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1. RATHEESH R.L

2. Group of malignant disorders affecting
the blood and blood forming tissues of
the bone marrow, lymph system and
spleen
OR
Leukemia is a cancer of blood forming
cells in the bone marrow.

3. The exact cause is still unknown
The risk factors include,
 Genetic and environmental factors
 Chromosomal changes( down syndrome)
 Chemical agents, chemotherapeutic
agents

4.  Viruses
 Radiation and chemotherapy
 Immunologic deficiencies
 near nuclear bomb sites
 Family history of leukemia

5. Acute Vs chronic
Based on the type of WBC involved

6. Acute leukemia
Characterized by proliferation of
immature hematopoietic cells.
The bone marrow will not produce
healthy blood cells.
Immediate treatment is required to
avoid rapid progression

7. Chronic leukemia
 Involve more mature forms of WBC and
the disease onset is more gradual
 The cells are produced at a higher rate than
the normal, resulting in many abnormal
white cells in the blood.
 Mostly occurs among old people

8. Acute myelogenous leukemia(AML)
Acute lymphocytic leukemia(ALL)
Chronic myelogenous leukemia(CML)
Chronic lymphocytic leukemia(CLL)

9.  Represents only one fourth of all leukemias
 Onset is abrupt
 Increase in incidence with advancing age,
peak incidence between 60 and 70 years of
age
 Characterized by uncontrolled proliferation of
myeloblasts( precursor of basophils and
esnophils)

10.  Clinical manifestations
 Fatigue
 Weakness
 Headache
 Mouth sores
 Anemia
 Fever
 Sternal tenderness
 Gingival hyperplasia
 Minimal hepatosplenomegaly
 Lymphadenopathy

11. Diagnostic findings
Low RBC count
Low Hb, Hct, Platelet
Low to high WBC count with
myeloblasts
Bone marrow aspiration
marked increase in myeloblasts

12. Most common type of leukemia in
children
Peak incidence between 2 and 9
years of age an in older adults
Immature lymphocytes proliferate in
the bone marrow

13.  Clinical manifestations
 Fever
 Pallor
 Anorexia
 Fatigue and weakness

14.  Bone, joint and abdominal pain
 Lymphadenopathy
 Weight loss
 Hepatosplenomegaly
 Headache
 Mouth sores

15. Neurologic manifestations( leukemic
meningitis)
Nausea, vomiting, lethargy, cranial
nerve dysfunction

16. Diagnostic findings
Low RBC count, Hb,Hct
Low platelet count
Low, normal or high WBC count
Hypercellular bone marrow with
lymphoblasts (an abnormal cell
resembling a large lymphocyte)

17.  Lymphoblasts present in the CSF
 Presence of philadelphia chromosome
(The Philadelphia
chromosome or Philadelphia translocation is a
specific genetic abnormality in chromosome 22
in case of leukemia cancer cells)

18.  Accounts for 15% to 20% of all cases of
leukemia
 Associated with benzene exposure and
high doses of radiation
 Seen between 20 and 60 years of age

19.  Caused by excessive development of mature
neoplastic granulocytes(a white blood cell with
secretory granules in its cytoplasm, e.g. an
eosinophil or a basophil) in the bone marrow
 Excessive neoplastic granulocytes in the
peripheral blood infiltrate liver and spleen

20. Cells contains philadelphia
chromosome(serves as the disease
marker)
Results from the translocation of
genetic material between
chromosomes 9 and 22
It has a chronic stable phase,
followed by the development of a
more acute, aggressive phase
referred to a the blastic phase

21.  Clinical manifestations
 No symptoms early in the disease
 Fatigue and weakness
 Fever
 Sternal tenderness
 Weight loss
 Joint pain
 Bone pain
 Massive splenomegaly

22.  Diagnostic findings
 Low RBC count
 Low Hb, Hct
 Normal no of lymphocytes, normal or low
no of monocytes
 Presence of philadelphia chromosome

23. Common leukemia in adults
Seen between 50 to 70 years of age
Characterized by the production and
accumulation of functionally
inactive but long lived small mature
appearing lymphocytes

24.  Lymphocytes infiltrate bone marrow,
spleen and liver
 Lymph node enlargement present
 Increased incidence of infection (T cell
deficiency)

25. Clinical manifestations
Chronic fatigue
Anorexia
Splenomegaly and
lymphadenopathy
Hepatomegaly
Fever
Weight loss
Frequent infections

26. Diagnostic findings
Mild anemia and thrombocytopenia
with disease progression
Total WBC count > 100,000|micro
litre
Increase in peripheral lymphocytes
Increase in the presence of
lymphocytes in bone marrow

27. Chemotherapy
First stage : Induction therapy (
attempt to induce or bring about a
remission)
Second stage: post induction or post
remission chemotherapy
* intensification
* consolidation
* maintenance therapy

28.  Seeks to destroy leukemic cells in the
tissues, peripheral blood and bone
marrow in order to restore normal
hematopoiesis
 Chemotherapeutic agents cytarabine
and anti tumour antibiotics(
daunorubicin, doxorubicin, idaribicin)

29. Intensification therapy
Given immediately after induction
therapy for several months
Includes the same drugs as those
used in induction but at higher
dosages

30.  Consolidation therapy
 Started after a remission is achieved
 Consists of one or two additional courses
of the same drugs given during induction
or involve high dose therapy
 Purpose eliminate remaining
leukemic cells that may or may not be
clinically evident

31. Maintenance therapy
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

32.  In addition to chemotherapy,
corticosteroids and radiation therapy are
used
 Total body radiation used to prepare a
patient for bone marrow transplantation
 In ALL prophylactic intrathecal
methotrexate or cytarabine ( given to
decrease the chance of CNS involvement)
 CNS leukemia cranial radiation

33.  Alkylating agents : Busulfan, chlorambucil,
cyclophosphamide
 Anti tumour antibiotics : daunorubicin, doxorubicin,
mitoxantrone, idarubicin
 Anti metabolites: cytarabine, 6-mercaptopurine,
methotrexate, fludarabine
 Corticosteroids: Prednisone, betamenthasone
 Nitrosoureas: carmustine
 Mitotic inhibitors: vincristine, vinblastine

34.  BIOLOGICAL THERAPY
it is used to help the immune
system to recognize and attack leukemia cells.
Eg: Rituximab, Gemtuzumab ozogamicin

35.  TARGETTED THERAPY:
In targetted therapy uses drugs
that attacks the specific vulnerabilities with in
cancer cells.
Eg: imatinib

36.  RADIATION THERAPY
radiation therapy uses X-Rays or other
high energy beams to damage the leukemia
cells and to stop their growth.

37.  STEM CELL TRANSPLANTATION
it is a procedure to replace diseased
bone marrow with healthy bone marrow.

38.  Assess the general condition of the patient
 Closely monitor the lab values
 Maintain good IPR with the patient
 Provide psychological support
 Instruct the patient to have a well balanced
diet
 Monitor vital signs

39.  Include family members also in providing
care
 Explain the side effects of chemotherapy and
radiation therapy
 Administer antibiotics
 Maintain aseptic techniques while doing the
procedures
 Proper isolation of the patient
 Provide health education to the patient

40.  Imbalanced nutrition less than body requirement
related to inadequate nutritional intake and
anorexia
 Activity intolerance related to weakness and
imbalance between oxygen supply and demand
 Impaired oral mucous membrane related to low
platelet count

41.  Ineffective therapeutic regimen management
related to lack of knowledge of disease
process, activity and medication
 Risk for infection related to bone marrow
depression