CHRONIC MYELOMONOCYTIC LEUKEMIA.pptx
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This document describes a case of a 43-year-old male diagnosed with chronic myelomonocytic leukemia (CMML). His symptoms included abdominal distension, weight loss, fever, and bleeding tendencies. Investigations found elevated white blood cell and monocyte counts, hepatosplenomegaly, and bone marrow findings consistent with CMML. He received supportive care including transfusions and hydroxyurea. Prognosis in CMML can vary depending on risk factors like ASXL1 mutations. Treatment options include hypomethylating agents like decitabine and azacitidine, as well as targeted therapies for mutations like low-dose imatinib for PDGFRB mutations.
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Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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CHRONIC MYELOMONOCYTIC LEUKEMIA.pptx
- 2. OUTLINE • CASE • INTRODUCTION • DIAGNOSIS • RISK STRATIFICATION • TREATMENT OPTIONS
- 3. CASE SCENARIO • S.C 43 year old male • Presented with a history of abdominal distension over 7 months associated with early satiety and symptoms of anemia requiring multiple transfusions • History of weight loss ,intermittent fever , night sweats • Had episodes of bleeding tendencies (epistaxis and intermittent bloody stools) • PMH: no DM/Asthma/HTN/Epilepsy/TB HIV neg • PSH /Allergies :nil
- 4. CASE SCENARIO • On examination : Alert pale temporal wasting • Chest: clear lung fields normal heart sounds • P/A: distended soft non tender hepatomegaly 5cm Splenomegaly 20cm • No cervical, axillary or groin lymphadenopathy • No pedal odema
- 5. INVESTIGATIONS • FBC WBC 118.4 HB 3.4 PLT 18 Lymphocytes 15.4 Monocytes 94.7 neutrophils 6.3 • Repeat FBC WBC 94.5 HB 8.6 PLT 55 Lymphocytes 43.5 Monocytes 39.7 neutrophils 5.3 • Normal Renal function • Normal Liver Function • Abdominal USS: hepatomegaly no focal lesions , splenomegaly measuring 22 cm in largest length, normal kidneys, pancreas no comment on lymph nodes • CXR : mediastinal enlargement ,no pleural effusion, no lesions suggestive of lung metastasis
- 6. INVESTIGATIONS • BCR-ABL not done as reagents out of stock • Bone marrow Aspirate and trephine (case discussed on telepathology conference 27/06/22) • Features are those of left shifted granulocytes and mononuclear cells with fibrosis in keeping with myeloproliferative neoplasm • IHC-CD20 negative • IHC-CD3 negative • IHC-MYELO positive • IHC-TDT negative • Peripheral blood film • Increased blasts consistent with Chronic Myelomonocytic Leukemia
- 7. MANAGEMENT • Supportive care • Transfusions • Received multiple of blood transfusions(red packed cells ,whole blood) , platelets , • Hydroxyurea • Infection control • Recently been started on imatinib • showed some clinical benefit
- 8. CMML
- 9. CMML
- 10. CMML • The most frequently occurring MDS/MPN (0.4 per 100 000) • Among the most aggressive myeloid leukemias (Median OS of 34mo)
- 16. Prognosis • Multiple molecularly integrated prognostic models • Most models are comparable • ASXL1 universally detrimental • Working group addressing a unified approach
- 19. • Cure rates 30-40% • Usually only 5- 10% eligible • Associated increased morbidity and mortality
- 21. HYPOMETHYLATING AGENTS (HMA) •Two types of HMS: Decitabine (given 5 days) and Azacitidine (given 5-7 days) on 28 days interval… IV OR SC •Choice of drug usually dependent on local clinical guidelines •Cause constipation and temporary lowering of blood counts •Work about 3 months after starting treatment
- 23. TREATMENT • IN CMML +/- eosinophilia (Check PDGFRB mutation) • Mutation present –respond to low dose Imatinib
- 28. • THANK YOU
Editor's Notes
- Monocytes 79.9% lymph 13%
- ASXL1 an independent marker for adverse effects TET2 ,SRSF2 97% SPECIFICITY
- HIGH RISK hb<10 plt <100 wbc >15 +ASXL1 Age >65 CPSS (intermediate risk or high risk ) recommended for HSCT
- Observation: 2 to 4 weekly bloods and follow up
- 40% chronic GVHD Adverse effects low KPS, High risk, graft type (BM)
- Phase 3 GFM topotecan vs hydrea (won)…(reduce wbc plus spleen)
- No prospective CMML specific studies