2. Definition
Leukemia is the general term used to describe a group of
malignant disorders affecting the blood and blood-
forming tissues of the bone marrow, lymph system, and
spleen.
The word Leukemia comes from the Greek leukos, which
means "white", and aima, which means "blood".
• Leukemia occurs in all age-groups.
• It results in an accumulation of dysfunctional cells
because of a loss of regulation in cell division.
4. Acute Myelogenous Leukemia.
AML represents only one fourth of all leukemia, but it
makes up approximately 85% of the acute leukemias in
adults.
Its onset is often abrupt and dramatic.
A patient may have serious infections and abnormal
bleeding from the onset of the disease.
5. • AML is characterised by uncontrolled proliferation of
myeloblast , before the precursor of granulocytes.
There is hyperplasia of the bone marrow.
8. Diagnostic Findings:
• Low RBC count
• Low platelet count
• High WBC count with myeloblasts
• High LDH(Lactate Dehydrogenase):due to the tumor
burden activity which reflects the function of leukemic
cell turnover and cell destruction.
• Greatly hypercellular bone marrow with myeloblasts
9. Chronic Myelogenous Leukomia
CML is caused by excessive development of mature
neoplastic granulocytes in the bone marrow.
The excess neoplastic granulocytes move into the
peripheral blood in massive numbers and ultimately
infiltrate the live and spleen.
10. Phases of CML
Chronic phase:
Approximately 85% of patients with CML are in the chronic
phase at the time of diagnosis.
During this phase patients are usually asymptomatic or have
only mild symptoms of fatigue, abdominal fullness etc.
The duration of this phase is variable and depends upon how
early the disease was diagnosed as well as the therapies used.
In the absence of treatment the disease progresses to an
accelerated phase.
11. Accelerated phase:
This is progressive phase of the CML.
The diagnosis of this phase is based when one of the
following is present on blood test.
Persistent presence of myeloblast in marrow or peripheral
blood. Major increase of WBC to over 50.000.
Red blood cells levels are low despite treatment.
Progressive enlargement of spleen.
Persistent unexplained fever or bone pain
12. Blastic phase:
The blastic phase is the final phase in the evolution of
CML known as acute leukemic phase with rapid
progression and short survival.
The diagnosis is based on the presence on one of the
following in bone marrow or peripheral blood.
Persistent presence of greater than 20% myeloblast in
marrow or peripheral blood.
Large clusters of blasts in the bone marrow on biopsy
Development of chloroma (solid mass of leukemia
outside the bone marrow)
13. • Even with treatment, the chronic phase of the disease will
eventually progress to the accelerated phase, ending in a
blastic phase.
• Once CML transforms to an acute or blastic phase, it is
often refractory to therapy and the patient may live for
only a few months.
14. Clinical Manifestation
No symptoms early in disease
Fatigue and weakness
Fever
Sternal tenderness
Weight loss
Joint pain
Bone pain
Massive splenomegaly
15. Acute Lymphocytic Leukomia
ALL is the most common type of leukemia in children
It accounts for about 15% of acute leukemia in adults.
In ALL, immature lymphocytes proliferate in the bone
marrow, most are of β-cell origin.
Fever is present in the majority of patients at the time of
diagnosis.
Central nervous system (CNS) manifestations are
especially common in ALL and represent a serious
problem.
Leukemic meningitis caused by arachnoid infiltration
occurs in many patients with ALL
16. Clinical Manifestation:
Fever
Pallor
Bleeding
Anorexia
Fatigue and weakness
Bone, joint, and abdominal pain
Generalized lymphadenopathy
Infections
Weight loss
18. Chronic Lymphocytic Leukemia
CLL is the most common leukemia in adults.
CLL is characterized by the production and accumulation
of functionally inactive but long-lived, small, mature-
appearing lymphocytes.
The type of lymphocyte involved is usually the B cell.
The lymphocytes infiltrate the bone marrow, spleen, and
liver.
Lymph node enlargement (lymphadenopathy) is present
throughout the body.
19. CLL are rare but may develop as the disease advances.
Pressure on nerves from enlarged lymph nodes causes
pain and even paralysis.
Mediastinal node enlargement leads to pulmonary
symptoms.
Because CLL is usually a disease of older adults, treatment
decisions must be made by considering the progression of
the disease and the side effects of treatment.
20. Clinical Manifestation
No symptoms frequently
detection of disease often during examination for
unrelated condition, chronic fatigue, anorexia,
splenomegaly and lymphadenopathy, hepatomegaly, may
progress to fever, night sweats, weight loss, fatigue, and
frequent infections
21. Hairy Cell Leukemia.
Hairy cell leukemia accounts for approximately 2% of all adult
leukemias.
It is a chronic disease of lymphoproliferation predominantly
involving B lymphocytes that infiltrate the bone marrow and
spleen.
