LEUKEMIA

HEMATO ONCOLOGY DIVISIONHEMATO - ONCOLOGY DIVISIONDEPARTEMENT OF CHILD HEALTH

MEDICAL SCHOOL UNIVERSITY OF SUMATERA UTARA

INTRODUCTIONINTRODUCTION

20-30 YEARS AGO LEUKEMIA DEATH.20 30 YEARS AGO LEUKEMIA DEATH.AT NOW : 70% CAN BE CUREINCIDENCE : INCIDENCE :

IN THE UNITED STATES : 6500 NEW CASES ARE DIAGNOSED EACH YEAR THN 3000 ARE DIAGNOSED EACH YEAR THN 3000 DIAGNOSED WITH ALLDEPARTEMENT OF PEDATRIC OF USU : O C O USUINCIDENCE OF LEUKEMIA INCREASE FROM 35,8% TO 46,15 %

LEUKEMIA IN THE CHILDREN :ALL : ACUTE LYMPHOBLASTIC LEUKEMIA (75 %)(75 %)AML : ACUTE MYELOID LEUKEMIA (20%)

ACUTE NON LYMPHOBLASTIC LEUKEMIA

CML : CHRONICMYELOID LEUKEMIA CLL CHRONIC LYMPHOBLASTIC LEUKEMIA CLL : CHRONIC LYMPHOBLASTIC LEUKEMIA (RARELY)

DIAGNOSEDANAMNESISANAMNESIS

MALAISE, ANOREXIA, PALLOR, FATIGUE, FEVER, BLEEDING, LYMPHADENIPATHY,HEPATOSPLENOMEGALY, BONE PAIN.

PHYSICAL EXAMINATIONPALLOR, FATIGUE, BLEEDINGPALLOR, FATIGUE, BLEEDINGLYMPHADENOPATHYHEPATOSPLENOMEGALYSPLENOMEGALY

LABORATORIUM FINDINGSCOMPLETE BLOOD COUNTPERPHERAL BLOOD SMEARIMUNNOPHENOTYPINGCYTOGENETICSMETABOLIC PANELMETABOLIC PANELCOAGULATION PROFILBLOOE CULTUREBLOOE CULTURE

ProliferatioonD

i ffferentiation

FAB CLASSIFICATION OF ALLL1 SMALL, MONOMORPHIC CELLSL2 LARGE, HETEROGENOUS CELLSL3 BURKITT CELL TYPE VACUOLATEDL3 BURKITT-CELL TYPE, VACUOLATED

ACUTE NON LYMPHOBLASTIC LEUKEMIAFAB CLASSIFICATION

M0UNDIFFERENTIATED LEUKEMIA (98013) STEM CELLS PREDOMINATE OR CELL

TYPE UNIDENTIFIEDM1 MYELOBLASTIC LEUKEMIA WITHOUT MATURATION (98723--

ACUTE) IMMATURE WHITE BLOOD CELLS PREDOMINATE

M2 MYELOBLASTIC LEUKEMIA WITH MATURATION (98723--ACUTE) WITH PARTIAL DIFFERENTIATION

M3 PROMYELOCYTIC LEUKEMIA (98663 ACUTE) M3 PROMYELOCYTIC LEUKEMIA (98663--ACUTE) PROMYELOCYTES PREDOMINATE

SUBDIVIDED M3A WITHOUT EOSINOPHILIAM3B WITH EOSINOPHILIA (98603) M3B WITH EOSINOPHILIA (98603)

M4 COMBINATION MYELOBLASTIC-MONOBLASTIC LEUKEMIA (98723 ACUTE; 98683 CHRONIC) EACH COMPONENT (98723--ACUTE; 98683--CHRONIC) EACH COMPONENT CONSTITUTES GREATER THAN

20% OF THE BLASTS IN THE BONE MARROWSUBDIVIDED M4 ACUTE MYELOMONOCYTIC LEUKEMIASUBDIVIDED M4 ACUTE MYELOMONOCYTIC LEUKEMIA

M4E0 ACUTE MYELOMONOCYTIC LEUKEMIA WITH EOSINOPHILIA

M5 MONOBLASTIC LEUKEMIA (98603 MONOCYTIC NOS; 98913M5 MONOBLASTIC LEUKEMIA (98603--MONOCYTIC, NOS; 98913--ACUTE; 98603--SUBACUTE; 98603--CHRONIC; 98603 ALEUKEMIC)

MONOBLASTS PREDOMINATEMONOBLASTS PREDOMINATESUBDIVIDED M5A ACUTE MONOCYTIC LEUKEMIA WITHOUT

DIFFERENTIATION (98913--MONOBLASTIC)M5B ACUTE MONOCYTIC LEUKEMIA WITH DIFFERENTIATION (PROMONOCYTIC)

M6 ERYTHROLEUKEMIA (98403) IMMATURE RED AND WHITE CELLS PREDOMINATE

M7 MEGAKAYROCYTIC LEUKEMIA (99103--ACUTE)

AML FAB M1AML FAB M1

AML FAB M2

AML FAB M3

AML FAB M4

AML FAB M 5A

AML FAB M5BAML FAB M5B

AML FAB M6

AML FAB M7

DIAGNOSTICS IMAGING : CHEST RADIOGRAPHUSGBONE RADIOGRAPH

RISK GROUP CLASSIFICATIONSTANDARD RISK

THE AGE : 1 - 9YEARSWBC < 50.000/μLμ

HIGH RISKTHE AGE : > 10 THNTHE AGE : 10 THNWBC > 50.000/μL

TREATMENTSTUDIES PRIOR TO THERAPY MAY INCLUDE :STUDIES PRIOR TO THERAPY MAY INCLUDE :A. A LUMBAR PUNCTURE CNS LEUKEMIA

CNS1 LEUKOSIT<5/ L NO BLASTCNS1:LEUKOSIT<5/ μL ,NO BLASTCNS2:LEUKOSIT<5/ μL ,BLAST PRESENTCNS3 LEUKOSIT 5/ L BLAST PRESENTCNS3:LEUKOSIT>5/ μL ,BLAST PRESENT

B. VIRAL SEROLOGIES :HEPATITIS B & C,CMV,HERVES SIMPLEXVARICELLA ZOOSTER

C ECG DAN ECHOCARDIOGRAM THERAPYC. ECG DAN ECHOCARDIOGRAM: THERAPYINCLUDING AN ANTHRACYLINE(CARDIAC TOXIC)TOXIC)

TREATMENTTHE PURPOSE OF THERAPY IS TO INDUCE A THE PURPOSE OF THERAPY IS TO INDUCE A BIOLOGIC & CLINICAL REMISSION.65-75%LEUKEMIA WILL BE CURED WITH MODIFICATION COMBINATION THERAPY

THE PHASES OF THERAPY THE PHASES OF THERAPY :1.INDUCTION

PURPOSE : REMISSION INDUCTION RATE PURPOSE : REMISSION INDUCTION RATE IN STANDARD RISK ALL : 98%

2.CONSOLIDATIONPURPOSE : CNS PROPHYLAXIS

3.MAINTENANCEPURPOSE PREVENT TO RELAPSPURPOSE : PREVENT TO RELAPS

SUPPORTIVE CARE

THE RATIONAL USE OF BLOOD COMPONENT THERAPYAN AGGRESSIVE APPROACH TO DETECTION & TREATMENT OF INFECTION COMPLICATIONTREATMENT OF INFECTION COMPLICATIONCAREFULL ATTENTION TO THE METABOLIC & NUTRITIONALNUTRITIONALPSYCHOSOSIAL SUPPORT FOR PATIENT & FAMILY

Thank You