LEUKEMIA

Neoplastic Disorders
LEUKEMIA
 Is a type of cancer of blood or bone marrow
 Characterized by an abnormal increased of
immature white blood cells called “blasts”
 Cancer of the blood-forming tissues
 Leukemia is a broad term given to a group of
malignant diseases of the bone marrow and
lymphatic system.
 Leuka = white, emia = blood
EPIDEMIOLOGY
 Is the most common form of childhood cancer.
 Demographics
 It
occurs more frequently in males than in females
 Whites more than blacks

 More commonly in patients with Down’s syndrome

MORPHOLOGY
 Two forms are generally recognized in children

 Acute lymphoid leukemia (ALL)

 Synonyms for ALL include lymphatic, lymphocytic,
lymphoblastic, and lymphoblastoid leukemia
 Stem Cell or Blast Cell Leukemia also refer to the lymphoid
type of leukemia
 Acutenon-lymphoid (myelogenous) leukemia (ANLL
or AML)
 Synonyms for the AML type include granulocytic, myelocytic,
monocytic, myelogenous, monoblastic, and monomyeloblastic
Acute Lymphoid Leukemia (ALL)
 Epidemiology
 Peakincidence in 2 to 6 years more in boys than girls
 Median age in adults – 35 years

 Etiology
 Less studied
 Environmental and genetic factors
BLAST CELL
 Are immature precursors of either lymphocytes
(lymphoblasts), or granulocytes (myeloblasts).
 Presence of Blast Cell in blood, signify ACUTE
LEUKEMIA.
Signs and Symptoms of ALL
 Anemia
 Generalized weakness and fatigue
 Bleeding and bruising
 Bone and joint pain (caused by the spread of “blast”
cells from the marrow cavity
 Fever and infection
 Weight loss and/or loss of appetite
 Enlarged lymph nodes, liver and spleen
 Petichiae (tiny red spots in the skin) due to low platelet
levels
PATHOPHYSIOLOGY
 Leukemia is an unrestricted proliferation of
immature WBCs in the blood-forming tissues of the
body.
 Therefore the resulting pathologic condition and
clinical manifestations are caused by infiltration and
replacement of any tissue of the body with
nonfunctional leukemic cells
 Highly vascular organs, such as the spleen and liver,
are the most severely affected.
 Leukemia is an overproduction of WBCs, most often
in the acute form of leukocyte count is low (thus the
term Leukemia)
 These immature cells do not deliberately attack and
destroy the normal blood cells or vascular tissues.
 Proliferating cells depress the production of formed
elements of the blood in the bone marrow by
competing for and depriving the normal cells of the
essential nutrients and metabolism.
 Confirmative
 CBC

 Bone marrow aspiration/biopsy

 Cyto geneticcs
Diagnosis
 Supportive tests
 Serum uric acid
 Coagulation Profile

 LFT, RFT (liver function test, renal function test)

 Chest x-ray

 CT scan of chest and brain

 Blood culture

 Baseline echo, ECG

THERAPEUTIC MANAGEMENT
 Chemotherapeutic agent – four phases:
 Induction therapy – which achieves a complete
remission or <5% leukemic cells in the bone marrow.
 CNS prophylactic therapy – which prevents leukemic
cells from invading the CNS
 Intensification therapy (consolidation) – which
eradicates residual leukemia cells, followed by delayed
intensification, which prevents emergence of resistant
leukemia clones
 Maintenance therapy – which serves to maintain the
remission phase.