2. Leukemia
A group of malignant disorders affecting
the blood and blood-forming tissues of
Bone marrow
Lymph system
Spleen
Occurs in all age groups
2
3. Leukemia
Results in an accumulation of dysfunctional
cells because of a loss of regulation in cell
division
Fatal if untreated
Progressive
3
4. They can be classified as acute or chronic based on
the rapidity of proliferation and myeloid or lymphoid
based on the cell of origin.
Predominant subtypes are acute myeloid leukemia
(AML) and chronic myeloid leukemia (CML), involving
the myeloid lineage;
acute lymphoblastic leukemia (ALL); and chronic
lymphocytic leukemia (CLL), involving the lymphoid
chain.
Other less common variants, such as mature B-cell
and T-cell leukemias, and NK cell-related leukemias,
to name a few, arise from mature white blood cells
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9. Many genetic risk factors have been
identified, such as Klinefelter and Down
syndromes, ataxia telangiectasia, Bloom
syndrome,
Viral infections associated with Epstein
Barr virus, human T-lymphotropic virus,
ionizing radiation exposure, radiation
therapy, environmental exposure with
benzene, smoking history, history of
chemotherapy with alkylating agents, and
topoisomerase II agents have also been
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13. Classification of leukemias
Two major types (4 subtypes) of leukemias
Acute leukemias
Acute lymphoblastic leukemia (ALL)
Acute myelogenous leukemia (AML)
(also "myeloid" or "nonlymphocytic")
Chronic leukemias
Chronic lymphocytic leukemia (CLL)
Chronic myeloid leukemia (CML)
(Within these main categories, there are typically
several subcategories)
15. Leukemia
Classification
Acute versus chronic
Cell maturity
Acute: clonal proliferation of immature hematopoietic cells (the
formation of blood or blood cells )
Chronic: mature forms of WBC; onset is more gradual Nature of
disease onset
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16. Myelogenous Leukemia
Leukemia characterized by proliferation of
myeloid tissue (as of the bone marrow and
spleen) and an abnormal increase in the
number of granulocytes, myelocytes, and
myeloblasts in the circulating blood
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17. Myeloid tissue is a biologic tissue with the
ability to perform hematopoiesis. It is mainly
found as the red bone marrow in bones, and
is often synonymous with this. However,
myeloid can also be present in the liver and
spleen .
A myelocyte is a young cell of the granulocytic
series, occurring normally in bone marrow,
but not in circulating blood (except when
caused by certain diseases).
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18. Granulocytes are a category of white blood cells
characterized by the presence of granules in their
cytoplasm.They are also called
polymorphonuclear leukocytes (PMN or PML)
because of the varying shapes of the nucleus,
which is usually lobed into three segments.
The myeloblast is a unipotent stem cell, which will
differentiate into one of the actors of the granular
series.
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19. Acute Myelogenous
Leukemia (AML)
Leukemia characterized by proliferation of
myeloid tissue (as of the bone marrow and spleen)
and an abnormal increase in the number of
granulocytes, myelocytes, and myeloblasts in the
circulating blood
One fourth of all leukemias
85% of the acute leukemias in adults
Abrupt, dramatic onset
Serious infections, abnormal bleeding
Uncontrolled proliferation of myeloblasts
Hyperplasia of bone marrow and spleen
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20. AML is characterized by greater than 20%
myeloid blasts and is the most common
acute leukemia in adults.
It is the most aggressive cancer with a
variable prognosis depending upon the
molecular subtypes.
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21. Acute Lymphocytic
Leukemia (ALL)
Most common type of leukemia in children
15% of acute leukemia in adults
Immature lymphocytes proliferate in the
bone marrow.
ALL is seen in patients with the blastic
transformation of B and T cells.
