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leukemia

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Title: PowerPoint Presentation Last modified by: apple Created Date: 1/1/1601 12:00:00 AM Document presentation format: Other titles – PowerPoint PPT presentation

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Title: leukemia


1
???????????
  • ? ? ?

leukemia
???
2
???
  • ? ?
  • ?????????????????????
  • ???????????????????,?????????????????????,??????
    ???
  • ?????????????????????????????????????????????
    ???????????????
  • ????????????????????????????

3
???.??
  • ????
  • ??????2.76/10?,????????6?(?)??8?(?),???35???????
    ?1?????????,?????,????,?gt??
  • ???????,?????????????????????????,?????

4
???.??
  • ???????
  • ??HTLV-1?EBV,HIV ?
  • ????X-????-???????,???????????(??????)???,??????
  • ????????????????? ????????????????????????????
    ??,?????????????????
  • ????????? 21????????????ph???????
  • ?????MDS?MM?PNH?MPD?Lymphoma??

5
  • ?????

???
????
  • ???????
  • ??????,??????????(??? ?????)????????????
  • ???????????????? ?,??????

6
????
  • ?????
  • ????????
  • ???????????????????,??????
  • ????????????,???????????,?????,???????
  • ??????????????,?????????????,M3???DIC,??
    ???????

7
?????
  • ??????????
  • ???????????????????,??????????
  • ????????G????,?????????????

8
????
  • ?????
  • ?????????
  • ??????????????????,??????????????
  • ???????????????????????????ANLL???????
  • ?????M4?M5?????????,????,???????????????
    ?????????

9
????
  • ?????
  • ?????????
  • CNS??????????????? ??,??????,?????,?ALL
    ? ??,????????????????????,?????????
  • ??????CNSL???????,????????,????,?????????
  • ?????,???,???,????????????????

10
?????
  • ?????
  • ??
  • ????????,?????,??10010
    e9/L??,??????????????,??110 e9/L??,?????,???????
    ?????????
  • ?????????????????,??????????????,???????

11
?????
  • ?????
  • ???
  • ??????,????????,?????(???????????,?????
    ?????),???????
  • ??????????? 30???
  • ????AL????,?????30
  • Auer?????ANLL,???M3?

12
?????
  • ?????
  • ??????

???? ?? ??
?? ?????? (POX) (?)
- ???????? (NSE)
(?) -
???? (PAS)
-
(??NaF??)
13
?????
  • ?????(POX)??
  • ???????????????????????????????,??????
    ????????,?????POX??????N?gt98,???350-400?E???,B???
    ????,????????????????
  • ????AML-M2???????????gt20,?????????(
    ),M0?M1???(-)?M3????M4??,???????????????M5??????,
    ?????????????????POX??????????

14
?????
  • ?????????(SE)???????(NSE)
  • ????SE????????,???AS-D?????,????????????
    ???????SE?NSE????????,????????NaF???

15
?????
  • ??????????(NAP)
  • ???????????????????NAP???10-40,???7-51
    ?
  • ????
  • (?)??????????,??????????????? ?,?????????
  • (?)??????????
  • 1.CML????????????????,???????
    ??,????????????????
  • 2.AA?PNH????,?????????
  • 3.???????????????????,????????

16
?????
  • ????(PAS)
  • ????????????????,?????????,??????????????
    ??????????????????????
  • ????????????????????????????????????????
    ???????????
  • ????????????????????????????????????????
  • ????????????????????????????,MDS?????????
    ???????????????

17
?????
  • ?????
  • ?????????????????,????????????????(?6-9-2)?
  • ????????M3 t(1517)(q22q21)??PML/RARa????,??A???
    ????????
  • ?-???????????
  • ???????????????????

18
? ?
  • ?????

?????????BR?BM?MICM??
??FAB?????????????
  • ?? L1???????
  • L2???????
  • L3???????
  • ?????8?M0M7

19
? ?
  • ?????
  • M0????????????
  • M1????????90
  • M2??????????30-89
  • M3?????????????30
  • M4??-??????gt30,??gt20
  • M5?????????80
  • M6????????50,????30
  • M7????????????30

ANLL
20
?????
M1, Bone marrow smear, May-Giemsa stain x1000
21
?????
M2, Bone marrow smear, May-Giemsa stain x1000
22
?????
M3, Bone marrow smear, May-Giemsa stain x1000
23
?????
M4, Bone marrow smear, May-Giemsa stain x1000
24
?????
M5, Bone marrow smear, May-Giemsa stain x1000
25
?????
M6, Bone marrow smear, May-Giemsa stain x1000
26
?????
M7, Bone marrow smear, May-Giemsa stain x1000
27
  • ?????

