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LEUKEMIA Dr MOKARIAN ICM 83/2/15. LEUKEMIA CLONAL DISORDER 8-10 /100.000 PATHOGENESIS: UNKNOWN. LEUKEMIA CHRONIC ACUTE CML CLL AML ALL

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LEUKEMIA Dr MOKARIAN ICM 83/2/15

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Leukemia dr mokarian icm 83 2 15

LEUKEMIA

Dr MOKARIAN

ICM

83/2/15


Leukemia dr mokarian icm 83 2 15

LEUKEMIA

CLONAL DISORDER

8-10 /100.000

PATHOGENESIS: UNKNOWN


Leukemia dr mokarian icm 83 2 15

LEUKEMIA

CHRONIC ACUTE

CML CLL AML ALL

ADULT ADULT 90% OF ADULT 10% OF ADULT

10%OF CHILD 90%OF CHILD


Leukemia dr mokarian icm 83 2 15

LEUKEMIA

APPROUCH TO LEUKOCYTOSIS

MATURE MATURE IMMATURE IMMATUR

MYLOID LYMPHOID MYLOID LYMPHOID

LEUKEMOID CML AML ALL

REACTION

LEUKOMOID RECTION CLL


Leukemia dr mokarian icm 83 2 15

  • LEUKEMIA

  • SYMPTOM & SIG

    • OF ANEMIA

    • OF THROMBOCYTOPENIA

    • OF LEUKOPENIA

    • OF BON MARROW EXPANTION

    • OF ORGAN DEPOSITION

    • OF INCREASED WBC

    • OF ELECTOROLITE DERANGMENT


Leukemia dr mokarian icm 83 2 15

LEUKEMIA

APROUCH TO LEKOCYTOSIS

MIC METHOD

LIGHT MICROSCOPY IMMUNOHISTOCHEMISTRY CYTOGENETIC

FLOCYTOMETRY HISTOCHIMISTRY


Leukemia dr mokarian icm 83 2 15

  • H history from patient with leukemia

    • Increasing fatigue or decreased exercise tolerance (anemia)

    • Excess bleeding or bleeding from unusual sites (DIC, thrombocytopenia)

    • Fevers or recurrent infections (granulocytopenia)

    • Headache, vision changes, nonfocal neurologic abnormalities (CNS leukemia or bleed)

    • Early satiety (splenomegaly)

    • Family history of AML (Fanconi, Bloom or Kostmann syndromes or ataxia telangiectasia)

    • History of cancer (exposure to alkylating agents, radiation, topoisomerase II inhibitors)

    • Occupational exposures (radiation, benzene, petroleum products, paint, smoking, pesticides


Leukemia dr mokarian icm 83 2 15

  • physical Examination

    • Performance status (prognostic factor)

    • Ecchymosis and oozing from IV sites (DIC, possible acute promyelocytic leukemia)

    • Fever and tachycardia (signs of infection)

    • Papilledema, retinal infiltrates, cranial nerve abnormalities (CNS leukemia)

    • Poor dentition, dental abscesses

    • Gum hypertrophy (leukemic infiltration)(M4)

    • Skin infiltration or nodules (leukemia infiltration)(M4)

    • Lymphadenopathy, splenomegaly, hepatosplenomegaly

    • Back pain, lower extremity weakness [spinal granulocytic sarcoma, most likely in t(8;21) patients]


Leukemia dr mokarian icm 83 2 15

CHRONIC MYELOGENOUS

LEUKEMIA


Leukemia dr mokarian icm 83 2 15

CHRONIC MYELOGENOUS

LEUKEMIA

  • PATHOGENESIS:

    • PHILADELPHIA CHROMOSOM

    • ABL / BCR GENE

    • THYROSIN KINASE

      ETHIOLOGY : UNKNOWN


Leukemia dr mokarian icm 83 2 15

CHRONIC MYELOGENOUS

LEUKEMIA

  • PRESENTATION

  • SYMPTOME

  • SIGN

  • PHASE OF DISEASE

    • CHRONIC PHASE

    • ACCELERATED PHASE

    • BLASTIC PHASE

      DIAGNOSIS


Leukemia dr mokarian icm 83 2 15

CHRONIC MYELOGENOUS

LEUKEMIA

  • TREATMENT :

    • HYDROXYURAE

    • INTERFERON

    • BONE MARROWWWW TRANSPLANTATION

    • GLIVEC

  • SUPORTIVE CARE


Leukemia dr mokarian icm 83 2 15

CML


Leukemia dr mokarian icm 83 2 15

CHRONIC LYMPHOCYTIC LEUKEMIA

(CLL)


Leukemia dr mokarian icm 83 2 15

CHRONIC LYMPHOCYTIC LEUKEMIA(CLL)

CLINICAL FINDING

ASYMPTOMATIC40%

SYMPTOMATIC

FATIGUE BLEEDIN TENDENCY

ILLBEING F8 DEF

FEVER VWF DEF

LAP THROMBOCYTOPENIA

HEPATOSPLENOMEGALLY AUTOIMMUN MANIFISTATION

STERNANAL TENDERNESS

ABDOMINAL MASS

SKIN INFILTERATION

INFILTERATION OF TONSILS

INFILTERATION OF ORGAN

DR F MOKARIAN


Leukemia dr mokarian icm 83 2 15

CHRONIC LYMPHOCYTIC LEUKEMIA(CLL)

INTERNATIONAL CLL WORKSHOP DIAGNOSTIC CRITERIA:

1- LYM> = 10000

2-BMA LYM > = 30% A= 1 + 2 OR 3

3- MONOCLONAL B- CELL B= 2+3

NCI-SPONSORED CLL WORKING GROUPED

1- LYM> 5000 + LESS 55% ATYPICAL LYM +

B-CELLMARKER

+ CD5 ( CD19 CD20 CD24 )

