Dr Meddy Leukemia 3z3035

“LEUKEMIA” dr. Meddy Setiawan, SpPD

FAKULTAS KEDOKTERAN UNIVERSITAS MUHAMMADIYAH MALANG

What Is Leukemia? • Cancer of the white blood cells • Acute or Chronic • Affects ability to produce normal blood cells • Bone marrow makes abnormally large number of immature white blood cells called blasts

Classification of leukemias Acute

Chronic

Myeloid origin

Acute Myeloid Leukemia (AML)

Chronic Myeloid Leukemia (CML)

Lymphoid origin

Acute Lymphoblastic Leukemia (ALL)

Chronic Lymphocytic Leukemia (CLL)

Hematopoiesis PLURIPOTENT MIXED STEM CELL PROGENITOR CELL

COMMITTED PROGENITOR CELL

RECOGNIZABLE BONE MARROW PRECURSOR CELL

BFU-E/CFU-E

CFU-Eos

red cell neutrophil monocyte eosinophil

CFU-Baso

basophil

CFU-GM

myeloid progenitor cell

pluripotent stem cell lymphoid progenitor cell

pronormoblast myeloblast monoblast

MATURE BLOOD CELL

CFU-Meg

megakaryocyte

platelet

pre-T

lymphoblast

T-cell

pre-B

lymphoblast

B-cell & plasma cell

Myeloid maturation myeloblast promyelocyte

myelocyte

metamyelocyte

band

neutrophil

MATURATION Adapted and modified from U Va website

Acute Leukemia • accumulation of blasts in the marrow

How to distinguish AML vs CML from looking at peripheral blood Myeloid cell blasts promyelocytes myelocytes metamyelocytes bands neutrophils

CML q q q q q q

AML q

#

normal

q

Classification of acute leukemias ALL

AML

• mainly children • M>F • curable in 70% of children • curable in minority of adults

• mainly adults • M>F • curable in minority of adults

Clinical manifestations • symptoms due to: – marrow failure – tissue infiltration – leukostasis – constitutional symptoms

• usually short duration of symptoms

Marrow failure • Neutropenia : infections, sepsis • Anemia : fatigue, pallor • Thrombocytopenia : bleeding

Infiltration of tissues/organs • Enlargement of liver, spleen, lymph nodes • Gum hypertrophy • Bone pain • Other organs: CNS, skin, testis, any organ

Gum hypertrophy

Leukostasis • Accumulation of blasts in microcirculation with impaired perfusion • Lungs: hypoxemia, pulmonary infiltrates • CNS: stroke • Only seen with WBC >> 50 x 109/L

Causes of acute leukemias • Idiopathic (most) • Underlying hematologic disorders • Chemicals, drugs • Radiation • Viruses • Hereditary/genetic conditions

Constitutional symptoms • Fever and sweats common • Weight loss less common

Laboratory features • WBC usually elevated, but can be normal or low • Blasts in peripheral blood • Normocytic anemia • Thrombocytopenia

Bone marrow in acute leukemia • Necessary for diagnosis • Useful for determining type • Useful for prognosis • Acute leukemias are defined by the presence of > 20% blasts in bone marrow (% of nucleated marrow cells)

Distinguishing AML from ALL • Light microscopy – AML: Auer rods, cytoplasmic granules – ALL: no Auer rods or granules.

• Special stains (cytochemistry) • Flow cytometry

AML

ALL

Auer rods in AML

Treatment of acute leukemias • Choice of Rx is influenced by: – type (AML vs ALL) – age – curative vs palliative intent

• Chemotherapy • Immunotherapy

• Radiation • Bone marrow transplant

Principles of treatment • Combination chemotherapy – first goal is complete remission – further Rx to prevent relapse

• ive medical care – transfusions, antibiotics, nutrition

• Psychosocial – patient and family

SEMOGA BERMANFAAT…………….