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Similar to Acute leukemia
Similar to Acute leukemia (20)
More from Puneet Shukla (20)
Acute leukemia
- 2. AML
Common acute leukemia in adults
Incidence increases with age
Risk factors-
MDS/MPD
Chemotherapy- alkylating agents-chr. 5,7,11,17,
topoisomerase II inhibitors-chr. 11,21
Radiation
Benzene
Genetic- Down’s syndrome, DNA repair defects
- 3. Diagnosis
s/s- anemia, bleeding tendency, infection
CBC- low Hb/platelets, WBC low/n/raised
Bone marrow- >20% myeloblasts, Auer rods
Cytochemistry- MPO/esterase +ve staining
Immunohistochemistry- CD 13, 33 +ve
Cytogenetics- inv 16, t(15:17)/(8:21), -5/-7
LFT, RFT, aPTT/INR, CxR etc.
- 4. Classification
WHO- prognosticates
With charac. cytogenetics- inv16, t(15:17)/(8:21)- good Px
With prior MDS/MPD- more in elderly- poor Px
Prior therapy related- poor Px
Other
FAB- M0-M7- morphological
M2- with granulocyte maturation- t(8;21)- good Px
M3- promyelocytic- t(15:17)- bleeding tendency- best Px
M4/5- monocytic- inv16- gum hypertrophy
M5- erythroid
M7- megakaryoblastic
- 5. Treatment & prognosis
Induction chemotherapy- goal is remission-
normal CBC with BM
blasts <5%
3+7- Dauno/Idarubicin + Cytarabine
M3- ATRA + chemotherapy
Consolidation chemo.- maintain remission
Good Px- 3-5 cycles of 2+5/3+7
Bad Px- allogeneic SCT
Prognosis-
Depends on- cytogenetics, primary/secondary, age, PS
Cure rates- ~25%
- 6. ALL
Common acute leukemia in children
s/s-
Fatigue, pallor, anemia
Easy bruisability, petechiae
Bone pains
LNE
HS’megaly
Fever, frequent infection
CNS (meningeal) involvement- cranial nerve defects
Testicular involvement- painless asymmetrical enlargement
- 7. Diagnosis
s/s
CBC with PBS examination
BM examination- >20% lymphoblasts
Cytochemistry- MPO –ve
IHC- CD 2/7/10/19 +ve, Tdt +ve, CALLA Ag +ve
Cytogenetics-
t(8:14)- Burkitt’s
t(9:22)/(4:11)- poor Px,
t(12:21)- good Px- commonest
CSF examination
CxR/CT chest, LFT, RFT, US/CT abdomen etc.
- 8. Classification-WHO
ALL- precursor cell- FAB L1 or L2- Tdt +ve
B-cell
T-cell
Burkitt’s leukemia- FAB L3- sIg +ve
Biphenotypic
Variants-
With cytoplasmic granules
Aplastic presentation
With eosinophilia
- 9. Treatment & prognosis
Chemotherapy- phases
Remission induction- V.P.L.D & IT CNS prophylaxis
Consolidation- multiple drugs in various combination
Maintenance- 2-3 years- Mtx.6-MP.V.Steroids
Prognosis-
Worsens as age increases
Worse with initial raised WBC, CNS involvement, 2° ALL
t(9:22)/(4:11)/(8:14)- poor Px
Hyperdiploidy, t(12:21)- good Px
Cure rates- ~30%
- 10. Treatment & prognosis
Chemotherapy- phases
Remission induction- V.P.L.D & IT CNS prophylaxis
Consolidation- multiple drugs in various combination
Maintenance- 2-3 years- Mtx.6-MP.V.Steroids
Prognosis-
Worsens as age increases
Worse with initial raised WBC, CNS involvement, 2° ALL
t(9:22)/(4:11)/(8:14)- poor Px
Hyperdiploidy, t(12:21)- good Px
Cure rates- ~30%