leukemia [autosaved] 1

8/19/2019 Leukemia [Autosaved] 1

1/23

“LEUKEMIA”

dr. Meddy Setiawan, SpPD

FAKULTAS KEDOKTERAN UNIVERSITAS MUHAMMADIYAH MALAN

1


2/23

What Is Leukemia?

• Cancer of the white blood cells

• Acute or Chronic

• Aects abilit! to "roduce normalblood cells

• #one marrow makes abnormall!

lar$e number of immature whiteblood cells called blasts

2


3/23

Classi%cation of leukemias

Acute Chronic

Myeloidorigin

Lymphoidorigin

Acute Myeloid

Leukemia (AML)

Acute Lymphoblastic

Leukemia (ALL)

Chronic Myeloid Leukemia

(CML)

Chronic Lymphocytic Leukemia

(CLL)

3


4/23

&emato"oiesis

PLURIPOTENT

STEM CELL

COMMITTED

PROGENITOR

CELL

RECOGNIZABLE

BONE MARROW

PRECURSOR CELL

MATURE

BLOOD

CELL

myeloblast

monoblast

pronormoblast re !ellne"trop#$l

mono!yte

basop#$l

platelet

C%U&Baso

C%U&Eos

C%U&GMB%U&E'C%U&E

eos$nop#$l

pre&T

pre&B

myelo$

pro(en$tor

!ell

lymp#o$

pro(en$tor!ell

lymp#oblast

lymp#oblast

T&!ell

B&!ell) plasma !ell

MI*ED

PROGENITOR

CELL

C%U&Me( me(a+aryo!yte

pl"r$potent

stem !ell

4


5/23

M!eloid maturation

myeloblast promyelocyte myelocyte metamyelocyte band neutrophil

MATURATIONMATURATION

Adapted and modified from U Va website

5


6/23

Acute Leukemia

• accumulation of blasts in the marrow

6


7/23

&ow to distin$uish AML 's CMLfrom lookin$ at "eri"heral

bloodMyeloid cell CML AML normal

blasts ( (

"rom!eloc!tes (

m!eloc!tes (

metam!eloc!tes (

bands (

neutro"hils ( (7


8/23

Classi%cation of acuteleukemias

ALL• mainl! children

•M ) *• curable in +,- ofchildren

• curable in minorit!

of adults

AML• mainl! adults

•M ) *

• curable in minorit!of adults

8


9/23

Clinical manifestations

• s!m"toms due to.

marrow failure

tissue in%ltration

leukostasis

constitutional s!m"toms

• usuall! short duration of s!m"toms

9


10/23

Marrow failure

• /eutro"enia . infections0 se"sis

• Anemia . fati$ue0 "allor

• 1hromboc!to"enia . bleedin$

10


11/23

In%ltration of tissues2or$ans

• Enlar$ement of li'er0 s"leen0 l!m"hnodes

• 3um h!"ertro"h!

• #one "ain

• 4ther or$ans. C/50 skin0 testis0 an!or$an

11


12/23

3um h!"ertro"h!

12


13/23

Leukostasis

• Accumulation of blasts inmicrocirculation with im"aired"erfusion

• Lun$s. h!"o6emia0 "ulmonar!in%ltrates

• C/5. stroke

• 4nl! seen with W#C )) 7, 6 8,92L

13


14/23

Causes of acute leukemias

• Idio"athic :most;

• Underl!in$ hematolo$ic disorders

• Chemicals0 dru$s•


15/23

Constitutional s!m"toms

• *e'er and sweats common

• Wei$ht loss less common

15


16/23

Laborator! features

• W#C usuall! ele'ated0 but can benormal or low

• #lasts in "eri"heral blood

• /ormoc!tic anemia

• 1hromboc!to"enia

16


17/23

#one marrow in acute

leukemia• /ecessar! for dia$nosis

• Useful for determinin$ t!"e

• Useful for "ro$nosis

• Acute leukemias are de%ned b! the"resence of ) >,- blasts in bonemarrow :- of nucleated marrowcells;

17


18/23

istin$uishin$ AML from ALL

• Li$ht microsco"!

AML. Auer rods0 c!to"lasmic $ranules

ALL. no Auer rods or $ranules@• 5"ecial stains :c!tochemistr!;

• *low c!tometr!

18


19/23

AML

19


20/23

ALL

20


21/23

Auer rods in AML

21


22/23

1reatment of acuteleukemias

• Choice of


23/23

Brinci"les of treatment

• Combination chemothera"!

%rst $oal is com"lete remission

further

leukemia [autosaved] 1

Documents