Leukemia CA

8/11/2019 Leukemia CA

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white blood A neoplastic proliferation of one particular

cell type

Defect originates in the hematopoieticstem cell, the myeloid, or the lymphoid

stem cell.

Common feature: unregulated proliferationof leukocytes in the bone marrow.


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Classification

Stem cell involved

Lymphoid

Myeloid Based on time it takes for symptoms to

evolve

- Acute- Chronic


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Acute Myeloid Leukemia (AML)

Results from a defect in the hematopoietic stem

cell that differentiates into all myeloid cells

All age groups are affected

Incidence rises with age; 65 y.o

Most common non-lymphocytic leukemia


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Clinical Manifestations

Fever

Infection

Weakness Fatigue from anemia

Bleeding tendencies from

thrombocytopenia Pain from an enlarged liver or spleen

Hyperplasia of the gums

Bone pain from expansion of marrow


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Assessment and Diagnostic

Findings

CBC, erythrocytes and

platelets

Leukocyte: varies

Normal cells is usually decreased

Bone Marrow Analysis: Excess ofimmature blast cells, more than

30 percent


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Medical Management

Objective of treatment is to achieve

complete remission

Induction therapy

High doses of cytarabine and daunorubicin

Or mitoxantrone or idarubicin

Supportive therapies

Use of granulocytic growth factors: G-CSF

or GM CSF


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Cx of Txtumor lysis syndrome:( )

Uric acid

Potassium

phosphate

Anorexia, N & V , diarrhea,

severe mucositis

serious infection and increasedrisk of bleeding


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Chronic Myeloid Leukemia

Arises from a mutation in the

myeloid stem cell.

9095 %percent of patients, asection of DNA is missing from

chromosome 22.

Uncommon in people younger than

20 years old

Incidence increases with age,

median age 55-to 65

Life ex ectanc 3 to 5 ears


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Asymptomatic

Leukocytosis is detected by a CBC

personnel for other reason

Leukocyte exceeds: 100 000/mm3

SOB or slightly confused from leukostasis

Enlarge, tender spleen Malaise, anorexia, weight loss


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Medical Mgt

Oral formulation of tyrosine

kinase inhibitors, imatinib Interferon-alfa , Roferon A and

cystosine, often in combination

Oral chemo drugs:, hydroxyureaor busulfan

Leukaphereis, BMT, PBSCT

Induction therapy


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WBC, RBC,

platelets

enlarged liver orspleen

bone painheadache

vomiting


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Medical Management

Expected outcome is complete

remission

Costeriods and vinca alkaloids

Prophylaxis with cranial irradiation or

intrathelal chemotx

Imatinib Alemtuzumab

BMT or PBSCT


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Chronic Lymphocytic Leukemia

A common malignancy of older adults,

older than 60 y.o

Survival ranges from 14 years (to 2 years

More often in males

Survival shorter in males


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Pathophysiology


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Asymptomatic, diagnosed incidentally

Increased lymphocyte count

Erythrocytes and platelets may be

normal;or decreased in late stages

Lymphadenopathy

B symptoms

Fevers Sweats

Unintentional weight loss


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Medical Management


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Leukemia CA

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