View
226
Download
0
Category
Preview:
Citation preview
8/18/2019 Acute Leukemia Lecture
1/21
8/18/2019 Acute Leukemia Lecture
2/21
8/18/2019 Acute Leukemia Lecture
3/21
AM
• Aetiology: unclear association with
pre !e"isting myelodiplasia or
pri#ious chemotherapyradiation therapy
$en%ene e"posure
&own sy
8/18/2019 Acute Leukemia Lecture
4/21
8/18/2019 Acute Leukemia Lecture
5/21
8/18/2019 Acute Leukemia Lecture
6/21
AM
• Morphological classi'cation
• renchAmerican$ritish system is based onthe degree of di-erentiation ! is a
morphological classi'cation• ,ytochemistry is based on
– udan black stain
– Myelopero"idase stain
hese stains are positi#e in AM and negati#e A
2on speci'c esterase is positi#e monocyticsubtype
8/18/2019 Acute Leukemia Lecture
7/21
AM
• 45 classi'cation correlatesmorphological genetic and clinicalfeature
• In this classi'cation the blastthreshold for the diagnosis AM is)/(*0+ blasts
8/18/2019 Acute Leukemia Lecture
8/21
8/18/2019 Acute Leukemia Lecture
9/21
AM
• Immunophenotyping ! monoclonal antibody tocell surface antigen di-erentiate AM from A
• ineage in'delity: in some situation thee"pression of markers of more than one cellularlineage
• $iphenotypic leukemia
• ,ytogenetic analysis should be always
performed7 there are 3 groups – a#ourable reisk
– Intermediate risk
– 8oor risk
8/18/2019 Acute Leukemia Lecture
10/21
AM
• Molecular analysis 9uorescence insitu hybridisation I4 and re#ersetranscriptase chain reaction !
8, 7 add sensiti#ity and precisionthe detection of translocationdeletions and aneoplodity in case
when cytogeenetics fails or gi#esnormal results
8/18/2019 Acute Leukemia Lecture
11/21
AM
• ,linical features
• Acute presentation is usual oftencritically ill due to bone marrowfailure
• ymptoms of anemia: weakness 7letargy7 breathlessnesslightheadedness and palpitation
• Infections: chest7 mouth7 perianal7skin staphylococcus7 8seudomonas7
,andida
8/18/2019 Acute Leukemia Lecture
12/21
8/18/2019 Acute Leukemia Lecture
13/21
AM
• In#estigation and diagnosis
• I4 and blood 'lm
• $one marrow aspirate and biopsy
• $one marrow cytogenetics
• Immunophenotyping of bone marrowblasts or blood blasts
• otal $, usually increased with blastson blood 'lm but $, may be low
• 4$7 neurophils and platelets low
8/18/2019 Acute Leukemia Lecture
14/21
8/18/2019 Acute Leukemia Lecture
15/21
AM
• upporti#e treatment
• ;ood communication with patientand family
• ransfusion platelet and $,
• 2eutropenic treatment
•
4ydration Allopurinol for pre#entinghypercalcemia
• ,entral #enous catheter
8/18/2019 Acute Leukemia Lecture
16/21
8/18/2019 Acute Leukemia Lecture
17/21
AM
• eukemia is not detected bycon#entional morphological methodsbut may be demonstrated by more
sensiti#e molecular techniue
• , is not synonymous with cure
8/18/2019 Acute Leukemia Lecture
18/21
AM
• reatment has 3 phases
• emission inductionusually 1* courses ofcombination ,
• ,onsolidation therapy to reduce leukemiaburden further and reduce the risk ofrelapse
• 5ptimum no of cycles *< with autologus or
allogenic sstem cell transplantation
• Maintenance therapy only when intensi#econsolidation can not be tolerated
8/18/2019 Acute Leukemia Lecture
19/21
AM
• 8rognosis
• 60B0+ of pts aged > C0 will achie#e,
• elapse risk of pts 7 C0 withfa#ourable risk cytogentics is *@
8/18/2019 Acute Leukemia Lecture
20/21
AM
• 8rognosis
• Age group >C0
•
eucocytic count at the presentation>*?"10@/ is fa#ourablre but when)100"10@/ is unfa#ourable
• 4istory od pre#ious mielodisplasia
• some A$ subtype has fa#ourableprognosis
8/18/2019 Acute Leukemia Lecture
21/21
Recommended