? ?
  • WHO??AML??
  • AML?????????
  • AML???????
  • AML?????
  • AML???(????)

28
  • ?????

? ?
  • AML?????????
  • AML?t(821)(q22q22)(AML1/ETO)
  • AML???????????inv(16)(p13q22)?t(1616
    )(p13q22)?
  • M3(AML?t(1517)(q22q12) (PML/
    RARa???)
  • AML?11q23(MLL)??

29
? ?
  • ?????
  • AML???????
  • ???MDS???????/???????
  • ???MDS
  • AML?MDS ,?????
  • ?????
  • ???????????(????????)
  • ??

30
? ?
  • ?????
  • AML,????(??FAB??)
  • M0 AML, ????
  • M1AML, ????
  • M2AML,????
  • M4??-?
  • M5 M5a ? M5b
  • M6??????
  • M7?????????
  • ???????????
  • ????????????
  • ????

31
  • ?????

????
  • MDS??????30?
  • ??????,??,???,???,???????????
  • ???????????
  • ???????????????????
  • ???????????

32
? ?
  • ?????

???? (1)?????????? (2) ???? (3)
???? (4) ????,M3?????DIC (5)
??????? (6) ???????? (7) ?????
33
? ?
  • ?????

???? ??????WBC????????????
????????????????? ???????????,??????
??????????,????,????? ?????,?????
34
? ?
  • ?????
  • ??????
  • ????????
  • ??????????????????????????????????????????????

35
? ?
  • ?????
  • ????
  • ??????????
  • ?????????????????????????????
  • ?????????
  • ???????????,????????????????????
  • ??CR????????,??????????

36
????
?????
  • CR1)???????????(?????????????????)5,??????
    ?????.M2b???????5,??????????????.M3??????
    5.M4????????????????5.M6???????5,???????
    ?????????.M7??\???????,????????????.     2)??Hb
    100g/L(?)?90g/L(????),????????1.510(9)/L,???1
    0010(9)/L,????????????. 3)????????????????,??????
    ???.       
  • PR??????????????(?????????)gt5?20??????2?
    ??1??????????.
  • NR?????????3??????????

37
????
?????
? ?????????CR ? ??????????????
?????????????? ??CR??????5,?????
????????HSCT?
38
?????
ALL???
  • ????
  • VP?VDPCR??80-90

  • ??50,????
  • VDLP??CR????72-78
  • ?????CNSL?

39
?????
ALL???
  • ?????
  • ????1?4????????
  • 2?5???EA??
  • 3?6??????MTX(?CF4??)
  • ???6-MP?MTX????
  • ?????????????,??????
  • HSCT????????????

40
?????
AML???
  • ????DACR85(?IDA)
  • HOAP?HACR60-80
  • ???????????4-6???????Ara-c ????????,?????D?M?
    ?????
  • ???????1-2??????????,???????

41
?????
??????
  • ??????,???????,??????
  • ???????????,????Ara-?HHT?CAG??,???????MDS??????
    ??????????

42
?????
??????
  • ?????????WBC???(???????DXM),??????
  • ??????????Ara-c,??????????
  • APL????A??????????

43
?????
????????
  • ?????????????????,????????????,CNSL??????,??MTXD
    XM??????,??CNSL?????Ara-c?
  • ????????(????)?????,???,??????

44
?????
  • ???????
  • ?????????????,?????

BMT/HSCT ???????,????AL
?????? ????? ??????????????
45
?????
? ?
  • ??????3?,????????
  • ????CR???????
  • 1-9?ALL?WBClt50109/L?Ptgt30109/L?APL?????
  • ??????????????

46
???????? (chronic myelogenous leukemia CM L)
????
  • ??????1525?
  • ?????3040???,20?????,????????
  • ????????(???)????(???)?????

