Foreign students acute leukemia-zhou

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Foreign students acute leukemia-zhou

  1. 1. Leukemia Department of Hematology, the First Affiliated Hospital ,Sun Yat-Sen University Zhenhai Zhou
  2. 2.   Overview <ul><li>A heterogeneous group of hematopoietic malignancies characterized by infiltration of the blood ,bone marrow,and other tissue by leukemic cells which exhibit differentiation and apoptosis arrest in any stage of maturation. </li></ul><ul><li>Classification: </li></ul><ul><li>acute chronic </li></ul><ul><li>lymphoblastic myloid </li></ul>
  3. 3. <ul><li>Incidence </li></ul><ul><li>2.76/100,00 in China </li></ul><ul><li>More acute leukemia </li></ul><ul><li>Etiology </li></ul><ul><li>---heredity </li></ul><ul><li>---Radiation </li></ul><ul><li>---Chemical and other exposures </li></ul><ul><li>---Drugs </li></ul><ul><li>---virus </li></ul>
  4. 4. Acute Leukemia <ul><li>classification </li></ul><ul><li>FAB </li></ul><ul><li>--- Acute myeloid leukemia(AML) </li></ul><ul><li>M0-M7 </li></ul><ul><li>---Acute lymphoblastic leukemia(ALL) </li></ul><ul><li>L1,L2,L3 </li></ul><ul><li>WHO </li></ul><ul><li>MICM </li></ul>
  5. 5. Clinical feature <ul><li>Decreased production of normal hematopoietic </li></ul><ul><li>---anemia:pale,tired </li></ul><ul><li>---bleeding: PLT, blood vessel wall, DIC </li></ul><ul><li>acute promyelocytic leukemia </li></ul><ul><li>---fever: infection ,or? </li></ul><ul><li>Leukemic cells infiltration </li></ul><ul><li>---Lymph node, liver spleen , Sternum… </li></ul><ul><li>---central nervous system (CNSL) </li></ul>
  6. 6. CT-fungi infection
  7. 7. CT
  8. 8. Laboraory findings <ul><li>Blood test : WBC ↑ , Hb ↓ , PLT ↓ </li></ul><ul><li>Bone marrow- morphology </li></ul><ul><li>Hypercellular </li></ul><ul><li>Cytochemical reactions: POX(aml)PAS(all) NAE(aml) </li></ul>
  9. 9. <ul><li>Immunophenotypic analysis </li></ul><ul><li>Flow cytometrry-antigen CD </li></ul><ul><li>---Myeloid lineage </li></ul><ul><li>MPO,CD117 ,CD33,CD13,CD14,CD15 </li></ul><ul><li>---Lymphoblastic lineage </li></ul><ul><li>B:CD79a,CD19,CD20,CD22… </li></ul><ul><li>T:CD7,CD3,CD5… </li></ul>
  10. 11. <ul><li>Cytogenetics : </li></ul><ul><li>Chromosome abnormality </li></ul><ul><li>Molecular genetics: </li></ul><ul><li>---t(8,21) (q22;q22) AML1-ETO,M2 </li></ul><ul><li>---t(15,17) (q22;q21) PML-RARa M3t() t() </li></ul><ul><li>Low risk, high risk </li></ul>
  11. 12. <ul><li>FISH </li></ul>
  12. 13. Differential diagnosis <ul><li>Myelodysplastic syndrome(MDS) </li></ul><ul><li>Myeloproliferative disorders </li></ul><ul><li>Chronic myelogenous leukemia </li></ul>
  13. 14. treatment <ul><li>Supporting treatment </li></ul><ul><li>Antimicrobial therapy </li></ul><ul><li>Blood transfusion </li></ul><ul><li>Hyperleucocytosis therapy </li></ul><ul><li>Tumor lysis therapy </li></ul><ul><li>oral allopurinol </li></ul>
  14. 15. Antileukemic treatment <ul><li>Treatment strategy --Complete remission(disapperance of all sign of cancer) </li></ul><ul><li>Treatment for ALL </li></ul><ul><li>---Induction : DVLP(DNR,VCR,L-ASP,Prednisone) </li></ul><ul><li>---Postremission therapy :Consolidation and maintain chemotherapy; Allogenetic BMT </li></ul><ul><li>CNS prophylasis :high dose systemic therapy iintrathecal drug </li></ul><ul><li>Relapsed ALL therapy </li></ul>
  15. 16. <ul><li>Treatment for AML </li></ul><ul><li>---Induction : DA(DNR,Ara-c) </li></ul><ul><li>---APL:ATRA(all trans-renotic acid),arsenic trioxide </li></ul><ul><li>---Postremission therapy :Consolidation and maintain chemotherapy; Allogenetic BMT </li></ul><ul><li>Relapsed AML therapy </li></ul>
  16. 17. Prognosis <ul><li>Adverse prognostic factors : unfavorable karyotype, age,high WBC,secondary AML… </li></ul>
  17. 18. Chronic myelogenous <ul><li>Incidence </li></ul><ul><li>Clinical features </li></ul><ul><li>---chronic phase: fatigue, night sweats, </li></ul><ul><li>low-grade fever </li></ul><ul><li>splenomegaly, leukostasis </li></ul><ul><li>---accelerated phrase </li></ul><ul><li>---blast phase </li></ul>
  18. 19. Laboratory findings <ul><li>Blood </li></ul><ul><li>---WBC Moderate-marked increase ,basophils,eosinophils </li></ul><ul><li>---anemia , PLT </li></ul><ul><li>---<5%blast,<10%blast and promyelocytes </li></ul><ul><li>Bone marrow </li></ul><ul><li>---hypercellular, granulocytic </li></ul>
  19. 20. <ul><li>Cytogenetic findings </li></ul><ul><li>Philadephia chromosome </li></ul><ul><li>t(9,22)(9q,22q) Bcr/abl </li></ul>
  20. 21. Treatment <ul><li>Leukophoresis </li></ul><ul><li>Hydroxyurea </li></ul><ul><li>---hematologic remissiom </li></ul><ul><li>Interferon- α </li></ul><ul><li>Imatinb Mesylate </li></ul><ul><li>Stem cell transplantation </li></ul>
  21. 22. Chronic lymphocytic leukemia <ul><li>Clinical features </li></ul><ul><li>Laboratory findings </li></ul><ul><li>The majority of patients with stage A have no symptoms and may be observed for a while to determine treatment. </li></ul>
  22. 23. <ul><li>Thank You ! </li></ul>

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