Leukemia PDF: Types, Treatment, and Diagnosis

Leukemia Treatment Diagnostic criteria Clinical manifestations Pathophysiology  Leukemia Pathophysiology Malignant neoplasms of blo...

Leukemia Treatment Diagnostic criteria Clinical manifestations Pathophysiology  Leukemia Pathophysiology Malignant neoplasms of blood and blood-forming organs Classification is based on: 1. Speed of disease development - Acute leukemia: rapidly dividing and the disease progresses quickly - Chronic leukemia: have features of both immature and mature cells. Can function but less than normal. Disease worsens slowly as compared to acute leukemia. 2. Cell type - Myeloid leukemia: Myeloid derived - Lymphocytic leukemia: Lymphoid derived There are four major types of leukemia: Acute myeloid leukemia (AML): This is the most common type of acute leukemia. It is more common in older adults (those over 65 years of age) and in men compared with women. About 1050 people are diagnosed each year in Australia. Acute lymphocytic leukemia (ALL): This is the most common type of leukemia in children, teens, young adults and those up to 39 years of age. About 370 people are diagnosed each year in Australia. Of these, more than 200 are children under 15. ALL mostly occurs in children 1–4 years old Chronic myelogenous leukemia (CML): This leukemia is more common in older adults (most common in those over 65 years of age) and in men. It rarely occurs in children. About 320 people are diagnosed with CML annually in Australia. Chronic lymphocytic leukemia (CLL): This is the most common chronic leukemia in adults (most common in those over 65 years of age). It is more common in men than women and especially in white men and is very rare in children. About 1600 people diagnosed each year in Australia.  Acute Leukemia Clinical Manifestations Leukemic cells are immature and poorly differentiated Proliferate rapidly and long life span Circulate in bloodstream, cross blood-brain barrier, infiltrate many body organs 80% of ALL (acute lymphocytic leukemia) has B-cell as precursor ALL is associated with Alterations in the number of chromosomes Chromosomal translocation Identifying alterations has prognostic significance Among non-lymphocytic leukemia: myeloblastic cell line involvement prevalent – AML (acute myelogenous leukemia) Immature myeloid cells proliferate in bone marrow Lack ability to differentiate into specific functional blood cells Anemia, leukopenia, thrombocytopenia Chromosomal alterations have prognostic significance  Acute Leukemia Clinical Manifestations Similar in ALL (acute lymphocytic leukemia) & in AML (acute myelogenous leukemia) Sudden onset and related to… Immaturity of WBCs and other cells originating in the bone marrow Increased infection Crowding of leukemic cells in bone marrow Suppressing RBCs and platelet production Anemia, bruising, bleeding problems: frequent nose bleeds (epistaxis) Anemia leads to fatigue Crowding leads to increase pressure and pain Infiltration of leukemic cells in the CNS, lymph nodes, liver, spleen In CNS: headaches, visual disturbances, nausea, vomiting, seizures, coma In lymph nodes, spleen, liver: enlargement, tenderness of organs Unexplained weight loss, fever  Chronic Leukemia Pathophysiology Gradual onset Most common in middle and older adults CLL (chronic lymphocytic leukemia): Overproliferation of B-lymphocytes Relatively mature but not fully functional Do not readily form antibodies in presence of antigens Infection is common CML (chronic myelogenous leukemia) Insidious in onset Immature myeloid cells are involved Relatively mature but not fully functional  Chronic Leukemia Clinical Manifestations Subtle or Not present until the disease well advanced Once present, similar to acute leukemias: Immaturity of WBCs and other cells originating in the bone marrow Increased infection Crowding of leukemic cells in bone marrow Suppressing RBCs and platelet production Anemia, bruising, bleeding problems: frequent nose bleeds (epistaxis) Anemia leads to fatigue Crowding leads to increase pressure and pain Infiltration of leukemic cells in the CNS, lymph nodes, liver, spleen In CNS: headaches, visual disturbances, nausea, vomiting, seizures, coma In lymph nodes, spleen, liver: enlargement, tenderness of organs Unexplained weight loss, fever  Leukemia Diagnostic Criteria History taking, physical examination Complete blood cell count >20% immature WBCs Cytologic examination of blood cells for leukemia subtype Cytogenetics looking for translocations, Philadelphia chromosome, other chromosomal abnormalities. ALL: acute lymphoblastic (lymphocytic) leukemia Irregular, prominent and independent nuclei  Acute Leukemia Treatment ALL (acute lymphocytic leukemia) Systemic combination chemotherapy Prophylactic CNS intrathecal (into spinal canal) chemotherapy with or without radiation cranial radiation Treatment protocol consists of: induction, intensification, maintenance Monitoring: myelosuppression and immunosuppression due to intense chemotherapy Goal: achieve remission 95% of children with ALL achieve remission 85% 5-year survival rate AML (acute myelogenous leukemia) Systemic combination chemotherapy in 2 phases: 1. Induction to achieve remission 2. Postremission 70% adults with AML can expect complete remission Better prognosis: younger age, lack of CNS involvement, lack of systemic infection,  Chronic Leukemia Treatment Optimal treatment regimen is still under investigation >50% patients may be cured by bone marrow or stem cell transplantation Transplantation option is limited: Age Overall health Inability to locate suitable donor Extremely high WBCs (>100.000/mm3) (normal value 5-10000/mm3) Immediate chemotherapeutic treatment to avoid death from obstructed blood perfusion Splenectomy due to physical discomfort and hematologic disorders caused by enlargement Median survival: CLL (chronic lymphocytic leukemia): 8-12 years CML (chronic myelogenous leukemia): 4-6 years