???
47
????
  • ???? ?????(?70)????????????????,????????????
    ????????????????????
  • ?? ??????,?????????????????????
  • ????????

48
????
  • ?????????????????
  • ?????????????,??????,???????,?????,??????????????
    ??
  • ????????????
  • ????????

49
?????
? ?
  • Hb??Hb??????,??????????
  • WBC??2040?/mm3(200400109/L)???100?,???90??,??
    ??????????,?????????E?B????????,???lt10?
  • ???????????
  • ???????????????
  • ????????

50
Here is a view of a peripheral blood smear
in a patient with CML. Often, the numbers of
basophils and eosinophils, as well as bands and
more immature myeloid cells (metamyelocytes
and myelocytes) are increased. Unlike AML, there
are not many blasts with CML.
51
?????
????
?????????,???????,??????,??lt10?B?E??
????????
  • ????????

52
?????
?????????????
  • 90??????????? Ph????t(922) (q34
    q11),?9???????C-ab1???????22????????????bcr/abl???
    ??
  • Ph??????????????????
  • ????????

53
Myeloid cells of CML are also characterized
by the Philadelphia chromosome (Ph) on
karyotyping. This is a translocation of a portion
of the q arm of chromosome 22 to the q arm of
chromosome 9, designated t(922).
54
?????
????
  • vit B12???vit B12???????,???????,????????????????
    ???????????
  • ?????,???????????
  • ????????

55
? ?
  • ??????????,????????????????,??????????
    ??????
  • ??????
  • ??WBC?,?????,??lt10,E?B??BM????,??lt15,
    B?E??AKP?
  • ?Ph()????????????????lt10 ??6????4?????????
  • ????????

56
????
  • Ph???????????
  • ?????????
  • ??????
  • ?????
  • ????????

57
????
  • ???
  • ???
  • ???

??????????
  • ????????

58
????
  • ???

????????????,??,????????? ??WBC?,???????????????
?,????lt10,??????????,????????? ???????,?????,???
???????????,????lt10? CRU-GM???????????????
  • ????????

59
????
  • ???

???????,?????
???????,???????,??????? ?????????????????????? ???
?????????1020 ???????????gt20?????????????? ???P
h??????????? ???????????????? ?CFU-GM??????,??????
?????
  • ????????

60
????
  • ???

?????????????,????????????
????????????????,???????????gt20 ??????????????
gt30 ?????????????gt50 ????????????????????
  • ????????

61
? ?
??????
??? ??? ???Ara-c ????
????
  • ??

????????????????AMN107?????
??????
  • ????????

62
? ?
??????
  • a-???,?????,???ph()????(-)?
  • ????????????????????
  • ????????????????
  • ????????
  • ?????
  • ????????

63
? ?
??????,???????,?????????
??????
  • ????????

64
? ?
?????????3947???5????2550,?????1020??
  • ????????

65
????????? (chronic lymphocytic leukemia CL
L)
????
  • 90????50?????,????????
  • ???????????,????????? ?????????????
  • ???????,??????

???
66
????
  • 50???????,?????????
  • ?8?????????????????
  • ????????,?????

?????????
67
?????
? ?
  • WBCgt10109/L,???30100109/L,????????????gt50,???
    ?gt90,???????5109/L??,??4????????????,??????????
    ? ???????????
  • Hb??Hb??????,??????????,??????????
  • pt????

?????????
68
?????
????
????,??????????gt40,?????????,????????
???
?????????
69
CLL,Bone marrow smear, May-Giemsa stain, x1000
70
?????
????? ??????????,????(r)?????
??? ??50?????????B?????12?14q???,T?
????inv(14)????
  • ?????????

71
????
  • A? ??????,?lt3??????? ????
  • B? ??????,?3??3?????????????
  • C? ?B??,???????????

?????????
72
???????
?????????????????,???5109/L,??????gt40,
?????????????????????????????????????,?????,??????
?
?????????
73
? ?
  • ?? A???????,?????
    B??C??????
  • ?? ??????????????????, ?CTX ????
  • ??????,????????????
  • ????????????,?????,??????????
  • ?????????

74
? ?
??????,???10??,???34?????????????????????
?????
  • ?????????

75
??!
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