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 !