LEUKEMIAFAKULTAS KEDOKTERAN UNIVERSITAS MUHAMMADIYAH MALANG

What Is Leukemia?Cancer of the white blood cellsAcute or ChronicAffects ability to produce normal blood cellsBone marrow makes abnormally large number of immature white blood cells called blasts

Classification of leukemiasAcuteChronicMyeloid originLymphoid originAcute Myeloid Leukemia (AML)Acute Lymphoblastic Leukemia (ALL)Chronic Myeloid Leukemia (CML)Chronic Lymphocytic Leukemia (CLL)

HematopoiesisPLURIPOTENTSTEM CELLCOMMITTEDPROGENITORCELLRECOGNIZABLE BONE MARROW PRECURSOR CELLMATURE BLOOD CELLmyeloblastmonoblastpronormoblastred cellneutrophilmonocytebasophilplateleteosinophilpre-Tpre-BmyeloidprogenitorcelllymphoidprogenitorcelllymphoblastlymphoblastT-cellB-cell& plasma cellMIXED PROGENITOR CELLCFU-Megmegakaryocytepluripotentstem cell

Myeloid maturationMATURATIONAdapted and modified from U Va website

Acute Leukemiaaccumulation of blasts in the marrow

How to distinguish AML vs CMLfrom looking at peripheral bloodMyeloid cell CML AML normalblasts q qpromyelocytes qmyelocytes qmetamyelocytes qbands qneutrophils q# q

Classification of acute leukemiasALLmainly childrenM > Fcurable in 70% of childrencurable in minority of adultsAMLmainly adultsM > F

curable in minority of adults

Clinical manifestationssymptoms due to:marrow failuretissue infiltrationleukostasisconstitutional symptoms

usually short duration of symptoms

Marrow failureNeutropenia : infections, sepsisAnemia : fatigue, pallorThrombocytopenia : bleeding

Infiltration of tissues/organsEnlargement of liver, spleen, lymph nodesGum hypertrophyBone painOther organs: CNS, skin, testis, any organ

Gum hypertrophy

LeukostasisAccumulation of blasts in microcirculation with impaired perfusion Lungs: hypoxemia, pulmonary infiltratesCNS: strokeOnly seen with WBC >> 50 x 109/L

Causes of acute leukemiasIdiopathic (most)Underlying hematologic disordersChemicals, drugsRadiationViruses Hereditary/genetic conditions

Constitutional symptomsFever and sweats commonWeight loss less common

Laboratory featuresWBC usually elevated, but can be normal or lowBlasts in peripheral bloodNormocytic anemiaThrombocytopenia

Bone marrow in acute leukemiaNecessary for diagnosisUseful for determining typeUseful for prognosisAcute leukemias are defined by the presence of > 20% blasts in bone marrow (% of nucleated marrow cells)

Distinguishing AML from ALLLight microscopyAML: Auer rods, cytoplasmic granulesALL: no Auer rods or granules.Special stains (cytochemistry)Flow cytometry

AML

ALL

Auer rods in AML

Treatment of acute leukemiasChoice of Rx is influenced by:type (AML vs ALL)agecurative vs palliative intentChemotherapyImmunotherapyRadiationBone marrow transplant

Principles of treatmentCombination chemotherapyfirst goal is complete remissionfurther Rx to prevent relapseSupportive medical caretransfusions, antibiotics, nutritionPsychosocial supportpatient and family

SEMOGA BERMANFAAT.

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