Cells have a “hairy” appearance under the microscope.
The spleen sequesters increasing numbers of normal
hematopoietic cells, making splenomegaly a common finding.
Liver infiltration may also occur, although hepatomegaly is less
common.
22. A patient with hairy cell leukemia usually has symptoms
from splenomegaly, pancytopenia.(deficiency of all three
cellular components of the blood (red cells, white cells,
and platelets).
patients are detected on routine CBC.
23. Clinical Manifestations
The clinical manifestations of leukemia are varied.
Essentially they relate to problems caused by bone marrow
failure and the formation of leukemic infiltrates.
Bone marrow failure results from
(1) bone marrow overcrowding by abnormal cells
(2) inadequate production of normal marrow elements.
The patient is predisposed to
• Anemia
• Thrombocytopenia(Decreased Platelet count in Blood)
• Decreased number and function of WBCs.
24. As leukemia progresses, fewer normal blood cells are
produced.
The abnormal WBCs continue to accumulate because they do
not go through the normal cell life cycle to death (apoptosis).
The leukemic cells infiltrate the patient's organs, leading to
problems such as splenomegaly, hepatomegaly,
lymphadenopathy, bone pain, meningeal irritation, and oral
lesions.
Solid masses resulting from collections of leukemic cells called
chloromas can also occur.
25. Diagnostic Studies
Peripheral blood evaluation and bone marrow
examination are the primary methods of diagnosing and
classifying the subtypes of leukemia.
Other studies such as lumbar puncture and computed
tomography (CT) scan can determine the presence of
leukemic cells outside of the blood and bone marrow.
26. TREATMENT
Once a diagnosis of leukemia has been made,
collaborative care is focused on the initial goal of
attaining remission.
cytotoxic chemotherapy is the mainstay of the treatment,
In some cases, such as nonsymptomatic patients with
CLL, watchful waiting with active supportive care may be
appropriate. Although a patient may not be cured,
attaining remission or disease control is a realistic option
for the majority of patients.
27. In some cases, cure is a realistic goal. In complete
remission there is no evidence of overt disease on physical
examination, and the bone marrow and peripheral blood
appear normal.
A lesser state of control is known as partial remission, is
characterized by a lack of symptoms and a normal
peripheral blood smear, but there is still evidence of
disease in the bone marrow.
Molecular remission is defined as <0.01% (1 out of 10,000)
blasts in the bone marrow.
The patient's prognosis is directly related to the ability to
maintain a remission.
28. Sometimes patients have such a high WBC count that initial
emergent treatment may employ the use of leukapheresis and
hydroxyurea. The purpose of these treatments is to reduce the
WBC count and risk of leukemia-induced thrombosis.
The chemotherapeutic treatment of acute leukemia is often
divided into stages.
1. induction therapy:
It is the attempt to induce or bring about a remission
Induction is aggressive treatment that seeks to destroy
leukemic cells in the tissues, peripheral blood, and bone
marrow in order to eventually restore normal hematopoiesis
on bone marrow recovery.
29. During induction therapy a patient may become
critically ill because the bone marrow is severely
depressed by the chemotherapeutic agents.
postinduction or postremission chemotherapy include
intensification: or high-dose therapy, may be given
immediately after induction therapy for several
months. This therapy may use the same drugs as those
used in induction but at higher dosages.
30. Consolidation:
• It is started after a remission is achieved.
• It may consist of one or two additional courses of the
same drugs given during induction or involve high-
dose therapy (intensive consolidation).
• The purpose of consolidation therapy is to eliminate
remaining leukemic cells that may not be clinically or
pathologically evident
31. Maintenance:
• It is treatment with lower doses of the same drugs used in
induction or other drugs given every 3 to 4 weeks for a
prolonged period of time.
• The goal is to keep the body free of leukemic cells.
• Each leukemia requires different maintenance therapy.
32. Drug therapy to treat leukemia
Drug classfication Drug Name
Alkylating agent Busulfan
Chlorambucil
Cychlophosphamide
Antitumor antibiotic Daunorubicin
Doxorubicin
Idarubicine
Antimetabolic Cytarabine
Methotrexate
Fludarabine
Corticosteroid Prednisone
Dexamethasone
Biology/targeted therapy Rituximab
Dasatinib
33. Hematopoietic stem cell transplantation (HSCT):
It is another type of therapy used for patients with different
forms of leukemia.
The goal of HSCT is to totally eliminate leukemic cells from
the body using combinations of chemotherapy with or without
total body irradiation.
This treatment also eradicates the patient's hematopoietic
stem cells, which are then replaced with those of an HLA-
matched sibling or volunteer donor (allogeneic), an identical
twin (syngeneic), or the patient's own (autologous) stem cells
that were removed (harvested) before the intensive therapy.
