Leukemia and Lymphomas: Types, Causes, and Treatment PDF

# Faculty of Allied Health Sciences ## CONTENT - INTRODUCTION - TYPES - SYMPTOMS - CAUSES - RISK FACTORS - DIAGNOSTIC METHODS - TREATMENTS ## INTRODUCTION - Leukemia is a group of cancers that usually begin in the bone marrow and result in high numbers of white blood cells. - These white blood c...

# Faculty of Allied Health Sciences ## CONTENT - INTRODUCTION - TYPES - SYMPTOMS - CAUSES - RISK FACTORS - DIAGNOSTIC METHODS - TREATMENTS ## INTRODUCTION - Leukemia is a group of cancers that usually begin in the bone marrow and result in high numbers of white blood cells. - These white blood cells are not fully developed and are called blasts or leukemia cells. - Clinically and pathologically, leukemia is subdivided into a variety of large groups. - The first division is between its *ACUTE* and *CHRONIC* forms. ## Acute leukemia - Acute leukemia is characterized by a rapid increase in the number of immature blood cells. - The* crowding* that results from such cells makes the bone marrow unable to produce healthy blood cells. - Immediate treatment required because of the rapid progression and accumulation of the malignant cells. - Most common form of leukemia in children. ## CHRONIC LEUKEMIA - It is 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. - Chronic leukemia are monitored for sometimes before treatment to ensure maximum effectiveness of therapy. - Mostly occurs in older people, but can occur in any age group. ## SUBDIVISION OF LEUKEMIA - The diseases are subdivided according to which kind of blood cell is affected. - This divides leukemias into lymphoblastic or lymphocytic leukemias and myeloid or myelogenous leukemias. - In lymphoblastic or lymphocytic leukemias, the cancerous change takes place in a type of marrow cell that normally goes on to form lymphocytes. - Most lymphocytic leukemias involve a specific subtype of lymphocyte, the B-cell. - In myeloid or myelogenous leukemias, the cancerous change takes place in a type of marrow cell that normally goes on to form red blood cells, some other types of white cells, and platelets. - There are some types of subcategories like hairy cell leukemia (subset of chronic lymphocytic leukemia), T-cell prolymphocytic leukemia (very Rare and aggressive), large granular lymphocytic leukemia (involve either T-cells or Nk cells, adult T-cell leukemia (caused by human T-lymphotropic virus), clonal eosinophilias (mutation in* hematopoietic* stem cells). ## MAJOR TYPES OF LEUKEMIA - Acute lymphoblastic leukemia. - Acute myeloid leukemia. - Chronic lymphocytic leukemia. - Chronic myeloid leukemia. ## ACUTE LYMPHOBLASTIC LEUKEΜΙΑ - Most common type of leukemia in young children. - It also affects adults, especially those 65 and older. - Standard treatment involve chemotherapy and radiotherapy. - The survival rate vary by age: 85% in children and 50% in adults. ## CHRONIC LYMPHOCYTIC LEUKEΜΙΑ - Most often affects adults over the age of 55. - Sometimes occurs in younger adults, but it almost never affects children. - Two-third of affected people are men. - It is incurable, but there are many effective treatments. - The five year survival rate is 75%. ## ACUTE MYELOGENOUS LEUKEΜΙΑ - It occurs more commonly in adults than in children, and are more commonly in men than women. - It is treated with chemotherapy. - The five year survival rate is 40%. ## CHRONIC MYELOGENOUS LEUKEMIA - It occurs mainly in adults; a very small number of children also develop this disease. - It is treated with imatinib (Gleevec in United states, Gluivec in Europe). - The five year survival rate is 90%. ## SYMPTOMS - Bleeding. - Bruising. - Feeling tired. - Fever. - Increased risk of infections. - Pale skin. - An enlarged spleen. ## CAUSES - Mutation in the DNA: can trigger leukemia by activating oncogenes or deactivating tumor suppressor gene. - Inherited: genetic predisposition towards leukemia. Demonstrated by family histories and twin studies. - Viruses: human T-lymphotropic virus causes adult T-cell leukemia. - Radiation: Large doses of Sr-90 emission from nuclear reactors, increases the risk of bone cancer and leukemia in animals and in people. - Non-ionizing radiation: High levels of extremely low frequency magnetic field energy might cause cases of childhood leukemia. ## RISK FACTORS - Smoking. - Family history. - Ionizing radiation. - Some chemicals. - Prior chemotherapy. - Down syndrome. ## PATHOPHYSIOLOGY - Sometimes an immature *blast cell* have two gene mutations which prevent it from maturing into a specialized blood cell and cause it to multiply out of control. - These immature blast cells crowd the bone marrow and impair the ability of the to make healthy blood cells. ## DIGNOSTIC METHODS - BLOOD TEST: Complete blood counts(white blood cell count increases abnormally). - LYMPH NODE BIOPSY: Performed to diagnose certain types of leukemia in certain