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Chronic myeloid leukaemia

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Chronic myeloid leukaemia ... Unknown Atom bomb exposure Japan Chronic myeloid leukaemia About 4,400 new cases of chronic myelogenous leukemia (CML) ... – PowerPoint PPT presentation

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Title: Chronic myeloid leukaemia


1
Chronic myeloid leukaemia
2
Chronic myeloid leukaemia
  • THE STORY OF CHRONIC MYELOID LEUKAEMIA
  • It is moreover, the same conclusion which
    Bennett came to in the much-discussed matter of
    priority between us when he observed a case of
    indubitable leukaemia, some months before I saw
    my first case'. With these words, spoken at a
    lecture in Berlin in 1858, Robert Virchow
    generously acknowledged that John Hughes
    Bennett's description of chronic myeloid
    leukaemia in Edinburgh in 1845 preceded his by a
    short period and called a truce to the unseemly
    controversy which had marred its discovery.

Rudolf Virchow (1821-1902)
3
Chronic myeloid leukaemia
  • The patient , a 49yr old teacher, saw her family
    physician because of fatigue for about six
    months.
  • Physical exam. Showed little except for pallour,
    normal temperature
  • Blood tests were ordered to investigate possible
    anaemia

4
Chronic myeloid leukaemia
  • Laboratory results indicated a high white count
    consistent with Chronic Myeloid Leukaemia

5
Chronic myeloid leukaemia
  • Sex 1.41 (mf)
  • 40-60 yrs old
  • Aetiology?
  • Unknown
  • Atom bomb exposure Japan

6
Chronic myeloid leukaemia
  • About 4,400 new cases of chronic myelogenous
    leukemia (CML) are diagnosed each year in the
    United States.

15 of leukaemas
7
Chronic myeloid leukaemia
  • Clinical features
  • Wt loss, lassitude anorexia night sweats
  • Splenomegaly
  • Anaemia pallor dyspnea tachycardia
  • Bruising epistaxis menorrhagia
  • Gout renal impairment
  • Incidental finding (CBC)

8
Chronic myeloid leukaemia
  • Laboratory findings
  • Leukocytosis gt50 x 109/L-?500
  • Spectrum of myeloid cells
  • Neutrophils myelocytes exceed blasts and
    promyelocytes
  • Increased basophils
  • Anaemia
  • Hypercellular marrow
  • Ph chromosome

9
Chronic myeloid leukaemia
  • Hypercellular
  • Myeloid cells
  • All stages
  • Shift to early forms
  • Less than 20 blasts

10
Chronic myeloid leukaemia
  • CAT scan
  • Very large spleen

11
Wt 3kgs
Normal c200gms
SplenomegalyCML
12
Blast transformation
Chronic myeloid leukaemia
13
Chronic myeloid leukaemia
blood
Blast cell crisis
marrow
14
Chronic myeloid leukaemia
  • Other studies
  • Flow cytometry
  • Myeloid markers
  • Maturity markers
  • Cytogenetics
  • Chromosome studies
  • FISH
  • RT-PCR

15
Chronic myeloid leukaemia
  • In 1960, two physicians studying chromosomes in
    cancer cells noticed that a chromosome in CML
    patients was shorter in length than that of the
    same chromosome in normal cells. They named this
    shortened chromosome the Philadelphia chromosome,
    because the observation was made at the
    University of Pennsylvania School of Medicine in
    that city.

Janet Rowley
Peter Nowell
16
Philadelphia
17
Chronic myeloid leukaemia
18
The Philadelphia Chromosome
Chronic myeloid leukaemia
19
Chronic myeloid leukaemia
  • Chromosomal banding at a microscopic level
    confirming the translocation
  • Miss-placed genetic information
  • Marker for CML

20
Chronic myeloid leukaemia
  • Chromosomal banding at a microscopic level
    confirming the translocation
  • Miss-placed genetic information
  • Molecular changes
  • Marker for CML

21
Chronic myeloid leukaemia
  • Treatment
  • Chronic phase
  • 5-6 yrs.more
  • Older regimens
  • New regimens
  • Acute blast phase
  • Brief survival 12 months

22
Chronic myeloid leukaemia
  • Death caused by
  • Acute transformation
  • Haemorrhage
  • Infection

23
Chronic myeloid leukaemia
  • References
  • Clinical features at diagnosis in 430 patients
    with CML seen at a referral centre over a 16yr
    period. Savage et al Br J Haem 1997 96, 111-116.
  • Chronological sequence in Appearance of Clinical
    and Laboratory findings Characteristic of CML.
    Kamada N, Uchino H, Blood 1978 51, 843-850.
  • The Story of CML. Geary C.G. Br J Haem 2000 110,
    2-11. (historical review)

24
Chronic myeloid leukaemia
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