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LEUKEMIA

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leukemia clonal disorder 8-10 /100.000 pathogenesis: unknown leukemia chronic acute cml cll ... – PowerPoint PPT presentation

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Title: LEUKEMIA


1
LEUKEMIA Dr MOKARIAN ICM 83/2/15
2
LEUKEMIA CLONAL DISORDER 8-10
/100.000 PATHOGENESIS UNKNOWN
3
LEUKEMIA CHRONIC
ACUTE CML CLL
AML ALL ADULT
ADULT 90 OF ADULT
10 OF ADULT
10OF
CHILD 90OF CHILD


4
LEUKEMIA APPROUCH TO LEUKOCYTOSIS MATURE
MATURE IMMATURE
IMMATUR MYLOID LYMPHOID
MYLOID LYMPHOID LEUKEMOID CML
AML
ALL REACTION
LEUKOMOID RECTION CLL
5
  • LEUKEMIA
  • SYMPTOM SIG
  • OF ANEMIA
  • OF THROMBOCYTOPENIA
  • OF LEUKOPENIA
  • OF BON MARROW EXPANTION
  • OF ORGAN DEPOSITION
  • OF INCREASED WBC
  • OF ELECTOROLITE DERANGMENT

6
LEUKEMIA APROUCH TO LEKOCYTOSIS MIC
METHOD LIGHT MICROSCOPY IMMUNOHISTOCHEMISTRY
CYTOGENETIC FLOCYTOMETRY
HISTOCHIMISTRY
AB CHROMOSOME
CML Phi
ALL Phi t(8-14)
AML T(15-17) T(9-11)
CLL -
AML ALL
PAS -
MPO -
SB -
NSE -
SE M4 M5
7
H history from patient with leukemia
Increasing fatigue or decreased exercise
tolerance (anemia) Excess bleeding or bleeding
from unusual sites (DIC, thrombocytopenia) Fevers
or recurrent infections (granulocytopenia) Headach
e, vision changes, nonfocal neurologic
abnormalities (CNS leukemia or bleed) Early
satiety (splenomegaly) Family history of AML
(Fanconi, Bloom or Kostmann syndromes or ataxia
telangiectasia) History of cancer (exposure to
alkylating agents, radiation, topoisomerase II
inhibitors) Occupational exposures (radiation,
benzene, petroleum products, paint, smoking,
pesticides
8
physical Examination Performance status
(prognostic factor) Ecchymosis and oozing from IV
sites (DIC, possible acute promyelocytic
leukemia) Fever and tachycardia (signs of
infection) Papilledema, retinal infiltrates,
cranial nerve abnormalities (CNS leukemia) Poor
dentition, dental abscesses Gum hypertrophy
(leukemic infiltration)(M4) Skin infiltration or
nodules (leukemia infiltration)(M4) Lymphadenopath
y, splenomegaly, hepatosplenomegaly Back pain,
lower extremity weakness spinal granulocytic
sarcoma, most likely in t(821) patients
9
CHRONIC MYELOGENOUS LEUKEMIA
10
CHRONIC MYELOGENOUS LEUKEMIA
  • PATHOGENESIS
  • PHILADELPHIA CHROMOSOM
  • ABL / BCR GENE
  • THYROSIN KINASE
  • ETHIOLOGY UNKNOWN

11
CHRONIC MYELOGENOUS LEUKEMIA
  • PRESENTATION
  • SYMPTOME
  • SIGN
  • PHASE OF DISEASE
  • CHRONIC PHASE
  • ACCELERATED PHASE
  • BLASTIC PHASE
  • DIAGNOSIS

12
CHRONIC MYELOGENOUS LEUKEMIA
TREATMENT HYDROXYURAE INTERFERON BONE
MARROWWWW TRANSPLANTATION GLIVEC SUPORTIVE CARE
13
CML
14
CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)
15
CHRONIC LYMPHOCYTIC LEUKEMIA(CLL)
CLINICAL FINDING ASYMPTOMATIC 40 SYMPTOMATIC
FATIGUE
BLEEDIN TENDENCY ILLBEING
F8 DEF FEVER
VWF DEF LAP

THROMBOCYTOPENIA
HEPATOSPLENOMEGALLY AUTOIMMUN MANIFISTATION
STERNANAL TENDERNESS ABDOMINAL MASS
SKIN INFILTERATION INFILTERATION OF TONSILS
INFILTERATION OF ORGAN
DR F MOKARIAN
16
CHRONIC LYMPHOCYTIC LEUKEMIA(CLL)
INTERNATIONAL CLL WORKSHOP DIAGNOSTIC
CRITERIA 1- LYMgt 10000 2-BMA
LYM gt 30 A 1
2 OR 3 3- MONOCLONAL B- CELL
B 23 NCI-SPONSORED CLL WORKING GROUPED
1- LYMgt 5000 LESS 55 ATYPICAL LYM
B-CELL MARKER
CD5 ( CD19 CD20 CD24 ) 2-
MARROW LYMgt30
DR F MOKARIAN
17
CHRONIC LYMPHOCYTIC LEUKEMIA(CLL)
DIFFERENTIAL DIAGNOSIS INFECTION CAUSES
MALIGNANT CAUSES
BACTERIAL ( eg TB)
B CELL VIRAL ( IM)
PLL
HYPERREACTIVE MALARIA NHL
SPLENOMEG(HMS)
HCL
T CEL

