ACUTE LEUKEMIA

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ACUTE LEUKEMIA

• Dr.Huda al abd alkarim
• Assistant prof consultant oncologist

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DEFINITION

• Clonal malignant disorders characterized by the
  
• proliferation of abnormal (leukemia)Blast cells
  and
• impaired production of normal blood cells.

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Lymphoblast/myeloblast
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EPIDEMIOLOGY

• Incidence 5 of all new cancer cases.
• AML common in adult
• ALL most common in children
• Etiology
• Ionizing radiation.
• Benzene.
• Chemotheraputic agent(alkylating
  agent,topoisomerase II inhibitor)
• Human T-lymphocyte leukemia virus (HTLV1).
• Congenital disorder
• Down syndrome.
• Immunodeficiency syndrome.

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Clinical presentation

• Will present with sign or symptoms related to
• Pancytopenia
• ?WBC?infection.
• ?Hb ?anemia.
• ?platelets ?bleeding.
• Organ infiltration
• Lymphadenopathy.
• Splenomegally.
• Hepatomegally.
• CNS5-10 of patient with ALL

More common with ALL than AML.
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Investigations

• CBC
• 60 of pts have an elevated WBC.
• Most are anemic
• Most are thrombocytopenic
• 90have blast in the periphral blood film.
• electrolytes
• Hypo/hyper kalemia
• Hypomagnesimia
• hyperphosphatemia
• Hypermetabolism
• ?LDH.
• ?uric acid.
• DIC
• Most common with promyelocytic leukemia,small
  monocytic leukemiaALL
• Bone marrow biopsy and aspirate
• 30or more of all nucleated cells are blast.
• Radiology
• CXRmediastinal mass(T-cell ALL)
• Osteopenia or lytic lesion 50 of patients with
  ALL.(itractable pain).

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CLASSIFICATION

• Criteria
• - Morphology apperance of cell under
  microscope.
• -Cytochemistrychemical activity of the
  cell.(myeloperoxidase , Sudan Black B)
• -immunophenotyping antigen pressent in the
  cell membrane
• - Cytogenetics chromosome of the cell
• - Molecular biology
• Classification
• 3 groups of acute leukemias
• - acute myeloid leukemias AML(M1 M6).
• - acute lymphoblastic leukemias ALL (L1-L3).
• - Biphenotypic leukemias or Acute
  undifferentiated
• leukemia

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Differential diagnosis of Acute leukemias

• Lymphoma.
• Myelodysplastic syndrome.
• Multiple myeloma.
• Aplastic anemia
• Sever megaloblastic anemia due to B12 defeciency.
• Severe lymphocytosis due to infections.

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Management

• A-Supportive measure
• -isolation in positive laminer flux room
• -insertion of central line
• -family and patient support by permanent social
  worker
• -AlKaline diuresis to prevent tumor lysis
  syndrome
• -oropharynx/GIT decontamination to prevent
  fungal infection
• -IV antibiotics for infection
• -Blood transfusion if anemia and
  thrombocytopenia.

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Therapeutic option

• B-Curative intent
• only allogenic bone marrow transplant
  .
• C_Classical approch(curative/palliative)
• -induction chemotherapy
• -consolidation of remission
• -intensification
• -maintenance chemotherapy
• -CNS prophylaxis

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Cont

• Special consideration
• CNS
• -neuroprophylaxis
• - meningeal infiltration
• Testis
• orchidectomy/radiotherapy if testis involvement.

by intrathecal chemotherapy,high dose systemic
MTX or Aracytine. OR cerebrospinal irradiation
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Prognosis in ALL
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Prognosis in AML