acute leukemia.ppt

8/14/2019 acute leukemia.ppt

1/16


2/16

Essentials of Diagnosis

Short duration of symptoms, including

fatigue, fever, and bleeding.

Cytopenias or pancytopenia.

More than 20% blasts in the bone marrow.

Blasts in peripheral blood in 0% of

patients.

Classify as acute myeloid leu!emia "#M$or acute lymphoblastic leu!emia "#$$.


3/16

General Considerations

#cute leu!emia is a hematopoieticprogenitor cell malignancy.

&ncontrolled proliferation cells and replace

normal bone marrow elements. #rise with no clear cause. 'owever,

radiation and some to(ins "ben)ene areleu!emogenic. # number of

chemotherapeutic agents "especiallycyclophosphamide, melphalan, otheral!ylating agents, and etoposide maycause leu!emia.


4/16


Most of the clinical findings in acute

leu!emia are due to replacement of

normal bone marrow elements by the

malignant cell. $ess common manifestations result from

organ infiltration "s!in, gastrointestinal

tract, meninges. #cute leu!emia is potentially curable

with combination chemotherapy.


5/16


#$$ comprises *0% of the acute leu!emias

of childhood. +he pea! incidence is

between and - years of age. t is also

seen in adults, causing appro(imately 20%of adult acute leu!emias.

#cute myeloid leu!emia "#M$ is primarily

an adult disease with a median age


6/16

Symptoms and Signs

Bleeding "usually due to thrombocytopenia /

S!in

Mucosal surfaces

inggival bleeding

1pista(is

Menorrhagia

$ess commonly, widespread bleeding isseen in patients with disseminated

intravascular coagulation "C.


7/16

Symptoms and Signs

nfection is due to neutropenia "falls below

3004mc$. +he most common pathogens

are gram5negative bacteria (Escherichia

coli, Klebsiella, Pseudomonas or fungi"Candida, Aspergillus. Common

presentations include cellulitis, pneumonia,

and perirectal infections6 death within a few

hours may occur if treatment withappropriate antibiotics is delayed.


8/16

Symptoms and Signs

7atients may also see! medical attention / um hypertrophy Bone and 8oint pain

+he most dramatic presentation ishyperleu!ocytosis, in which a mar!edlyelevated circulating blast count "usually 9200,0004mc$ leads to impaired circulation /

'eadache Confusion yspnea


9/16

Laboratory Findings

+he hallmar! of acute leu!emia is the

combination of pancytopenia with

circulating blasts

'owever, blasts may be absent from theperipheral smear in as many as :0% of

cases ";aleu!emic leu!emia;.

+he bone marrow is usually hypercellular

and dominated by blasts. More than 20%

blasts are re


10/16

Laboratory Findings

'yperuricemia may be seen. f C is present / +he fibrinogen level will be reduced +he prothrombin time prolonged =ibrin degradation products or fibrin 5dimers present.

7atients with #$$ "especially + cell may have amediastinal mass visible on chest radiograph.Meningeal leu!emia will have blasts present in thespinal fluid, seen in appro(imately 3% of cases atdiagnosis6 it is more common in monocytic types of#M$.

+he #uer rod, an eosinophilic needle5li!e inclusion inthe cytoplasm, is pathognomonic of #M$


11/16

Laboratory Findings

#M$ classification by ;=#B,; "=rench,#merican, British was based of morphologyand histochemistry /

#cute undifferentiated leu!emia "M0

#cute myeloblastic leu!emia "M: #cute myeloblastic leu!emia withdifferentiation "M2

#cute promyelocytic leu!emia "#7$ "M #cute myelomonocytic leu!emia "M> #cute monoblastic leu!emia "M3 1rythroleu!emia "M? Mega!aryoblastic leu!emia "M-


12/16

Differential Diagnosis

#M$ must be distinguished from othermyeloproliferative disorders /

Chronic myeloid leu!emia Myelodysplastic syndromes.

#$$ must be separated from otherlymphoproliferative disease such as /

Chronic lymphocytic leu!emia $ymphomas

'airy cell leu!emia. #typical lymphocytosis of mononucleosis and

pertussis.


13/16

Treatment

+he first step in treatment is to obtain

complete remission /

normal peripheral blood with resolution of

cytopenias normal bone marrow with no e(cess blasts

normal clinical status.

+he type of initial chemotherapy dependson the subtype of leu!emia.


14/16

AML

#M$ are treated with a combination / anthracycline "daunorubicin or idarubicin plus cytarabine, either alone or in combination with other

agents.

+his therapy will produce complete remission in *0%of patients under age ?0 years and in 30@?0% ofolder patients.

#7$ is treated differently from other forms of #M$.nduction therapy should include anthracycline plusall5trans5retinoic acid.

Aith this approach 0@3% of patients will achievecomplete remission.


15/16

ALL

#dults with #$$ are treated / aunorubicin incristine

7rednisone #sparaginase +his treatment produces complete

remissions in 0% of patients.

emission induction therapy for #$$ is lessmyelosuppressive than treatment for #M$and does not necessarily produce marrowaplasia


16/16

Prognosis

#ppro(imately -0@*0% of adults with #M$ under age ?0years achieve complete remission. 'igh5dose postremission chemotherapy leads to cure in

3@>0% of these patients, and high5dose cytarabine hasbeen shown to be superior to therapy with lower doses.

#llogeneic bone marrow transplantation is curative in 30@

?0% of cases. #utologous bone marrow transplantation may be superior

to nonablative chemotherapy. Dlder adults with #M$ achieve complete remission in up

to 30% of instances.

+he cure rates for older patients with #M$ have been verylow "appro(imately :0@:3% even if they achieveremission and are able to receive postremissionchemotherapy.

acute leukemia.ppt

Documents