situations. - BONE MARROW THERAPY: abnormal cell division in the bone marrow WBC's amount continues to increase. - X-ray (bones), MRI (Brain), Ultrasound(kidney, spleen, liver). ## TREATMENT - Chemotherapy: - *Acute Lymphoblastic / Acute Myelogenous:* to prevent leukemic cells from spreading to other sites, particularly the CNS. Treatment divided in several phases: - Induction Therapy(bone marrow remission) - Adults: predinisone, vincristine and an anthracycline drug. - Children: prednisone, L- asparginase and vincristine. - Consolidation therapy or intensification therapy (eliminate remaining leukemia cells) - Antimetabolite drugs: methroxate and 6- meracaptopurine. ## Chronic Lymphocytic leukemia - Primary chemotherapeutic plan, - Combination therapy with chlorambucil or cyclophosphamide, plus a corticosteroid such as prednisone or prednisolone. - In Resistant cases, single agent treatments with nucleoside drugs such as fludarabine, pentostatin, orcladribine. ## Chronic Myelogenous - Standard of care of newly diagnosed patient - imatinib (Gleevec) therapy ## Hairy Cell - One week of cladribine(i.v) or 6 months of pentostatin, given every 4 weeks by i.v route. - Other treatments include rituximab infusion or self- injection with Interferon- alpha. ## T-cell prolymphocytic leukemia - Purine Analogues (pentostatin, fludarabine, cladribine) chlorambucil. - Combination Therapy (cyclophosphamide, bleomycin VAPEC-В). - Alemtuzumab (Campath), a monoclonal antibody. ## BONE MARROW TRANSPLANTATION. # LYMPHOMA ## INTRODUCTION - Lymphoma is a group of blood cell tumors that develop from lymphocytes(a type of white blood cell). - Lymphoma most often spreads to the lungs, liver, and brain. - Lymphoma's symptoms are like enlarged lymph nodes, fever, sweat, itching etc. - The enlarged lymph nodes are usually painless. - There are two types of lymphomas: - Hodgkin's lymphomas - Non- hodgkin lymphoma. - About 90% of lymphomas are non-hodgkin lymphomas. ## HODGKIN'S LYMPHOMAS - Hodgkin lymphoma is one of the most common known types of lymphomas. - A hodgkin lymphoma is marked by the presence of a type of cell called the reed-sternberg cell. ## PATHOPHYSIOLOGY - The pathophysiology of lymphoma refers to the process or processes going on inside the body that are sometimes reflected in the signs and symptoms that are identified as being indicative of lymphoma. - For example, swollen, painless lymph nodes are a symptom of lymphoma. Pathophysiology of lymphoma with this symptoms is that it becomes this way when cancerous lymphocytes do not die, as they are supposed to, but rather proliferate and collect at the lymph nodes. - In follicular lymphoma, it is very common to find that a specific gene, known as BCL-2, has undergone chromosomal rearrangement-in other words, a structural change has occurred to that gene and is likely the reason it turned cancerous. As it develops, the pathophysiology of lymphoma often includes mutations of certain proteins that encode certain genes, such as p53 and p16. Since the gene encoded by p53 is a tumor suppressor gene, a mutation in p53 could mean that the ability of that gene to suppress tumor development is compromised. ## SYMPTOMS - Enlarged lymph nodes Or lymphadenopathy. - B symptoms (systemic symptoms)- can be associated with both Hodgkin lymphoma and non-hodgkin lymphoma. They consist of: - Fever - Night Sweats - Unintended weight loss - Itching - Feeling tired/fatigue. - Anorexia or loss of appetite. ## RISK FACTORS - Risk factors for Hodgkin lymphoma include infection with, - Epstein-barr virus. - History of the disease in the family. - Risk factors for common types of non-Hodgkin lymphomas include, - Autoimmune disease. - HIV/AIDS. - Infection with human T- lymphotropic virus. - Immunosuppresant medications. - Pesticides. - Tobacco smoking. ## DIAGNOSTIC METHOD - Lymph Node Biopsy. - A partial or total excision of a lymph node examined under the microscope. - This examination reveals the histopathology features that may indicate lymphoma. - After lymphoma is diagnosed, a variety of tests may be carried out to look for specific characteristic of different types of lymphoma. These includes: - Immunophenotyping (study the protein expressed by cells). - Flow cytometry (simultaneous multiparametric analysis of the physical and chemical characteristics of up to thousands of particles per second). - Fluorescence in situ hybridization testing. (to detect and localize the presence or absence of specific DNA sequences on chromosomes). ## TREATMENT - Treatment may involve chemotherapy, medication, radiation therapy and rarely stem-cell transplant. - Medications - Chemotherapy, - Bone marrow stimulant, - Steroid, and Blood transfusion - Surgery - Autotransplantation ## REFERENCE - Clinical pharmacy and therapeutics, Roger Walker - Rang & Dale's pharmacology - Essential of medical pharmacology, KD Tripathi - www.Google.com ## Thanks!