Foreign students acute leukemia-zhou
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Leukemia
Department of Hematology,
the First Affiliated Hospital ,Sun Yat-Sen University Zhenhai Zhou
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Overview
A heterogeneous group of hematopoietic malignancies characterized by infiltration of the blood ,bone marrow,and other tissue by leukemic cells which exhibit differentiation and apoptosis arrest in any stage of maturation.
Classification: acute chronic lymphoblastic myloid
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Incidence 2.76/100,00 in China More acute leukemia
Etiology ---heredity ---Radiation ---Chemical and other exposures ---Drugs ---virus
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Acute Leukemiaclassification
FAB
--- Acute myeloid leukemia(AML)
M0-M7
---Acute lymphoblastic leukemia(ALL)
L1,L2,L3
WHO
MICM
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Clinical feature
Decreased production of normal
hematopoietic
---anemia:pale,tired
---bleeding: PLT, blood vessel wall, DIC
acute promyelocytic leukemia
---fever: infection ,or?
Leukemic cells infiltration
---Lymph node, liver spleen , Sternum…
---central nervous system (CNSL)
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CT-fungi infection
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CT
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Laboraory findings
Blood test : WBC ↑, Hb ↓ , PLT ↓
Bone marrow-morphology
Hypercellular
Cytochemical reactions: POX(aml)PAS(all)
NAE(aml)
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Immunophenotypic analysis
Flow cytometrry-antigen CD
---Myeloid lineage
MPO,CD117 ,CD33,CD13,CD14,CD15
---Lymphoblastic lineage
B:CD79a,CD19,CD20,CD22…
T:CD7,CD3,CD5…
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Cytogenetics : Chromosome abnormality
Molecular genetics:
---t(8,21) (q22;q22) AML1-ETO,M2
---t(15,17) (q22;q21) PML-RARa M3t() t()
Low risk, high risk
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FISH
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Differential diagnosis
Myelodysplastic syndrome(MDS)
Myeloproliferative disorders
Chronic myelogenous leukemia
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treatment
Supporting treatment
Antimicrobial therapy
Blood transfusion
Hyperleucocytosis therapy
Tumor lysis therapy
oral allopurinol
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Antileukemic treatment
Treatment strategy --Complete
remission(disapperance of all sign of cancer)
Treatment for ALL
---Induction : DVLP(DNR,VCR,L-ASP,Prednisone)
---Postremission therapy :Consolidation and
maintain chemotherapy; Allogenetic BMT
CNS prophylasis :high dose systemic therapy
iintrathecal drug
Relapsed ALL therapy
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Treatment for AML
---Induction : DA(DNR,Ara-c)
---APL:ATRA(all trans-renotic acid),arsenic
trioxide
---Postremission therapy :Consolidation
and maintain chemotherapy; Allogenetic
BMT
Relapsed AML therapy
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Prognosis
Adverse prognostic factors : unfavorable
karyotype, age,high WBC,secondary AML…
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Chronic myelogenous
Incidence
Clinical features
---chronic phase: fatigue, night sweats,
low-grade fever
splenomegaly,
leukostasis
---accelerated phrase
---blast phase
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Laboratory findings
Blood
---WBC Moderate-marked
increase ,basophils,eosinophils
---anemia , PLT
---<5%blast,<10%blast and promyelocytes
Bone marrow
---hypercellular, granulocytic
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Cytogenetic findings
Philadephia chromosome
t(9,22)(9q,22q) Bcr/abl
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Treatment
Leukophoresis
Hydroxyurea
---hematologic remissiom
Interferon-α
Imatinb Mesylate
Stem cell transplantation
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Chronic lymphocytic leukemia
Clinical features
Laboratory findings
The majority of patients with stage A
have no symptoms and may be
observed for a while to determine
treatment.
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Thank You !