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1) Acute leukemia is a type of cancer that affects the blood and bone marrow with two main types - acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). 2) ALL is more common in children between ages 2-5 years old and comprises 30% of all childhood cancers. The causes are unclear but some studies link it to environmental exposures and immune response to infections. 3) Diagnosis involves blood tests, peripheral smear, bone marrow aspirate and biopsy to examine cells for abnormalities. Risk classification is determined based on factors like age, white blood cell count, and genetics to guide treatment.
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Slidecast
- 1. Acute leukemia - DrDinesh Bhurani, DM, FRCPA Senior bone marrow transplant physician Rajiv Gandhi Cancer Inst & RC, Delhi
- 2. ALL MMCLL Lymphomas Hematopoietic stemcell Neutrophils Eosinophils Basophils Monocytes Platelets Red cells Myeloid progenitor Myeloproliferative disordersAML Lymphoid progenitor T-lymphocytes Plasma cells B-lymphocytes naïve
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- 7. Production failure • Stemcell defect – Apastic anaemia • Bone marrow suppression – Drugs – Infections eg malaria, dengue, HIV • Ineffective haemopoiesis – Megaloblastic anaemia – Myelodysplastic syndrome
- 8. Production failure • Bonemarrow infiltration – Haematological malignancy – Non haematological malignancy • Marrow fibrosis – Primary – Secondary • Haemophagocytic syndrome
- 9. Increased consumption • Hypersplenism •Immune cytopenia
- 10. Peripheral smear • Ovalmacrocytes, hypersegmented neutrophils – megaloblastic anaemia • Leuko-erythroblastic blood picture – marrow infiltration • Leuko-erythroblastic picture with tear drop cells – marrow fibrosis • Blast or atypical lymphoid cells – haematological malignancy • Dysplastic feature – MDS, drugs or HIV infection
- 11. Leukaemia • Pancytopenia orbicytopenia – Can it be haematological malignancy? CBC & peripheral smear • Avoid steroids prior to confirmation of diagnosis
- 12. Bone marrow aspirateand biopsy both are essential.
- 13. Acute Leukaemia • Comprisesapproximately 30 percent of all childhood malignancies • An incidence of 2.8 cases per 100,000 • The peak incidence 2-5 Yrs • Studies of the relationship between childhood ALL, urban/rural status and population density, as well as other possible etiologic factors (eg, environmental exposures, abnormal immune response to common infections) have yielded inconsistent results
- 14. Acute leukaemia • Persistentor progressive lymphadenopathy that does not respond to antibiotic therapy suggests the need for more extensive evaluation.
- 15. Differential diagnosis • Juvenileidiopathic arthritis • Osteomyelitis • Epstein-Barr virus • Idiopathic thrombocytopenic purpura • Pertussis, parapertussis • Aplastic anemia • Acute infectious lymphocytosis • Other malignancies with bone marrow involvement (eg, neuroblastoma, retinoblastoma, rhabdomyosarcoma, and Ewing sarcoma
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- 31. Prognostic factors • Age •Initial WBC count • Cytogenetics • Immunologic subtype • Response to initial therapy
- 32. Risk groups • Lowrisk — 92 percent • Standard risk — 82 percent • High risk — 73 percent • Very high risk — 46 percent
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- 38. Acute lymphoblastic leukaemia •INDUCTION THERAPY – To eradicate more than 99 percent of the initial burden. – to restore normal hematopoiesis – Usually last for 4-5 weeks • Intensification (consolidation) therapy – High dose methotrexate – Reinduction therapy • CNS targeted therapy – Intrathecal chemo, cranial RT, High Mtx • Maintenance therapy – Oral 6MP and Mtx • Allogenic bone marrow transplantation
- 39. Acute myeloid leukaemia •Induction therapy – Cytarabine (7 days) & Daunorubicine (3days) • Consolidation therapy – 3-4 cycles of high dose cytarabine • Autologous and allogenic bone marrow transplantation
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- 42. Minimal residual disease Techniqueand criterion Blasts per 100,000 nucleated cells Standard microscopy ("complete remission") 5,000 Karyotype analysis (20 mitotic figures) 5,000 Microscopy, expert 1,000 Immunophenotyping: multi- parameter flow cytometry 10 Colony growth 1 Polymerase chain reaction 0.1