Leukemia and its types presentation 1

 Presented by :
 Sana Yasin
 Uswa Rafiq
 Hina Ikram
 Aneeqa Naeem
 Fajar Nadeem
 Noor ul Huda Butt

Definition
A group of malignant disorders affecting
the blood and blood-forming tissues of
Bone marrow
Lymph system
Spleen
Occurs in all age groups
Results in an accumulation of
dysfunctional cells because of a loss of
regulation in cell division

 Leukemia, also spelled as leukaemia.

Leukemia
 Leukemia is a cancer that starts in blood stem cells.
 Stem cells are basic cells that develop into different types of cells that have different
jobs.
 Blood stem cells develop into either lymphoid stem cells or myeloid stem cells.
 Lymphoid stem cells develop into lymphocytes, a type of white blood cell.
 Lymphocytes help fight infection and destroy abnormal cells.
 The 3 types of lymphocytes are B cells, T cells and natural killer (NK) cells.
 Myeloid stem cells develop into red blood cells, granulocytes, monocytes or platelets.
 Red blood cells carry oxygen to all tissues of the body.
 Granulocytes and monocytes are types of white blood cells that destroy bacteria and
help fight infection.
 Platelets form clots in damaged blood vessels to stop bleeding.

• Uncontrolled proliferation of partially mature
WBC’s
• Cancer of blood cells
TYPES OF ACUTE LEUKEMIA
• Acute Lymphoblastic leukemia (ALL)
• Acute Myeloid leukemia (AML)

• Cancer of blood cell characterized by development of large
number of immature lymphocytes
• Common in the age of 2-10years
• Peak at 3-4 years
• Incidence decreased with age and a
secondary rise after 40 years
• Most common malignant disease in children
• 85% of childhood leukemia

Causes
 Error in DNA of bone marrow cell
 Chromosomal translocation
 Abnormal chromosome number

Symptoms
 Bleeding from gums and nose
 Bone pain
 Fever , fatigue , weakness
 Frequent infections
 Pale skin
 Shortness of breath
 Lumps caused by swollen lymph nodes

Types Of Acute Leukemia
 T-cell ALL
 B-cell ALL

Treatment
Chemotherapy :
 Use drugs to kill cancer
 Use in induction , consolidation and maintenance phase

Targeted therapy:
 Targeted drug attack specific abnormality present in cancer cells
 Used to cure Philadelphia chromosome
 Used during or after chemotherapy
Radiation therapy:
 Used high power beam such as X-rays or protons
 When cancer spread to CNS then radiation therapy is used.
Bone Marrow transplant:
 Also known as stem cell transplant
 Replace infected bone marrow with healthy bone marrow

Definition:
 Acute myeloid leukemia (AML) is a cancer of the myeloid line of blood
cells, characterized by the rapid growth of abnormal cells that build up in
the bone marrow and blood and interfere with normal blood cells.

Pathophysiology
 Pathophysiology in AML consists of maturational arrest of
bone marrow cells in the earliest stages of development.
 Patients with AML present with symptoms resulting from
bone marrow failure , symptoms resulting from organ
infiltration with leukemic cells , or both .
 The time course is variable.

Survival rate:
The 5-year survival rate for people 20 and older
with AML is approximately 24%.
 For people younger than 20, the survival rate is 67%.

Signs:
 Signs and symptoms of acute myelogenous leukemia include:
 Bone pain
 Fever.
 Lethargy and fatigue.
 Shortness of breath.
 Pale skin.
 Frequent infections.
 Easy bruising.
 Unusual bleeding, such as frequent nosebleeds and bleeding from the gums

Causes:
 Acute myeloid leukemia (AML) is caused by a DNA mutation in the
stem cells in your bone marrow that produce red blood cells, platelets and
infection-fighting white blood cells.
 The mutation causes the stem cells to produce many more white blood
cells than are needed.

Types:
 Myeloblastic (M0) - on special analysis.
 Myeloblastic (M1) - without maturation.
 Myeloblastic (M2) - with maturation.
 Promyeloctic (M3)
 Myelomonocytic (M4)
 Monocytic (M5)
 Erythroleukemia (M6)
 Megakaryocytic (M7)

Treatment:
 AML has several subtypes for which treatments and outcomes may vary.
AML typically is initially treated with chemotherapy, with the aim of
inducing remission.
 People may then go on to receive additional chemotherapy, radiation
therapy, or a stem cell transplant.

