Haematological malignancies are best understood by lineage (myeloid vs lymphoid) and tempo (acute vs chronic). This dual framework is essential for exams and clinical reasoning. Both groups represent uncontrolled clonal proliferation, but differ in cell lineage, pathophysiology, clinical presentation, and prognosis.

🧬 Acute vs Chronic Myeloid & Lymphoid Disorders

Type	Acute 🔥 (rapid onset, aggressive)	Chronic 🕐 (slower course, indolent or progressive)
Myeloid Lineage 🧬	Acute Myeloid Leukaemia (AML) Acute Promyelocytic Leukaemia (APML, M3) → ATRA responsive	Chronic Myeloid Leukaemia (CML, BCR-ABL fusion) Polycythaemia Vera (PV) Essential Thrombocythaemia (ET) Primary Myelofibrosis (PMF)
Lymphoid Lineage 🧪	Acute Lymphoblastic Leukaemia (ALL, esp. children) T-cell ALL (mediastinal mass, SVC obstruction) B-cell ALL (most common in paediatrics)	Chronic Lymphocytic Leukaemia (CLL) Hodgkin’s Lymphoma Non-Hodgkin’s Lymphoma (NHL) Post-Transplant Lymphoproliferative Disorder (PTLD)

🔬 Myeloproliferative vs Lymphoproliferative Disorders

Feature	Myeloproliferative Disorders (MPDs) 🧬	Lymphoproliferative Disorders (LPDs) 🧪
Cell line affected	Myeloid stem cells → ↑ granulocytes, platelets, RBCs	Lymphoid lineage → ↑ B-cells, T-cells, NK cells
Driver mutations	BCR-ABL (CML), JAK2 (PV, ET, MF), CALR, MPL	Genetic lesions affecting apoptosis (e.g., TP53, BCL2); viral triggers (EBV, HTLV-1, HIV)
Clinical features	Splenomegaly, thrombosis, bleeding, constitutional symptoms, risk of AML transformation	Painless lymphadenopathy, B symptoms (fever, night sweats, weight loss), cytopenias from marrow infiltration
Investigations	FBC: raised counts, bone marrow biopsy (hypercellular), mutation testing	FBC: lymphocytosis or cytopenias, excisional node biopsy, flow cytometry, staging CT/PET
Management	Imatinib (CML), JAK inhibitors, hydroxycarbamide, phlebotomy (PV), stem cell transplant in selected	Watch-and-wait (indolent), chemo-immunotherapy (R-CHOP, ABVD), rituximab, stem cell transplant if refractory
Prognosis	Chronic course with risk of AML transformation; survival improved with TKIs	Variable: Hodgkin’s lymphoma curable in >80%; CLL/NHL often indolent but incurable

🧑‍⚕️ Case Examples (6)

Case 1 (AML): 🔥 A 52-year-old man presents with fatigue, recurrent infections, and gum hypertrophy. FBC shows pancytopenia with circulating blasts. Diagnosis: Acute Myeloid Leukaemia. He receives induction chemotherapy and is considered for stem cell transplant.
Case 2 (ALL): 👶 A 6-year-old boy presents with fever, pallor, bruising, and hepatosplenomegaly. Peripheral smear shows lymphoblasts. Diagnosis: Acute Lymphoblastic Leukaemia. He starts combination chemotherapy and CNS prophylaxis, with good prognosis.
Case 3 (CML): 🧬 A 45-year-old man with night sweats and massive splenomegaly has a WCC of 150 × 10⁹/L. Cytogenetics reveal the Philadelphia chromosome (BCR-ABL). Diagnosis: Chronic Myeloid Leukaemia. He responds well to imatinib.
Case 4 (CLL): 🧪 A 72-year-old woman with fatigue and painless cervical lymphadenopathy has marked lymphocytosis on FBC. Flow cytometry confirms clonal B-cell population. Diagnosis: Chronic Lymphocytic Leukaemia. Managed initially with “watch and wait” until symptomatic.
Case 5 (Polycythaemia Vera): 🩸 A 60-year-old man presents with headache, pruritus after hot baths, and ruddy complexion. Hb = 21 g/dL, JAK2 V617F mutation positive. Diagnosis: Polycythaemia Vera. Managed with venesection, aspirin, and cytoreduction.
Case 6 (Hodgkin’s Lymphoma): 🎗️ A 28-year-old man has painless cervical lymphadenopathy and night sweats. Node biopsy shows Reed–Sternberg cells. Diagnosis: Classical Hodgkin’s Lymphoma. Treated with ABVD chemotherapy with curative intent.

💡 Management Principles

Control blood counts to reduce thrombosis/bleeding risk.
Target driver mutations (TKIs for BCR-ABL, JAK inhibitors).
Reduce cardiovascular risk factors (🚭 smoking cessation, BP, lipids).
Chemo-immunotherapy for lymphoproliferative disorders (e.g., R-CHOP, ABVD).
🩹 Allogeneic stem cell transplantation remains the only curative option in advanced/refractory disease.

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Myeloproliferative vs Lymphoproliferative Disorders

🧬 Acute vs Chronic Myeloid & Lymphoid Disorders

🔬 Myeloproliferative vs Lymphoproliferative Disorders

🧑‍⚕️ Case Examples (6)

💡 Management Principles

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