2- MARROW LYM>30%

DR F MOKARIAN


Leukemia dr mokarian icm 83 2 15

CHRONIC LYMPHOCYTIC LEUKEMIA(CLL)

DIFFERENTIAL DIAGNOSIS:

INFECTION CAUSESMALIGNANT CAUSES

BACTERIAL ( eg TB) B CELL

VIRAL ( IM) PLL

HYPERREACTIVE MALARIA NHL

SPLENOMEG(HMS) HCL

T CEL

PLL

NHL

HCL

LGL L

DR F MOKARIAN


Leukemia dr mokarian icm 83 2 15

CHRONIC LYMPHOCYTIC LEUKEMIA(CLL)

PRETREATMEN INVESTIGATION

CBC PBS

RET

COOMB’S TEST

LDH

LFT KFT

SPEP IEP

B2 MICROGLOBULIN

IMMUNOPHENOTYPING

BMA

CYTOGENETIC ANALYSIS

DR F MOKARIAN


Leukemia dr mokarian icm 83 2 15

CHRONIC LYMPHOCYTIC LEUKEMIA(CLL)

RAI CLASSIFICATION

STAGE MODIF STAGE DESCRIPTION MS (YR)

0 LOW RISK LYM >10

1 INTERMED RISK LYM+ LAP >8

2 INTERMED RISK LYM + SPL+/-LAP 6

3 HIGH RISK LYM +ANEM+/- LAP OR SPL 2

4 HIGH RISK LYM +THROM 2

+/- ANEM +/- SPL +/- LAP

LYM > 5000 >4WEAK HB<11 PLT< 100000

DR F MOKARIAN


Leukemia dr mokarian icm 83 2 15

CHRONIC LYMPHOCYTIC LEUKEMIA(CLL)

BINET CLASSIFICATION FOR CLL

INVOLVED MS

SRAGE BLOOD COUNTS AREA (YRS)

A HB>10 <3 >10

PLT>100000

B HB>10 >3 7

PLT>100000

C HB<10 ANY NUMBER 2

PLT< 100000

FIVE AREA OF INVOLVEMENT:

H&N AXILLA GROINS SPLEEN HEPATOMEG

DR F MOKARIAN


Leukemia dr mokarian icm 83 2 15

CHRONIC LYMPHOCYTIC LEUKEMIA(CLL)

SUMMARY OF TREATMENT:

INDICATION OF CCR

CHLORAMBUCIL OR FLUDARABIN

PREDNISOLON

RADIOTHERAPY

SPLENECTOMY

GAMMAGLOBULIN

DR F MOKARIAN


Leukemia dr mokarian icm 83 2 15

CHRONIC LYMPHOCYTIC LEUKEMIA(CLL)

  • MARKERS OF POOR PROGNOSIS IN CLL:

    • ADVANCE STAGE

    • DOUBLING TIME <12 M

    • DIF MARROW INVOL

    • PROLYM OR CLEAVED CELL INCREASED

    • POOR RESPONSE TO CCR

    • HIGH B2 MG LEVEL

    • ABNORMAL CARYOTYPE

    • P53 MUTATION

DR F MOKARIAN


Leukemia dr mokarian icm 83 2 15

CLL


Leukemia dr mokarian icm 83 2 15

ACUTE MYELOGENOUS LEUKEMIA

  • CLASIFICATION

  • LEUKOSTASIS

  • DIAGNOSIS

  • TREATMENT

    • SUPORTIVE CARE

    • CHEMOERAPY

      • INDUCTION OF REMMISION

      • CONSULIDATION

      • MAINTENANCE


Leukemia dr mokarian icm 83 2 15

Acute Myeloid Leukemia (AML) Classification Systems

French-American-British (FAB) Classification

M0: Minimally differentiated leukemia

M1: Myeloblastic leukemia without maturation

M2: Myeloblastic leukemia with maturation

M3: Hypergranular promyelocytic leukemia

M4Eo: Variant: Increase in abnormal marrow eosinophils

M4: Myelomonocytic leukemia

M5: Monocytic leukemia

M6: Erythroleukemia (DiGuglielmo's disease)

M7: Megakaryoblastic leukemia


Leukemia dr mokarian icm 83 2 15

  • World Health Organization Classificationb

  • I. AML with recurrent cytogenetic translocations

  • AML with t(8;21)(q22;q22);AML1(CBFa)/ETO

  • Acute promyelocytic leukemia [AML with t(15;17)(q22;q12) and variants; PML/RARa]

  • AML with abnormal bone marrow eosinophils [inv(16)(p13q22) or t(16;16)(p13;q22) CBFb/MYH1]

  • AML with 11q23 (MLL) abnormalities

  • II. AML with multilineage dysplasia

  • With prior myelodysplastic syndrome

  • Without prior myelodysplastic syndrome

  • III. AML and myelodysplastic syndrome, therapy-related

  • Alkylating agent-related

  • Epipodophyllotoxin-related

  • Other types

  • IV. AML not otherwise categorized

  • AML minimally differentiated

  • AML without maturation

  • AML with maturation


Leukemia dr mokarian icm 83 2 15

AML


Leukemia dr mokarian icm 83 2 15

AML AUER ROD


Leukemia dr mokarian icm 83 2 15

ACUTE LYMPHOBLASTIC LEUKEMIA

  • CLASIFICATION

  • LEUKOSTASIS

  • DIAGNOSIS

  • TREATMENT

    • SUPORTIVE CARE

    • CHEMOERAPY

      • INDUCTION OF REMMISION

      • CONSULIDATION

      • MAINTENANCE


Leukemia dr mokarian icm 83 2 15

ALL


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