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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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Clinical Manifestations
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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Clinical Manifestations
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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Clinical Manifestations
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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