PLL

NHL
HCL

LGL L
DR F MOKARIAN
18
CHRONIC LYMPHOCYTIC LEUKEMIA(CLL)
PRETREATMEN INVESTIGATION CBC PBS
RET COOMBS TEST LDH LFT
KFT SPEP IEP B2 MICROGLOBULIN
IMMUNOPHENOTYPING BMA
CYTOGENETIC ANALYSIS
DR F MOKARIAN
19
CHRONIC LYMPHOCYTIC LEUKEMIA(CLL)
RAI CLASSIFICATION STAGE MODIF STAGE
DESCRIPTION MS (YR)
0 LOW RISK LYM
gt10
1 INTERMED RISK LYM LAP
gt8 2
INTERMED RISK LYM SPL/-LAP
6 3 HIGH RISK
LYM ANEM/- LAP OR SPL 2 4
HIGH RISK LYM THROM
2
/- ANEM /- SPL /-
LAP LYM gt 5000 gt4WEAK HBlt11 PLTlt
100000
DR F MOKARIAN
20
CHRONIC LYMPHOCYTIC LEUKEMIA(CLL)
BINET CLASSIFICATION FOR CLL

INVOLVED MS SRAGE
BLOOD COUNTS AREA
(YRS) A HBgt10
lt3
gt10
PLTgt100000 B HBgt10
gt3
7
PLTgt100000 C HBlt10
ANY NUMBER 2
PLTlt 100000 FIVE
AREA OF INVOLVEMENT HN AXILLA
GROINS SPLEEN HEPATOMEG
DR F MOKARIAN
21
CHRONIC LYMPHOCYTIC LEUKEMIA(CLL)
SUMMARY OF TREATMENT INDICATION OF CCR
CHLORAMBUCIL OR FLUDARABIN PREDNISOLON
RADIOTHERAPY SPLENECTOMY GAMMAGLOBULIN
DR F MOKARIAN
22
CHRONIC LYMPHOCYTIC LEUKEMIA(CLL)
  • MARKERS OF POOR PROGNOSIS IN CLL
  • ADVANCE STAGE
  • DOUBLING TIME lt12 M
  • DIF MARROW INVOL
  • PROLYM OR CLEAVED CELL INCREASED
  • POOR RESPONSE TO CCR
  • HIGH B2 MG LEVEL
  • ABNORMAL CARYOTYPE
  • P53 MUTATION

DR F MOKARIAN
23
CLL
24
ACUTE MYELOGENOUS LEUKEMIA
CLASIFICATION LEUKOSTASIS DIAGNOSIS TREATMENT
SUPORTIVE CARE CHEMOERAPY INDUCTION OF
REMMISION CONSULIDATION MAINTENANCE
25
(No Transcript)
26
World Health Organization Classificationb I. AML
with recurrent cytogenetic translocations AML
with t(821)(q22q22)AML1(CBFa)/ETO Acute
promyelocytic leukemia AML with
t(1517)(q22q12) and variants PML/RARa AML
with abnormal bone marrow eosinophils
inv(16)(p13q22) or t(1616)(p13q22)
CBFb/MYH1 AML with 11q23 (MLL) abnormalities II.
AML with multilineage dysplasia With prior
myelodysplastic syndrome Without prior
myelodysplastic syndrome III. AML and
myelodysplastic syndrome, therapy-related Alkylati
ng agent-related Epipodophyllotoxin-related Other
types IV. AML not otherwise categorized AML
minimally differentiated AML without
maturation AML with maturation
27
AML
28
AML AUER ROD
29
ACUTE LYMPHOBLASTIC LEUKEMIA
CLASIFICATION LEUKOSTASIS DIAGNOSIS TREATMENT
SUPORTIVE CARE CHEMOERAPY INDUCTION OF
REMMISION CONSULIDATION MAINTENANCE
30
ALL
31
Classification of Acute Lymphoid Leukemia (ALL) Classification of Acute Lymphoid Leukemia (ALL) Classification of Acute Lymphoid Leukemia (ALL) Classification of Acute Lymphoid Leukemia (ALL) Classification of Acute Lymphoid Leukemia (ALL)
Immunologic Subtype of Cases FAB Subtype Cytogenetic Abnormalities  
Pre-B ALL T cell ALL B cell ALL 75 20 5 L1, L2 L1, L2 L3 t(922), t(411), t(119) 14q11 or 7q34 t(814), t(822), t(28)  
NOTE FAB, French-American-British classification. NOTE FAB, French-American-British classification. NOTE FAB, French-American-British classification. NOTE FAB, French-American-British classification. NOTE FAB, French-American-British classification.
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