 April 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2] Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [3]; Grammar Reviewer: Natalie Harpenau, B.S.[4]

Overview

The differential diagnosis of acute promyelocytic leukemia includes a variety of other hematologic malignancies, specifically acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML), and chronic lymphocytic leukemia (CLL). Each of these conditions has distinct causes and therapies. There is some overlap between the causes and laboratory abnormalities amongst these diseases.

Differentiating Acute promyelocytic meukemia from other Diseases

The following table differentiates acute promyelocytic leukemia from other leukemias that may present with similar clinical features such as fever, fatigue, weight loss, recurrent infections and elevated leukocyte counts. The following are the differentials:

Characteristic Causes Laboratory abnormalities Physical examination Therapy Other associations
Acute myeloid leukemia
  • Variable prognosis based on cytogenetic and molecular profile
  • Five new FDA-approved therapies became available in 2017-2018
Acute promyelocytic leukemia
Acute lymphoblastic leukemia
Chronic myeloid leukemia
Chronic lymphocytic leukemia[6]
  • Elevated absolute lymphocyte count (in all stages)
  • Presence of >5000 clonal B cells per microliter in peripheral blood
  • Anemia (in Rai stage III)
  • Thrombocytopenia (in Rai stage IV)
  • Fludarabine
  • Cyclophosphamide
  • Rituximab
  • Obinutuzumab[7]
  • Ofatumumab
  • Ibrutinib
  • Venetoclax

References

  1. ↑ Döhner H, Estey E, Grimwade D, Amadori S, Appelbaum FR, Büchner T; et al. (2017). "Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel". Blood. 129 (4): 424–447. doi:10.1182/blood-2016-08-733196. PMC 5291965. PMID 27895058.
  2. ↑ McClellan JS, Kohrt HE, Coutre S, Gotlib JR, Majeti R, Alizadeh AA; et al. (2012). "Treatment advances have not improved the early death rate in acute promyelocytic leukemia". Haematologica. 97 (1): 133–6. doi:10.3324/haematol.2011.046490. PMC 3248942. PMID 21993679.
  3. ↑ Terwilliger T, Abdul-Hay M (2017). "Acute lymphoblastic leukemia: a comprehensive review and 2017 update". Blood Cancer J. 7 (6): e577. doi:10.1038/bcj.2017.53. PMC 5520400. PMID 28665419.
  4. ↑ Inaba H, Greaves M, Mullighan CG (2013). "Acute lymphoblastic leukaemia". Lancet. 381 (9881): 1943–55. doi:10.1016/S0140-6736(12)62187-4. PMC 3816716. PMID 23523389.
  5. ↑ Chen Y, Li S (2014). "Omacetaxine mepesuccinate in the treatment of intractable chronic myeloid leukemia". Onco Targets Ther. 7: 177–86. doi:10.2147/OTT.S41786. PMC 3916637. PMID 24516334.
  6. ↑ Kipps TJ, Stevenson FK, Wu CJ, Croce CM, Packham G, Wierda WG; et al. (2017). "Chronic lymphocytic leukaemia". Nat Rev Dis Primers. 3: 16096. doi:10.1038/nrdp.2016.96. PMC 5336551. PMID 28102226.
  7. ↑ Al-Sawaf O, Fischer K, Engelke A, Pflug N, Hallek M, Goede V (2017). "Obinutuzumab in chronic lymphocytic leukemia: design, development and place in therapy". Drug Des Devel Ther. 11: 295–304. doi:10.2147/DDDT.S104869. PMC 5279834. PMID 28182141.

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