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Acute Leukemia15!11!2023جامعة دار السلام
Acute Leukemia15!11!2023جامعة دار السلام
Prepared by:
Dr. Laila Mohammed AL Gharasi
Leukaemia
2- Chronic leukemia
characterized by the excessive buildup of relatively mature, but still
abnormal, white blood cells. Typically taking months or years to progress,
the cells are produced at a much higher rate than normal, resulting in
many abnormal white blood cells. Whereas acute leukemia must be
treated immediately, chronic forms are sometimes monitored for some
time before treatment to ensure maximum effectiveness of therapy.
Chronic leukemia mostly occurs in older people, but can occur in any
age group.
Effects of Leukemia on the Body
• Leukemic cells from the bone marrow may reproduce so greatly that
they invade the surrounding bone, causing pain and, eventually, a
tendency for bones to fracture easily.
• Almost all leukemias eventually spread to the spleen, lymph nodes, liver,
and other vascular regions, regardless of whether the origin of the
leukemia is in the bone marrow or the lymph nodes.
• Effects of Leukemia on the Body
This will define whether the blasts are of myeloid or lymphoid lineage
and also localize the stage of cellular differentiation .
Cytochemistry can be useful in determining the blast cell lineage but is no longer
performed in centres where the newer and more definitive tests are available.
Acute myeloid leukaemia
Pathogenesis
The AML genome contains an average of about 10 mutations within
protein‐coding genes, amongst the smallest number of any adult cancer..
The mutations usually occur on only one of the two alleles for the gene and
may be ‘loss of function’ or ‘gain of function’.
The wide variety of cytogenetic abnormalities and molecular mutations are
such that each case usually has a unique pattern of mutations.
Incidence
Acute myeloid leukaemia (AML) is the most common form of acute
leukaemia in adults and becomes increasingly common with age, with a
median onset of 65 years.
It forms only a minor fraction (10–15%) of the leukaemias in childhood.
Cytogenetic abnormalities and response to initial treatment have a major
influence on prognosis .
Classification of AML
o Currently this is not possible but many genetic subtypes have been
determined. Approximately 60% of tumours exhibit karyotypic
abnormalities on cytogenetic analysis and many cases with a normal
karyotype carry mutations .
o Six FAB subtypes (M1 through to M6) were initially proposed in 1976,
although later revisions added M7 in 1985, and M0 in 1987
Type Name
M6 acute erythroid leukemias, including erythroleukemia (M6a) and very rare pure erythroid leukemia (M6b)
remission does not mean the disease has been cured; rather, it signifies
no
Response to this treatment varies with age, with people aged less than 60
years having better remission rates between 60% and 80%, while older people
Acute promyelocytic leukemia is treated with all-trans-retinoic
acid
during the initial few days of treatment or at the time the leukemia is
infections.
In pregnancy
o AML is rare in pregnancy, affecting about 1 in 75,000 to 100,000
pregnant women.
o It is diagnosed and treated similarly to AML in non pregnancy, with a
recommendation that it is treated urgently.
o There is a secondary rise after the age of 40 years. Eighty‐five per cent
of cases are of B‐cell lineage and have an equal sex incidence;
o Studies in identical twins have shown that both may be born with the
o One twin may develop ALL early (e.g. at age 4) because of a second
o Within B‐ALL there are several specific genetic subtypes such as those with the t(9;22) or
t(12;21) translocations,
o The subtype is an important guide to the optimal treatment protocol and to prognosis.
Organ infiltration
This causes tender bones, lymphadenopathy moderate splenomegaly,
hepatomegaly and meningeal syndrome
(headache, nausea and vomiting, blurring of vision
and diplopia).
Clinical features
Organ infiltration
o The total white cell count may be decreased, normal or increased to 200
× 109/L or more.
o Biochemical tests may reveal a raised serum uric acid, serum lactate
dehydrogenase or, less commonly, hypercalcaemia. Liver and renal function
tests are performed as a baseline before treatment begins.
o Radiography may reveal lytic bone lesions and a mediastinal mass caused
by enlargement of the thymus and/or mediastinal lymph nodes
characteristic of T‐ALL
Treatment
The risk of tumour lysis syndrome is highest in children with a high white
cell count, T‐cell disease or concurrent renal impairment at presentation.
Any episode of fever must be treated promptly
Specific therapy of ALL
o There are several phases in a treatment course, which usually has four
components .
o The factors that guide treatment include age, gender and white cell count
at presentation.
o Few of the drugs given systemically are able to reach the CSF and
specific treatment is required to prevent or treat central nervous
system (CNS) disease.