Chronic leukemia
 A disease in which clonal expansion of white blood cell takes place in the
bone marrow .

Classification
 Depending upon the type of white blood cell that is involved, chronic
leukemia can be classified as:
 Chronic Lymphocytic Leukemia(CLL)
 Chronic Myelocytic Leukemia(CML)

Chronic Lymphocytic Leukemia(CLL)
 It is a disease which involves T or B lymphocytes.
 B type abnormalities are more common than T cell abnormalities.
 T cells are affected by only 5% of the patient.
 T and B lymphocytes can be differentiated from other types of WBCs on basis
of size and granules`.

Stages of CLL
 To stage CLL two systems are used which are as under:
1. Rai System(Used in United States)
2. Binet System(Used in Europe)

Sub Types of CLL
1. T-Cell leukemia
2. B-Cell leukemia
1: T-Cell leukemia has further four types
They are as under:
 Large granular lymphocytic leukemia ( LGLL )
 T-Cell prolymphocytic leukemia (T-PLL )
 Adult T-Cell leukemia/lymphoma ( ATLL )
 Sezary syndrome
 2: B-Cell leukemia has 2 types. They are as under:
 B-Cell prolymphocytic leukemia (B-PLL)
 Hairy cell leukemia

Clinical PRESENTATION
 Symptoms
Fever ,
Fatigue ,
Weight loss.
Night sweats,
Swollen glands in neck , armpits or groin.
Anemia-persistent tiredness ,
Shortness of breath and pale skin.
 Physical Examination:
lymphadenopathy (87%)
splenomegaly (54%)
hepatomegaly (14%)

Risk factors
 The factors that may increase the risk of chronic lymphocytic leukemia include :
Age
Race
Exposure to chemicals
Family history of blood and bone marrow cancer
Survival rate
The 5 year survival rate is about 83%.
However , in those over age 75, the 5 year
survival rate drops to 70 %.

Treatment
 Chemotherapy
 Monoclonal antibodies
 Radiation therapy
 Supportive treatment for CLL
 More than one treatment may be used

Chemotherapy
 Use of drugs to kill cancer cells
 Chemotherapy may be given orally, intravenously (IV)
 Typical medications include fludarabine , pentostatin , cladribine
,chlorambucil ,cyclophosphamide.
 Orally administered alkylating agents such as chlorambucil and
cyclophosphamide can be used dose-15 to 40 mg/m2 orally every 28 days or daily
doses of 4 to 8 mg/m2 per day.

Monoclonal Antibodies or Biological therapy
 Substances that support or stimulate the body’s immune system to fight cancer.
 Who had been treated with alkylating agents and had failed fludarabine therapy
.Rituximab can be used for B-cell CLL .
 Alemtuzumab a monoclonal antibody approved for use by U.S.Food and drug
administration (FDA) for treatment of advanced CLL after other treatments
fail.It is used in both B-Cell and T-Cell CLL.
 Dose of 30mg intravenously given three times a week for 12 weeks.

Radiation Therapy
 The use of high energy X-Rays to destroy cancer cells.
 External beam : Outside the body usually given to shrink or enlarged spleen or
swollen lymph nodes and eliminate symptoms associated with such growths.
 Side effects can include fatigue, mild skin reactions, nausea, diarrhea or
constipation.

Supportive treatment for CLL
 Used to control or treat symptoms (either from CLL or its treatment)
 Blood transfusions
 Antibiotics to treat infection
 Immunoglobulin infusion for people with recurrent infections
 Splenectomy (surgery used to remove an enlarged spleen)

Defination
 Chronic Myelogenous leukemia (CML) ,also known as Chronic myeloid
leukemia , is a cancer of WBCs .
 It is a form of leukemia characterized by the increased and unregulated
growth of myeloid cells in the bone marrow and the accumulation of these
cells in the blood .

CML
 CML is a myeloproliferative disease that results from a malignant
transformation of an early hematopoietic progenitor cell.
 This leads to abnormal proliferation and accumulation of progenitor and
mature myeloid cells in the bone marrow and peripheral blood.

