leukemias ppt
TRANSCRIPT
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LEUKEMI S
Normal human blood
White Cell Red Cell
Platelet
Blood with leukemia
BlastsRed Cell
Platelet
White Cell
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DEVELOPMENT OF LEUKEMIA
IN THE BLOODSTREAM
Stage 1- Normal Stage 2- Symptoms Stage 3- Diagnosis
Stage 4- Worsening
Stage 5a- Anemia
Stage 5b- Infection
Legend
White Cell
Red Cell
PlateletBlast
Germ Sources from Leukemia, by D. Newton and D. Siegel
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1. ACUTE MYELOID LEUKEMIA
(AML)
It results from a defect inthe hematopoetic stem
cell that differentiatesinto all myeloid cells – monocytes, granulocytes( neutrophils, basophils,
eosinophils )erythrocytes andplatelets.
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Cont….
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CLINICAL MANIFESTATION
Fever and infectionfrom neutropenia
Bleeding tendencies
from thrombocytopenia Weakness and fatigue
from anemia
Pain from enlarged liver
or spleen Hyperplasia of gums
Bone pain fromexpansion of marrow
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MEDICAL MANAGEMENT
INDUCTION THERAPY:Involves high doses of
Cytarabine ( cytosar) and Daunarubicin(cerubidin) or Idarubicin (idamycin) to eradicate
the leukemic cells.
CONSOLIDATION THERAPY (post remission) :
For this, multiple
treatment cycles of various agents are used ,usually containing some form of cytarabine ( eg.Cytosar, ara-c) frequently, patient receives onecycle of treatment at a lower dosage resulting inless toxicity.
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Cont….
Supportive careincludes –
Administering
blood products(PRBCs and platelets)and promptly treating
infections.
BMT
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2. CHRONIC MYELOID
LEUKEMIA
CML originate in thepluripotent stem cell or it arisesfrom a mutation in the myeloidstem cell.
Normal myeloid cells continueto be produced , but then ispathologic increase in theproduction of forms of blastcells. Therefore a widespectrum of cell types existswithin the blood, from blastforms through mature
neutrophils.
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CLINICAL MANIFESTATIONS
CBC –Leukocyte count greaterthan 100,000/mm
Short of breath or slightly confuseddue to decrease capillaryperfusion to the lungs and brainfrom leukostasis.
Enlarged tender spleen
Sometimes malaise, anorexia ,weight loss.
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MANAGEMENT
Treatment is usually divided into 4 areas:
1. Stem cell transplantation
2. Interferon alpha therapy with or without
chemotherapy
3. Single agent chemotherapy ( hydroxyurea)
4. The use of specific Tyrosine kinase
inhibitors
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Cont…..
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Cont…..
The goal of therapy in the chronic phase is tocontrol leukocytosis and thrombocytosis.
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APHERESIS
LEUKAPHERESISSPLENECTOMY
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Cont….
Most widely used medicationsare interferon alphaadministered IV or SC andhydroxyurea administeredorally.
Clients with blast crisis requireintensive chemotherapy withsame agent as in acuteleukemia
Targeted therapy: Imatinibmesylate ( Gleevec) inhibitsproliferation
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