Leukemia Department of Hematology, the First Affiliated Hospital ,Sun Yat-Sen University Zhenhai Zhou
Leukemia
Department of Hematology,
the First Affiliated Hospital ,Sun Yat-Sen University Zhenhai Zhou
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
Incidence 2.76/100,00 in China More acute leukemia
Etiology ---heredity ---Radiation ---Chemical and other exposures ---Drugs ---virus
Acute Leukemiaclassification
FAB
--- Acute myeloid leukemia(AML)
M0-M7
---Acute lymphoblastic leukemia(ALL)
L1,L2,L3
WHO
MICM
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)
CT-fungi infection
CT
Laboraory findings
Blood test : WBC ↑, Hb ↓ , PLT ↓
Bone marrow-morphology
Hypercellular
Cytochemical reactions: POX(aml)PAS(all)
NAE(aml)
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…
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
FISH
Differential diagnosis
Myelodysplastic syndrome(MDS)
Myeloproliferative disorders
Chronic myelogenous leukemia
treatment
Supporting treatment
Antimicrobial therapy
Blood transfusion
Hyperleucocytosis therapy
Tumor lysis therapy
oral allopurinol
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
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
Prognosis
Adverse prognostic factors : unfavorable
karyotype, age,high WBC,secondary AML…
Chronic myelogenous
Incidence
Clinical features
---chronic phase: fatigue, night sweats,
low-grade fever
splenomegaly,
leukostasis
---accelerated phrase
---blast phase
Laboratory findings
Blood
---WBC Moderate-marked
increase ,basophils,eosinophils
---anemia , PLT
---<5%blast,<10%blast and promyelocytes
Bone marrow
---hypercellular, granulocytic
Cytogenetic findings
Philadephia chromosome
t(9,22)(9q,22q) Bcr/abl
Treatment
Leukophoresis
Hydroxyurea
---hematologic remissiom
Interferon-α
Imatinb Mesylate
Stem cell transplantation
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.
Thank You !