Epidemiology
 CML occur in all age groups.
 Most common in elder age and middle aged.
 Incidence 1-2 per 100,000 people.
 More common in males than in females (1.4.1) .
 Represents 15-20 % of all cases of adult leukemia in western population.
 Increase rates of CML were seen in people exposed to atomic bombings of Hiroshima
and Nagasaki and ionizing radiation exposure.

Philadelphia Chromosome
 This chromosome is formed when chromosome 9 and 22 break and exchange
portions .
 This creates an abnormally small chromosome 22 and a new combination of
instruction for your cell can lead to the development of CML.

The picture below shows formation of abnormal chromosome :

Phases
 CML has three phases:
1. Chronic phase
2. Accelerated phase
3. Blast crisis

Newly Proposed System for Defining
Phase of CML

Clinical representation of CML
 Signs and symptoms
Fatigue
Weight loss
Abdominal pain
Night sweats
Left upper quadrant pain
 Physical examination
Splenomegaly
Hepatomegaly
 Laboratory tests
Peripheral blood
Bone marrow
Cytogenetics

Treatment
 Different treatment options are available for patients with CML
 Conventional Chemotherapy
 Bone marrow transplantation
 Tyrosine Kinase Inhibitor

Conventional Chemotherapy
 Conventional cytotoxic chemotherapy can be used in chronic phase.
 Two agents are used busulfan and hydroxy urea.
 Busulfan is rarely used.
 Hydroxy urea is mostly used.
 40-50 mg/kg/day in divided doses until WBCs count falls below 10,000 cells/mm3.
 At this point dose can be decreased to 20 mg/kg/day.

Bone Marrow Transplantation (BMT)
 In BMT the patient’s bone marrow is replaced with healthy marrow.
 Allogeneic bone marrow transplant
 In this healthy marrow is taken from another person (donor).
 First the patient bone marrow is destroyed with very high doses of
chemotherapy and radiation therapy.
 Then to replace the destroyed marrow , healthy marrow from the donor is given
to the patient through a needle in the vein.

Tyrosine Kinase Inhibitor (TKI)
Dasatinib and nilotinib are two recently approved TKI used to overcome resistance in CML.
Dasatinib Nilotinib
 Is an oral bcr - abl TKI that
was FDA approved in 2006 .
 It binds to both active and
inactive forms of bcr-abl
kinase and can overcome
most bcr-abl mutations .
 DOSE:
70 mg twice daily or 100
mg once daily.
 It ia also oral TKI of inactive form
of bcr-abl .
 It was FDA approved in 2007 .
 Nilotinib is 10-30 times more
potent in inhibiting bcr-abl .
 DOSE:
400 mg twice daily .

Presented by
Noor-ul-Huda Butt

What is leukemia?
Leukemia is a cancer of blood cells that usually begin
in the bone marrow and result in high numbers of
abnormal blood cells.

Comparison of acute and chronic leukemia
Acute Chronic
Age All ages Adults
Clinical onset Sudden Long term
Leukemia cells Immature Mature
Anemia Mild to severe Mild
Thrombocytopenia Mild to severe Mild
WBCs Variable Increased
Organomegaly Mild Prominent
8/12/2009 61

Types of leukemia chronic and
Acute leukemia
Acute
 Acute myeloid leukemia
 Acute lymphoblastic
leukemia
Chronic
 Chronic myeloid leukemia
 Chronic lymphoblastic
leukemia

Signs and Symptoms
Common leukemia signs and symptoms include:
 Fever or chills.
 Persistent fatigue, weakness.
 Frequent or severe infections.
 Losing weight without trying.
 Swollen lymph nodes, enlarged liver or spleen
 Easy bleeding or bruising.
8/12/2009 63

Prevalence and Incidence
8/12/2009 65

Treatment
 Treatment for leukemia depends on many factors.
 Leukemia treatment options are based on age and
overall health, the type of leukemia patient has, and
whether it has spread to other parts of the body,
including the central nervous system.
8/12/2009 66

Prevention:
 Be a non smoker….not smoking is the best way to lower your
risk of leukemia.
 Maintain a healthy body weight. ...
 Avoid breathing in benzene and formaldehyde. ...
 More information about preventing cancer.
8/12/2009

Types of treatments
Common treatments used to fight leukemia include:
 Chemotherapy
 Biological treatment
 Targeted therapy
 Radiation therapy
 Stem cell transplantation
8/12/2009 68

Leukemia and its types presentation 1

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Leukemia and its types presentation 1