LEUKEMIA

What is Leukemia?

 It is a Proliferative Disorder of WBC.

 Leukemia is a malignant progressive disease
in which the bone marrow & other blood
forming organs produce increased number
of immature or abnormal Leukocytes.
 These suppress the production of normal blood
cells, leading to Anaemia & other symptoms.
 Types of Leukemia

Leukemia

Acute Chronic (Mature

(Immature Cell) Cell)

Acute Myeloid Chronic Chronic Myeloid

Acute Lymphocytic
Leukemia AML Lymphocytic Leukemia CML
Leukemia ALL
(Granulocytes & Leukemia CLL (B (Granulocytes &
(B cell, T cell & NK
Monocytes cell, T cell & NK Monocytes
cell)
affected) cell) affected)
 Acute Leukemia
Acute Lymphocytic Leukemia (ALL)
• Age – Less than 15 years
• Precursor – Lymphocytes
Ø Pre B cells
Ø Pre T cells
Ø Pre NK cells
• Response to Chemotherapy
• Diagnosis – Terminal deoxynucleotide transferase + (Tdt+)
“Specialised DNA polymerase”
Acute Myeloid Leukemia (AML)
• Age - 15 - 20 year
• Diagnosis – Auer Rod cells
• No response to chemotherapy – Develop Disseminated Intravascular
Coagulation (DIC)
• Treatment – with Retenoic Acid (vit A)
Ø Convert Immature to Mature cells
Ø Main treatment with Methotrexate
• FAB Classification
Ø M3 – Translocation (15:17)
Ø M4 – Nonspecific esterosis
Ø M5 – Acute monocytic leukemia; affect to gum (gum infiltration)
Ø M6 – Affect RBC
Ø M7 – Affect megakareyocyte

 ACUTE LEUKEMIA AFFECTS ALL THREE CELL LINE

RBC(ANEMIA ) WBC,NEUTROPHILES PLATELETS

(LEUCOPEMIA) (THROMBOCYTOPENIA)

• fategue • Bacterial • Mucous membrane

• pallor infections bleeding
• Pnemonia • Epitaxis(nose
• Dyspnea
bleed)
• Pale conjuctiva • UTI
• Echymoisis
• Cellulitis
• Splenomegaly
• Pharyngitis • Hepatomegaly
• esophagitis • lymphoadenopathy
DIAGNOSIS-
§ Complete blood count
§ Electrolyte abnormalities
§ Bone marrow test

WBC

phosphate
§ Phosphate
Hyperphosphatemia
§ Potassium § Phosphate
§ DNA( purine chemotherapy § Potassium K Hyperkalemia
& § DNA Uric acid Hyperuracemia
pyrimidi
ne)
 CHRONIC LEUKEMIA
Chronic Lymphocytic Leukemia (CLL)
Age – 50-60 years
MONOCLONAL PROLIFERATION OF MATURE LYMPHOCYTES
§ Lymphocytosis
§ Painless lymphonapathy
§ Splenomegaly
STAGES OF CLL
0 - WBC
1 – Lymphoarnapathy
2 – Hepatosplenomegaly
Treatment
3 - Anaemia § Fludararabine
4 – Thrombocytopenia § Chlorambucil
 Chronic Myeloid Leukemia CML
A Neoplastic myeloid stem cell line
§ Granulocytes (Neutrophils)
§ Erythrocytes (RBC)
§ Platelets
Age – 40 years
DIAGNOSIS – Philadelphia Chromosome translocation t(9:22)
Low alkaline phosphatase activity
SYMPTOMS – Asymptomatic, fever, wt. loss, anamea, night
sweat
TREATMENT – Imatinib (tyrosin kinase inhibitors)
 HODGKINGS DISEASE
Reed sterinberg cells (OWL EYE) found in Hodgkings Lymphoma.
Rarely affected, less aggressive
STAGES –
1. One Lymph node
2. two & More Lymp node at same side of body ( Diaphragm )
3. Both side of Diaphragm
4. wild spread
SYMPTOMS – Painless lymphanopthy, fever, wt.loss, night sweat, cough.
DIAGNOSIS – Lymphnode Bioapsy, CT Scan, (chest X ray), Bone Marrow, WBC, ESR,
Eosinophils.
TREATMENT – Chemotherapy & Radiation.
 Non-hodgkings disease
Risk factors –
1. Immunological- HIV, Immune disease.
2. Viral – HIV, EBV, HCV.
3. Genetic – Klienfeltems, SCID.
4. Environmental – pesticides, Hembicides, Smoking.
TYPES- 1. T – CELL
§ Precursor T cell lymphoma
§ Peripheral T cell lymphoma
T cell lymphoma is less common than B cell lymphoma
2. B CELL –
§ CLL & SLL
§ Burkins lymphoma
§ Germinal celline
§ Fallicular lymphoma
§ M ultiple myeloma
IT OCCURES BY –
1. Translocation of chromosomes
2. Genetic mutations during rearrangement
SIGN & SYMPTOMS OF LEUKEMIA

SYSTEMIC SKIN
1. Wt.loss LUNGS 1. Night sweats
2. Fever 1. Easy shortness of 2. Easy bleeding
3. Frequent infections breath 3. Purplish patches or
sport

MUSCULAR BONES OR JOINTS LYMPH NODE

1. weakness 1. Pain or tenderness 1. swelling
DIAGNOSIS OF LEUKEMIA

1.Complete blood counts ( CBC )

2.Bone marrow examination
3.Lymph node bioapsy
4.X – Ray
5. MRI
6.Ultrasound
7.CT Scan
 TREATMENT
ACUTE LEUKEMIA
1.Induction chemotherapy – About bone marrow remission
• Prednisone
• Vincristine
• Anthracycline
• L – Asparaginase
• Cyclophosphamide

2. Consolidation therapy OR intensification therapy – To

elimination any remaining leukemia cells
i. ANTIMETABOLITE – Methotrexate, 6-mercaptopurine
ii. CNS PROPHYLAXIS – (preventive therapy) To stop the cancer from spreading
to the brain and nervoud system
iii. ALTERNATIVE – Bone marrow transplantation.
iv.
 CHRONIC LEUKEMIA

1.COMBINATION CHEMOTHERAPY –
• Chlorambucil
• Cyclophoshamide
• Corticosteroid (Pridnisone & Prednisolone)

2. SINGLE AGENT – NUCLEOSIDE DRUG

• Fludarabine
• Pentostatin
• Cladribine

3. BONE MARROW TRANSPLANTATION

•
THANKING YOU
AKSHAY. S . KAMDE