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22. Acute Lymphocytic
Leukemia
Signs and symptoms may appear abruptly
Fever, bleeding
Insidious with progressive
Weakness, fatigue
Central nervous system manifestations
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24. Chronic Myelogenous
Leukemia (CML)
Excessive development of mature neoplastic
granulocytes in the bone marrow
Move into the peripheral blood in massive numbers
Ultimately infiltrate the liver and spleen
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26. Chronic Lymphocytic
Leukemia (CLL)
Production and accumulation of
functionally inactive but long-lived, mature-
appearing lymphocytes
B cell involvement
Lymph node enlargement is noticeable
throughout the body
↑ incidence of infection
26
27. Most cases occur in people between the
ages of 60 and 70. CLL is considered an
indolent disease.
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29. Hairy Cell Leukemia
2% of all adult leukemias
Usually in males > 40 years old
Chronic disease of lymphoproliferation
B lymphocytes that infiltrate the bone marrow and liver
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30. Hairy Cell Leukemia
Cells have a “hairy” appearance
Symptoms from
Splenomegaly, pancytopenia, infection, vasculitis
Treatment
alpha-interferon, pentostatin, cladribine
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31. Unclassified Leukemias
Subtype cannot be identified
Malignant leukemic cells may have
Lymphoid, myeloid, or mixed characteristics
Frequently these patients do not respond
well to treatment
Poor prognosis
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33. Leukemia
Clinical Manifestations
Relate to problems caused by
Bone marrow failure
• Overcrowding by abnormal cells
• Inadequate production of normal
marrow elements
• Anemia, thrombocytopenia, ↓ number
and function of WBCs
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34. Leukemia
Clinical Manifestations
Relate to problems caused by
Leukemic cells infiltrate patient’s organs
• Splenomegaly
• Hepatomegaly
• Lymphadenopathy
• Bone pain,
• meningeal irritation, oral lesions
(chloromas)
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35. Leukemia
Diagnostic Studies
To diagnose and classify
• Peripheral blood evaluation (CBC and blood smear)
• Bone marrow evaluation
To identify cell subtype and stage
• Morphologic, histochemical, immunologic, and
cytogenic methods
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36. Chemotherapy
The treatment on ALL is divided into 4 stages:
(i) Induction therapy (to attain remission),
(ii) CNS prophylaxis or CNS preventive therapy,
(iii) intensification ( consolidation)
(iv) maintenance therapy (continuation).
•The intensification (consolidation) phase, following
induction of remission, may not be required in low risk
patients, though recent studies suggest benefits in
longterm survival with intensification therapy in both
low risk and high risk patients.
•The average duration of treatment in ALL ranges
between 2 and 2.5 yr; there is no advantage of
treatment exceeding 3 yr.
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39. Leukemia
Collaborative Care
Goal is to attain remission (when there is no
longer evidence of cancer cells in the body)
Chemotherapeutic treatment
Induction therapy
• Attempt to induce or bring remission
• Seeks to destroy leukemic cells in the tissues,
peripheral blood, bone marrow
• Patient may become critically ill
• Provide psychological support as well
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40. What is remission?
The main aim of treatment for acute lymphoblastic
leukaemia is to give a remission. This means that the
abnormal, immature white cells or blasts can no
longer be detected in the blood or bone marrow,
and normal bone marrow has developed again.
For many people with acute lymphoblastic leukaemia
the remission lasts indefinitely and the person is said
to be cured.
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42. Leukemia
Collaborative Care
Chemotherapeutic treatment (cont.)
Consolidation therapy
• Started after remission is achieved
• Purpose is to eliminate remaining leukemic cells
that may not be evident
Maintenance therapy
• Lower doses of the same drug
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44. Leukemia - Bone Marrow and
Stem Cell Transplantation
Goal
Totally eliminate leukemic cells from the body using
combinations of chemotherapy with or without total
body irradiation
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45. Leukemia - Bone Marrow and
Stem Cell Transplantation
Eradicates patient’s hematopoietic stem
cells
Replaced with those of an HLA-matched
(Human Leukocyte Antigen)
Sibling (is a brother or a sister; that is, any person
who shares at least one of the same parents )
Volunteer
Identical twin
Patient’s own stem cells removed before
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